386 2nd St driveway permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
DRIVEWAY PERMIT
MUST CALL BY 4PM FOR NE)ff DAY INSPECTION: 247-5814
JOBINFORMATION:
Job ID: 17-DWAY-3302
Job Type: DRIVEWAY
Description: replace current retaining wall & replace & widen driveway
with pervious pavers
Estimated Value: $21,000.00
Issue Date: 3/13/2017
Expiration Date: 9/9/2017
PROPERTY ADDRESS:
Address: 386 2ND ST
RE Number: 169793-0000
PROPERTYOWNER:
Name: Sklenicka, Laura
Address: 386 2Nd ST
PERMIT INFORMATION:
FEES:
Fence/ROW $35.00
UTIL REV RESIDENTIAL BLDG $25.00
Total Payments: $60.00
PEMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORIHNANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach APPLICATION NUMBER
Building Department (to be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-IA46 rl-owAl - a
Phone(904)247-5826 Fax(9D4)247-5845
E-mail: building-dept@wab.us Date routed: a—
City web-site: hftp:/twww.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 9 %(.P e�a uired Yes 0
uldi:nent review req
Applicant: [)"-A ��' an ning&Zomn@�-�
Tree Adm-`Wni§fm-Tor
Project: U0\11LIL
U c S
';u Utoflftie
,Qbli.
A;'koo-� L�C�A Public Safety
Fire Services
Review fee $ aw Dept Signature -
Other Agency Review or Permit Required Revirew oreReceipty Date
of Pe hnit V rifle" .
Florida Dept.of Envronmental Protection
Florida Dept.of Transportation
StAohns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Toba=
Other:
APPLICATION STATUS
Reviewing Department First Review: [RA*pproved. []Denied.
(Circle one.) Comments:
(!S�P
PLANNING &ZONING Reviewed by:— Date
TREEADMIN. Second Review: []Approved as revised. E]Denied.
PUBUCWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
rl RE SERVICES Third Review: E]Approved as revised. E]Denied.
Comments:
Reviewed by: Date:—
Reviwd 05/14/09
City of Atlantic Beach APPLICATION NUMBER
1 11.1 Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach,Florida 32233-5445 il- riwM-a
Phone(904)247-5826 Fax(904)247-5845
0�,I� E-mail: buiiding-de;pt@coab.us Date routed: It
Cityweb-site: hftp://�.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: '9W(f a4s� . De artiment review re uired Yes No
Applicant: 06-NA-Lf tanning &Zonin
Tree A minis ra or
Project: EJLQXALjt f"nInki4gLk 4C4%Ajh u lc 0 5
ublic Utilities
&iwcov-A t,�rvit fPjW1�A1P&1Jfi45 Public Safety
Fire Services
R6&W fee $ Dept Signature— '�j�
Other Agency Review or Permit Required Review or Receipt
of Pennilt Verified By Date
Florida Dept.of Environmental refection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverage,..A 7�k
Other.
APPLICATION STATUS
Reviewing Department First Review: E]Approved. A]Denied.
(Circle one.) Comments:
NuNU BER
'L
ld,r�
4_g; P
A an R or Permit Required
p' ants'Protection
'letter,
'v an.gem.rt District
P
AN y evew
Other g c
Florida De of Env'ronm
Florida Dept of Tne.-Po
St John. or Water M
y C. a ang n
id..ra-t-
mg. Tobacco
rpofn
I in son of at .I ser
H .1 nd Re
D.'.,..of Alwh.1.gave and
Othe,
ev"""'mig Departm First R Ap ad
(Circle one
BUILDING
Con "new prov
main
BUILDING
PLANNING &ZONING Reviewed by: 49:01�z 4ef!�:� Date:
TREEADMIN. Second Review:—oApproved as revised. DIDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: 41—._< � Date geotiz
Vil
FIRE SERVICES Third Review. ElApproved as revised. ElDenied.
Comments:
Reviewed by: Date:—
Revised 05/14109
City of Atlantic Beach APPLICATION NUMBER
Building Department
800 Seminole Road Cro be assigned by the Building Department.)
Atlantic Beach,Florida 32233-5445
Phone(904)247-5826 Fax(904)247-58453 2017 nwA4- aaM
E-mail: building-dept@coab.us Date routed 4
Cityweb-site: hftp://�w.coab,tis
APPLICATION REVIEW AND TRACKING FORM
Property Address; A4S.V . Department revi re uired Yes No
(L]Biuildma -N
Applicant: Tree Aclawn—istim-tor
Project: 4L4kektA
r"UN4 'CELk 4"Atl)
public Safety
Fire Services
Review fee $ bept signature'L__1��
Other Agency Review or Permit Required Re
Of P
Florida Dept.of Environmental Protection
Florida Dept. of Tramporation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Bevemges an�
W OW
lanninq &Zonin
u le 0 s
ublic Utilities
7P
v or '4% Date
. itlfe!dlefl�
00there—r1ml
APPLICATION STATUS
Reviewing Department First Review: WrApproved. EE41]Denied. xsv-17
(Circle one.) Comments:
BUILDING -fee #hl"44 ("A14
161
rPLANNING&ZONING Reviewed by: Date:.
T E M S
TREEADMIN.
FSecond Review: E]Approved as revised. Ey6niled.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: OApproved as revised. [:Ibenied.
Comments:
ate:_
Reviewed by: D
Revised 06114109
City of Atlantic Beach APPLICATION NUMBER
Building Department
Cro be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-54
.(a
Phone(904)247-5826 Fe go, 47F"2 3 2017
s
E-mail: building-dept@coala.us T1 0 Date routed:
City web-site: hftp:/�www.00a1h.us By..
APPLICATION REVIEW AND TRACKING FORM
Property Address: '9 '9(0 a4sv . De artmentreviewre uired Yes 0
ildin
Applicant: 1)WA A4 lanning&Zonin
TreeAdmim mor
Project: (L cLkt 44%A U c or s
t';CN 1,4,ibAl pA.0 5 oblio Uti itie
Public Safety
Fire Services
E71
Review fee D6pf Signature—
Other Agency Review or Permit Required Review or Receipt
of P mit Verified By Data
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division at Alcoholic Beverages and Tobacco
Other,
APP1,116ATION STATUS
Reviewing Department First Review: VApproved. E]Denied.
(Circle one.) Comments:
V'e BUILDING
w
C B U g
rc
'e
L
D
0
D
0
n
IN
p
a
art
G
F R Ap,
m 'rat ev'ew`
Comm-rds.
PLANNING &ZONING
Date
TREEADMIN. S PP
�E
Second�Revlew: OlApproved as revised. E]Denled.
W
V�ORKS,) Comments:
P B IC UTILTFIEng
"__��q I
- Z9-17
LI
PUBLIC SAFETY Reviewed by: Date:
S
I S VIC S
FIRE SERVICES Third Review: ElApproved as revised, DIDenied.
Comments:
Reviewed by: Date:
Revised 05/14109
BUILDING PERMIT APPLICATION FEB 2 1 2017
CITY OF ATLANTIC BEACH
goo Seminole Road,Atlantic Besch Fl,32233
Offim:(904)247-5826 - Fax:(904)247-5845
Job Address: 334 .2" &-- P4&,A� AA, a 32231 PeratitNumber: Il-OWAI-3301a
Legal Description 2;k-k) Qkdiawp� S4P RF#. __1 (0q'7q3 - 0000
I . L�� Z'j
Valuation of Work(Replacement Cost)$;_�Olileated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition (A-_ftcn�jj�Qu (J� Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Communciall
• If an existing structure,is a fimspritilder system installed?(Circle one): Yes No (j�4_1
• Submit a Tree Removal Permit Application if my tmes am to be removed or Affidavit of No Troc Removal
Describe in detail the ofwqrktobeperfomed: P;eplotx� c,�rre�+-
CA'M%;
Florida Product Approval# W I A for multiple products use product approvRI form
Pmperty Owner Information
Nerm: S:� Address: IW% F�� 3ZZ3?
City,A�(A,rh�, ge�,� State fLZip V_2_�3 honc.i�oi-_Ifl F-Piky
E-Mail C> �1- cc—
OwnerorAgent
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTOE OF COMMENCEMENT.
Contractor Information;
N m of Company: 171111aliktr, Agent: kt� e'r-
am
Address, '�itSr, \—b- Rt"'O, City - t Zi 3zol
.Er
.Er q /I/--
Office Phone qOq YW Raq itetcon bftr_ DQ_ ,
State Certification/Registrution# E-M
Architect Narne&Phone#
Engineer's Name ne#
workees c sation
.1 1*pl I Mv.-,4.-2�
Application is hereby mad�to or an, permit to wark and myrallation,as indaated. I certify that no wark or installation has�omatcarcd
amith.t.11.4.111br,ps
h el'
hjs,penai,b�comaoa11aadw1d1fuvrk isnotcannoracq �ithi.�&(Y.O.Ihs, ororcg,mtmetionor�rk&:�,R,,,�d�d.,ak.d..�dP,.
471. its most Instcunniftr loctrlrat Wak,Plain itre,
r..ytrm,.ft,waA*isca.ou,amd Jundersion thatsepanateprm
or, U
a ices, &.11 Hour Tanks andAl,Comfklw,�d,
Signature of propusty?9�7�7= signature Of Connector
Before me __Before me this Day of
this Al Day of
Notary Public: k\A Agj:�-- Notary Public:
V U
I Arrobj,cerfify that 19.,v, r ad ay�� "irtoberrueandcomirct. Allprumsionsofla.%and
1,o;,0 d*1FLVj~=, or 1,gruming ofa Permit does not
ordinances trowning th f, a a or lm�
Presume to stir mah.riti,to wora". laiv regulating construction or the
perfaratance ofeurisint6ion EIXPM&�27.2=
Rev 3/14/16
CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WTHIN CITY RIGHTS OF WAY AND EASEMENTS
800 Serninde Ro"d
Allantic&ach,Flonda 32233-5445 SP-247-5600
Fax 904-247-5M
PLEASE SUBMIT(2)COMPLETE SETS OF PLANS WITH APPLICATION. PERMIT#
Date ISSUES BY THE CITY
Job Address-SA(in 11,111 21:- MAIAL, && MIS E-mail SSWPK�C" Pant ea,�-L
Pemnitee: 1.�U� ?, - Telephone# 130tt -?(C/ Isa
PermiteeAddress: -%AA4e- ac, &"p
Requesting Permissionto Construct: bmue'-wcLA� 1.1i-14-A Mg�Ima
Location:(ReferencetoCross-Street) � V)ct LIA bc'.
1. Applicant declares that prior to filing this application he has ascertained the location of all existing utilities, both
aerial and underground and the accurate locations are shown on the sketches.
A Letter of Notification was mailed to the following Utilities I Municipalities: C., �A-
Jacksonville Electric Authority Yes ( No( Date: 9/;Z(//-7
Bell South Telephone Company Yes ( No ( Date: 7-4Z4 //2 -
Fennell Gas Yes( No( Date: ;;12A'j 1-7
Comcast Yes( NO( Uale: 2 /14�'p
2, Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation,
alteration or relocation of all,or any portion of said street or easement as determined by the Director of Public
Works, any or all of said poles,wires, pipes,Cables or other facilities and appurtenances authorized hereunder,
shall be immediately removed from said streat or easement or reset or relocated hereon as required by the
Director of Public Works, and at the expense of the Permitee unless reimbursement is authorized.
3. All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed
under the supervision of Z-a,,c JOger- (Contractor's Pmject Superintendent)
located at -030 Q�, � L?Xd&jjdj"6j, Te e#: 161f V),- 9 f,&
4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee.
5. All city property shall be restored to its original condition as far as practical,in keeping with city specifications and
the manner satisfactory to the city.
6. A sketch of plans covering details of this installation,as well as, a copy of a recent survey shall be made a part of
this permit. Calculations showing any increase In Impervious area on owner's lot or In the city Right of
Way are to be included with this application.
7. This pernniftee shall commence actual construction in good faith with_days. If the beginning date is more
than 60 days from date of permit approval,then permittee must review the permit with the Director of Public
Works to make sure no changes have occurred in the area that would affect the permitted construction.
8. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's
right, title and interest in the land to be entered upon and used by the holder,and the Holder will, at all times,
assume all risk of and indemnify,defend, and save harmless the City of Atlantic Beach from and against any and
all loss, damage, and cost of expenses arising in any manner of the exercise or attempted exercises by the holder
of the aforesaid rights and privileges.
The Director of Public Works shall be notified twenty-four(24)hours prior to starting work and again immediately
upon completion.
OWNER
Sign A—It� Date2 Before me this Q1 5t ay
ti S Of JrR!�ounly of Duval, State—Of Florida.-,*hs personally appeared
f-��Notary Public at Large, State of Florida, County of Duval. My
comt(rsion etimls?. Personally Known:
'lu L41k V Lt Ax 0 Produced Identification
RevIsed 7=116
CITY OF ATLANTIC BEACH
OWNER/ BUILDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 CONSTRUCTION
CONTRACTING'REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW.
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMP71ON TO THAT
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUS
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS, THE BUILDING
MUXTA�R Y UR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUC11ON MUST
BE DONE ACCORDING TO TIM BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED By YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
I ORDMAJACIE5, ___j
IL INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
Ill. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES,
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(l). AN-OCCUPATIONAL LICENSE'IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY 'CERTIFICATE OF COMPETENCY" OR THE FLORIDA 'CONTRACTORS
CERTIFICATE' TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER�BUILDER PERMIT.
190L, W4 1?9(OB
ADDRESS PHCfJE NUMBER
PRIN Ill —
r 0-7
�Rl! f
Bek,.bmtbis-;I0%,.FLb 20Lq in M..*of
DuA`l.Saide d Florida.hm,oemvnmllfti-�l henn by him.I hatimlind Monny th.
all dammerds and cloolarafions am brue and atautand
Notar,P,alic at Lai,e,State 0 P1, Countyaf lhkq�k
0 P---11,immn
Xomdu�aaj.- &WILItS 3Mw
Nobay Signinum
abantato
IMD,G�mmu. 'abansau,�lwxaq
R.O.W.Permit Attachment Of for
R.O.W.Permit# OW issued_,20 Atlantic Beach,FL 32233
Owner'sName:
PropertyAddress: MID
Subdivision: R.E.#:
REVOCABLE ENCROACHMENT PEPJvHT
THIS REVOCABLE ENCROACHMENT PERNUT, issued on this _ day of
, 20� by Atlantic Beach,Florida, a municipal corporation organized and existing
under the laws of the State of Florida, hereinafter referred to as"CITY"and
of Atlantic Beach,Florida,hereinafter referred to as"USER".
WITNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the
right to enter upon the property of the City of Atlantic Beach for the purpose as described in the City of
Atlantic Beach Right-of-Way/Eascment permit numbers noted above(copics attached).
This m�,,s ge;,c��Iyde!Vbcd as: ?Aue�
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted
remains subject to relocation or removal on thirty (30)days notice by CrrY to the USER, said notice to
USER shall be given by certified = 7,eipt yquested, to the following address:
% *7-d a 44,
Z
The depositing of said notice of cancellation in the United States mail shall constitute the notice of
cancellation and the burden is upon USER to keep the CITY informed of USER's proper address.
The USER shall promptly make my and all necessary repairs to my facility erected or maintained in
the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe
condition.
In the event it is necessary for the CITY or the City's approved representative or other franchised
utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's
sole expense, my and all material necessarily displaced during the action of maintaining, repairing,
operating,replacing,or adding to of the utilities and facilities of the CITY or franchise utility provider.
The facilities allowed by the permit shall meet the current requirements of the City Code, Building
Codes,Land Development Code,and all other land we and code requirements of the CITY,including
City Code Section 19-7 (h) which states "Driveways that cross sidewalks: City sidewalks may not be
replaced with other materials, but must be replaced with smooth concrete left natural in color so that it
matches the existing and adjoining sidewalks."
Page 1 of 2
The USER, prior to making my changes from the approved plans and/or method, must obtain
written approval f1min the City of Atlantic Beach, Public Works Deparnnent, for said change. The
USER shall, at the discretion of the CITY, be requested to submit as-built drawings showing the change
within thirty(30)days after the day of completion.
This permit shall inure to the benefit of, and be binding upon, the USER and their respective
successors and assigns.
USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY
laws and/or specifications, to include utilities locate requirements and use limitations/requirements of
public rights-of-way and other public land. USER further agrees that the CITY and its officers and
employees shall be saved harinless by die USER from my of the work herein under the terms of this
permit and that all of said liabilities are hereby assumed by the USER.
DATED and SIGNED this ZI day of 201'
er
a
p
(to be ign 0 presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this tie day of F:&['tyj 20 0+ ared before me, a Notary
Public &IIU6r�;d ZP tcllr�'Z
CiVty and State, &k the property owner of
a1W , Atlantic Beach, Florida, known to me to be the person(s)
described in and who executed the foregoing instrument; who acknowledged to me that he or she
executed the same freely and voluntarily and for the uses and purposes therein mentioned.
Notao PublicV for a&County and State
o"
o"
EiOl I I ER I o"INW5(IQ-
, " '7 0
'co.�'ES
W WIRES�V.M20
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RES
CITY OF ATLANTIC BEACH,FLORIDA,
a municipal corporation:
ed:
Approv Ex
Donald D.Jacg6ovitz,
Public Works Director
Fi1c: 12/12116
Page 2 of 2
Dac#"'7053248.OR8Ki790j Paget4al,
NwberPaaa, 1
Raoe`aW03/07/2017at02:32PM,
Ronnie Ftea;ea CLERK CIRCUIT COURT DUVAL
COLN rY
NOUCE OF COMMENcIEMENT RECORDING$10.00
cmarry of
Towinnaltmayconcern:
3 Of
A
Cej
0
0'aMer's interest in site ofth,improvement:
Fee Simple Titleholder(ifother than mor); 1-7
Name:
Address:'
Telephone N
Suretyafany)
Address:
Telephone No. Amend QfBoad$
Fax 140:
Name and address ofeRY Person making a los,for the constroado. fhe improvements
Name:
Address:
Phone No.
Fax No:
Name ofpemon Within the state ofploi&,other than
served: Name: hinseell designated by"mar Up-Whom DOUCCS 0�other documents my be
Address:
Telephone No: Fax No:
In addition to himself 0",designate, h
713.06(2)(b),Florida S��, (Fill in at 150110Vving person to receive
Name: Ovinter's option) "FY of'a Uourn's Notice as provided in Sfttion
Address:
Telephone No: Fax No:
RKpim6o.date orNotim,of�Comn�t(the'Thati
Specified): on date is one(1)Yeer Damn the data Of reenating on]=2 diffmni date is
T10 SPACE FOR RECORDER'S USE ONLy OWNM
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