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439 20TH ST - PAVER PERMIT ,�s ' '' ,';sA CITY OF ATLANTIC BEACH iv, s 800 SEMINOLE ROAD ,� �r ATLANTIC BEACH, FL 32233 ` 0;ti�%' INSPECTION PHONE LINE 247-5814 RESIDENTIAL OTHER - SINGLE OR TWO FAMILY RESIDENTIAL OTHER MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: RESO18-0038 Description: PAVER DRIVEWAY&WALKWAY& FRONT PORCH Estimated Value: 17730 Issue Date: 8/2/2018 Expiration Date: 1/29/2019 PROPERTY ADDRESS: Address: 439 20TH ST RE Number: 169506 1628 PROPERTY OWNER: Name: JESSICA MERINGOLO Address: 439 20TH ATLANTIC BEACH, FL 32233 GENERAL CONTRACTOR INFORMATION: Name: Address: , Phone: Name: KETTELL INC. Address: 1860 MAYPORT RD ATLANTIC BEACH, FL 32233 Phone: PERMIT INFORMATION: Please see attached conditions of approval. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. * A notice of Commencement is only required for work exceeding an estimated value of $2,500. For HVAC work, a Notice of Commencement is only required when HVAC work exceeds and estimated value of$7,500. * Permit Conditions ar, ' si ' � City of Atlantic Beach Permit Number: RES018-0038 Description: PAVER DRIVEWAY&WALKWAY& FRONT PORCH Applied:6/19/2018 Approved: 7/26/2018 Site Address:439 20TH ST Issued:8/2/2018 Finaled: City,State Zip Code:Atlantic Beach, Fl 32233 Status: ISSUED Applicant: <NONE> Parent Permit: Owner:JESSICA MERINGOLO Parent Project: Contractor:<NONE> Details: LIST OF CONDITIONS SEQ NO ADDED DATE REQUIRED DATE SATISFY DATE TYPE STATUS DEPARTMENT CONTACT REMARKS 1 6/22/2018 EROSION CONTROL INSTALLATION INFORMATIONAL PUBLIC WORKS Scott Williams Notes: Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line(247- 5814)to request an Erosion and Sediment Control Inspection prior to start of construction. 2 6/22/2018 ON SITE RUNOFF INFORMATIONAL PUBLIC WORKS Scott Williams Notes: All runoff must remain on-site during construction. 3 6/22/2018 POST CONSTRUCTION TOPO INFORMATIONAL SURVEY PUBLIC WORKS Scott Williams Notes: If on-site storage is required,a post construction topographic survey documenting proper construction will be required. All water runoff must go to retention area and retention overflow must run to street. 4 6/22/2018 ROLL OFF CONTAINER INFORMATIONAL PUBLIC WORKS Scott Williams Notes: Roll off container company must be on City approved list(Advanced Disposal,Realco Recycling,Shapell's,Inc.,Republic Services,Donovan Dumpsters). Container cannot be placed on City right-of-way. 5 6/22/2018 RIGHT OF WAY RESTORATION INFORMATIONAL PUBLIC WORKS Scott Williams Notes: Full right-of-way restoration,including sod,is required. Printed:Thursday,02 August, 2018 1 of 2 1 CL.=L`lr n, Permit Conditions r) . City of Atlantic Beach ,0;3`-)' 6 6/22/2018 CONSTRUCTION SITE INFORMATIONAL MANAGEMENT PUBLIC WORKS Scott Williams Notes: Provide construction site management plan,including location of silt fence,dumpster,portable toilet. Right-of-Way Permit is required if using right- of-way for construction parking. 7 6/22/2018 RUNOFF INFORMATIONAL PUBLIC WORKS Scott Williams Notes: All runoff must remain on-site. Cannot raise lot elevation. 8 6/22/2018 MAXIMUM DRIVEWAY INFORMATIONAL PUBLIC WORKS Scott Williams Notes: Maximum driveway width within the City right-of-way is 20'. 9 6/26/2018 UNDERGROUND WATER SEWER INFORMATIONAL UTILITIES PUBLIC WORKS Kayle Moore Notes: Avoid damage to underground water and sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is needed,call 247-5834. 10 6/26/2018 METER BOX SEWER CLEAN OUT INFORMATIONAL PUBLIC WORKS Kayle Moore Notes: Ensure all meter boxes,sewer cleanouts and valve covers are set to grade and visible. 11 6/26/2018 RT1 SEWER CLEANOUT INFORMATIONAL • • PUBLIC WORKS Kayle Moore Notes: A sewer cleanout must be installed at the property line. Cleanout must be covered with an RT1 concrete box with metal lid. Cleanout to be set to grade and visible. I Printed:Thursday,02 August,2018 2 of 2 s rs:Afik City of Atlantic Beach APPLICATION NUMBER BuildingDepartment (To be assi ned by the Building Department.)'' ,,,\ p 800 Seminole Road Cc'` J (�/ -6 Sj ��'.—_ ') Atlantic Beach, Florida 32233-5445 J V c o (J u \,\� �Vr Phone (904) 247-5826 • Fax (904) 247-5845 p ;\01,j9r E-mail: building-dept@coab.us Date routed: p City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 4139 204 ST7 _De•artment review required i_ No p Y Applicant: ke---44e(() Cf �pp7s aliiiiiiir•inistrator _- Project: brj✓ie° tAJ °JCL1 Q.l�.S�- Pu. A . . Public Safety _- �6 Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By 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 of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: ❑Approved. nDenied. Not applicable (Circle one.) Comments: }!r© c____,ail LDINe ' v PLANNING & ZONING Reviewed by: /V Date: -.7 -2c? v A -- TREE ADMIN. • Second Review: Approved as revised. nDenied. ( INot applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. Denied. [Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 ��I :' P , �fr OFFICE �'� B3ilding Permit Application 1- d�ted2/8/17 City of Atlantic Beach € JUN 1 800 Seminole Road,Atlantic Beach,FL 32233 4 n Phone:(904)247-5826 Fax:(904)247-5845 Job Address: �� �' Permit Number:P—eW tj F 6 38'1 Legal Description ),- 31 0 -ZS- tq E SSV&Nri-t,On:1-Z 4464 RE# wisp sp 6 -/6 zS Valuation of Work(Replacement Cost)$ 11 t1 3 0 Heated/Cooled SF - -'Non-Heated/Cooled ------ • Class of Work(Circle one): New Additi.n Alteratio Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circ e one): Commercia Residential • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes N(N/A • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: 910ifiu_ (6,-(16-yrA- 1 r I tINAp cf--tAlt,114.40..,34 k06aver-f. Add con 1-- Risett,_ Florida Product Approval# for multiple products use product approval form Property Owner Information U 7'� Name: FA''j(1 (1 Q 10 Address: "13 q w t .S-1.4.16(>r City 4 . ' (' State FL Zip 3vz. 3 Phone G3/ 30t) 8775- E-Mail -sLSsr)o,r1ngcid e/Tg . c.E1"N Owner or Agent(If Agent, ower of Attorney or Agency Letter Required) Contractor Information (----. `� gdiett Name of Company: 1.0/ / Qualifyi Agent: Gut e Address /g( O / a.. pa..r * gam' City A. = S ate L . Zip 3Z Z - 3 Office Phone 9Qq 3I 1 -7z-Li, Job Site/Conn(tact Number I . AV , 'C 31 /Oa State Certification/Registration# E-Mail tA�'Ce f ill it %�nr .oOr-r) Architect Name&Phone# Engineer's Name&Phone# Workers Compensation 0r C,-1.e Exempt/Insurer/Lease Employees/Expiration Date Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS, and AIR CONDITIONERS,etc. NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and there may be additional permits required from other governmental entities such as water management districts,state agencies,or federal agencies. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. 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 NOTICE OF COMMENCEMENT. ., % -' /ms /ioe :4e1iAliitt;,-/(Signature of• n r or Agent) (Signature of Contractor) (inclu. : ,ontractor Signed and sworn to(or affi -.) befo of Signed and sworn to(or af' -• .efor hi 4 d•y of �;y i;t I -► b c C4iptils_i_s_.ay ;i. • t'A t .Xunt , _ 45 b /�/ I- .a _vG'.iii il mums 1 SIATOMM IA IIPAMW.1 ,t: + ; r, , Si nature A :., ,, , Signature o ot• ) ' ( g ' �l ` S Personally Known OR .k �..:: i 4/ [ ]Produced Identification r 4 •y' TONI GINplNSPERG8R19 [ ]Produced Identification ; �� /! 3 Type R ru :: MY.COMMIaSL 40. .....F69E49�38rs Type of Identification: Z T e of Identification: 1 •„oF F Bonded Thru Notary Public Underwriters o!.-vlf City of Atlantic Beach APPLICATION NUMBER (.5Y ? Building Department (To be assi ned by the Building Department.) "' A '` 800 Seminole Road '`/ —636Y r Atlantic Beach, Florida 32233-5445CSv` Vw myPhone(904)247-5826 • Fax(904)247-584562 / 4 p J1.09 E-mail: building-dept@coab.us Date routed: / 0 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM q39Property Address: 2641 De•artment review required Yes No Applicant: I<C+te`1 l A c. 1 - _I in• &z..•'g �•�nistrator Project: br fife tJIO.y (�� Q. 1 P • A . 111111=1111=1 Public Safety _- �Q �� Fire Services _- Review fee $ Dept ature;v`*'.. . Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By 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 of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: ❑Approved. Denied. ['Not applicable (Circle one.) Comments: BUILDING eecl I i TG GCe. PLANNING &ZONING Reviewed by: --- Date: i -2 6-10 TREE ADMIN. Second Review: ZApproved as revised. ❑Denied. ❑Not applicable PUBLIC WORKS Comments: K F PUBLIC UTILITIES IN o+ 1dd any -6-"%* cG'1 lel s tet Il,;,., vefs PUBLIC SAFETY Reviewed by: Date: I k- i8 FIRE SERVICES Third Review: ['Approved as revised. ['Denied. ['Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 41APa: City of Atlantic Beach APPLICATION NUMBER 4/ `' r Building Department (To be assi ned by the Building Department.) �; Ss1 r A 800 Seminole Road CSC)/ Si s 6)46 3 e .. f Atlantic Beach, Florida 32233-5445 �.., ,� 11":- ,` - 6 Vw Phone(904)247-5826 • Fax(904)247-5/EC' •..;,� , , ,111 ? E-mail: building-dept@coab.us ; Date routed: / /Qp City web-site: http://www.coab.us JUN 1 9 2018 S •. APPLICATION REVIEW._AND TR KING FORM Property Address: 439 "1: 1 Si ' De•artment review required Yes No kf+-teApplicant: (() (il 1_ ' _• ins &z.1'-g ri ....iiiiikiaLinistrator Project: L rj re 0 ( G.1 . 4_P • A • . I ) Public Safety _- �� Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By 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 of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: ['Approved. I VlDenied. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed b Date: e l',202,-Ye TREE ADMIN. Second Review: Approved as revised. ❑Denied. Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed •y: : / ,/,r, _, . , Date:7� rie FIRE SERVICES Third Review: ['Approved as revised. ❑Denied. ['Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 4 -" . - r�'Jf r fes' CITY OF ATLANTIC BEACH t'"\ Department of Public Works 1200 Sandpiper Lane Atlantic Beach, FL 32233 1119''' 904 247-5834 PUBLIC WORKS PLAN REVIEW COMMENTS Date: 6/22/18 Applicant: Kettell, Inc. Permit#: RESO18-0038 Email: info@kettellinc.com Review Status: DENIED Property Owner: Jessica Meringolo Site Address: 439 20th Street Email: jessmeringolo@me.com THIS PLAN REVIEW IS ONE OF MULTIPLE DEPARTMENT REVIEWS Correction Items must be submitted to the Building Department at 800 Seminole Road. Submittals that respond to only one or a few correction items will not be accepted. Revisions may not be submitted until ALL departments have completed their respective reviews. Revisions must be submitted to the Building Department and must respond to EACH department review. PUBLIC WORKS CORRECTION ITEMS: APPROVE D • Provide erosion and sediment control plans with installation details. 4 75,zie • Section 24-66(b) of the Land Development Regulations requires on-site storage for increased runoff if adding 400 SF or more impervious surface. Provide Delta volume calculations and on-site retention required per Section 24-66(b). • Provide a detailed plan of water retention area and how water runoff gets to water retention areas and then to street. • Provide a detailed plan of extra impervious area. PUBLIC WORKS CONDITIONS OF APPROVAL: (The following comments will be printed on your permit as Conditions of Approval) • Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line (247-5814) to request an Erosion and Sediment Control Inspection prior to start of construction. • All runoff must remain on-site during construction. • If on-site storage is required, a post construction topographic survey documenting proper construction will be required. All water runoff must go to retention area and retention overflow must run to street. • Roll off container company must be on City approved list (Advanced Disposal, Realco Recycling, Shapell's, Inc., Republic Services, Donovan Dumpsters). Container cannot be placed on City right-of-way. • Full right-of-way restoration, including sod, is required. • Provide construction site management plan, including location of silt fence, dumpster, portable toilet. Right-of-Way Permit is required if using right-of-way for construction parking. • All runoff must remain on-site. Cannot raise lot elevation. • Maximum driveway width within the City right-of-way is 20'. Scott Williams, Public Works Director swilliams@coab.us/904-247-5834 Page 1 of 2 0:\Public Works\ADMIN\PLAN REVIEW COMMENTS\RES018-0038(Kettell).docx , Resubmittal Notes: All revisions and changes shall clearly stand out from the rest of the drawing on the sheet as a revision by way of completely encircling the change with "clouding". The revision shall also be identified as to the sequence of revision by indicating a triangle with the revision sequence number within it and located adjacent to the cloud. The revision date and revision sequence number shall also be indicated in a conspicuous location in the title block for each sheet on which a revision for that sequence occurs. For projects still in the initial review stage and permit pending, all sheets with revisions shall be inserted into each set of drawings. The original sheets must be clearly marked "VOID" but are to be left within the set of drawings. Complete new sets of drawings will not be accepted. ADDITIONAL ITEMS MAY BE REQUIRED DEPENDING UPON NEW INFORMATION AND CLARITY OF FINAL PLANS SUBMITTED FOR REVIEW. Page 2 of 2 O:\Public Works\ADMIN\PLAN REVIEW COMMENTS\RES018-0038(Kettell).docx Property Appraiser- Property Details Page 1 of 2 MERINGOLO JESSICA • Primary Site Address Official Record Book/Page Tile# 439 20TH ST 439 20TH ST 18081-00950 9409 ATLANTIC BEACH, FL 32233-4561 Atlantic Beach FL 32233 MERINGOLO PETER 439 20TH ST Property Detail Value Summary RE# 169506-1628 ]2017 Certified 2018 In Progress Tax District USD3 Value Method CAMA CAMA Property Use 0100 Single Family Total Building Value $304,097.00 $405,066.00 #of Buildings 1 Extra Feature Value $1,182.00 $1,114.00 Legal For full legal description see Land Value(Market) $180,000.00 $235,000.00 - Land&Legal section below Land Value(Agric.) $0.00 $0.00 SubdIvision 03958 SELVA NORTE UNIT 02 Just(Market)Value $485,279.00 $641,180.00 !Total Area 17500Assessed Value $331,407.00 $641,180.00 _ The sale of this property may result in higher property taxes.For more information go Cap Diff/Portability Amt $153,872.00/$0.00 $0.00/$0.00 to Save Our Homes and our Property Tax Estimator.'In Progress'property values, Exemptions $50,000.00 See below exemptions and other supporting information on this page are part of the working tax Taxable Value ._ roll and are subject to change.Certified values listed in the Value Summary are those _ i$281,407.00 See below certified in October,but may include any official changes made after certification Learn how the Property Appraiser's Office values property. Taxable Values and Exemptions-In Progress 4. If there are no exemptions applicable to a taxing authority,the Taxable Value is the same as the Assessed Value listed above in the Value Summary box. County/Municipal Taxable Value SJRWMD/FIND Taxable Value School Taxable Value No applicable exemptions No applicable exemptions No applicable exemptions Sales Histor�f Book/Page Sale Date Sale Price I Deed Instrument Type Code I Oualified/Unqualified Vacant/Improved 18081-00950 8/1/2017 $775,000.00 i WD-Warranty Deed I Qualified Improved 07314-00777 14/16/1992 $49,500.00 ! WD-Warranty Deed Qualified Vacant 07175-02036 19/3/1991 $100.00 QC-Quit Claim Unqualified Vacant 106079-00974 11/30/1986 $29,500.00 WD-Warranty Deed Unqualified Vacant Extra Features i. _ LN Feature Code Feature Description Bldg. I Length Width Total Units Value 1 FPPR7 Fireplace Prefab i 1 10 1 0 i 1.00 I$1,114.00 Land&Legal Land L-.al LN Code Use Description Zoning Front Depth Category Land Land Land LN Legal Description Units Type Value I 1 140-37 09-2S-29E 1 0100 RES LD 3-7 UNITS PERAC ARS-1 90.00 155.00 Common 1.00i Lot I $235,000.00 2 I SELVA NORTE UNIT TWO 3 I LOT 69 Buildings#J Building 1 Building 1 Site Address Element Code Detail 439 20T1-I ST Atlantic Beach FL 32233 Exterior Wall 16 16 Frame Stucco Roof Struct 3 3 Gable or Hip Building , r r-1-_. Type 0108-SFR CLASS 2 Roofing Cover 3 3 Asph/Comp Shng r-' r' r'' ', I BAs FUA Year Built 1992 Interior Wall 5 5 Drywall r1--p ir-J L_, A_Li LBuilding Value $405,066.00 Int Flooring 14 14 CarpetL FG J`" LJ Int Flooring 12 12 Hardwood Gross Heated I Effective Heating Fuel 4 4 Electric man Area Area Area Heating Type 4 4 Forced-Ducted Finished 552 0 276 I Air Cond 3 13 Central Garage Base Area 1948 1948 1948 Finished Open I Element I Code I I Porch 16 0 5 I Stories 12.000 https://paopropertysearch.coj.netBasic/Detail.aspx?RE=1695061628 6/22/2018 Property Appraiser - Property Details Page 2 of 2 Finished upper 11763 11763 11675 I Bedrooms 13.00000 I story 1 Adds Additional 0 0 0i Rooms/Units 1.000 Area Total 4279 3711 3904 2017 Notice of Proposed Property Taxes Notice(TRIM Notice1 Taxing District Assessed Value Exemptions 1 Taxable Value Last Year , Proposed Rolled-back Gen Govt Beaches $331,407.00 $50,000.00 $281,407.00 $2,238.25 I$2,293.80 $2,175.95 Public Schools:By State Law $331,407.00 $25,000.00 $306,407.00 $1,364.34 $1,298.25 $1,323.22 By Local Board $331,407.00 $25,000.00 $306,407.00 $673.48 $688.80 $653.20 FL Inland Navigation Dist. $331,407.00 $50,000.00 $281,407.00 $8.79 $9.01 $8.44 Atlantic Beach I$331,407.00 $50,000.00 $281,407.00 $886.52 $908.52 $863.41 Water Mgmt Dist.SJRWMD $331,407.00 $50,000.00 $281,407.00 $79.22 $76.66 $76.66 Gen Gov Voted $331,407.00 $50,000.00 I$281,407.00 $0.00 $0.00 $0.00 School Board Voted $331,407.00 $25,000.00 I$306,407.00 $0.00 $0.00 $0.00 Urban Service Dist3 I$331,407.00 ;$50,000.00 $281,407.00 $0.00 $0.00 I$0.00 Totals l$5,250.60 $5,275.04 I$5,100.88 Just Value Assessed Value Exemptions 'i Taxable Value Last Year $459,130.00 $324,591.00 $50,000.00 $274,591.00 Current Year $485,279.00 $331,407.00 $50,000.00 $281,407.00 2017 TRIM Property Record Card (PRC) This PRC reflects property details and values at the time of the original mailing of the Notices of Proposed Property Taxes(TRIM Notices) in August. Property Record Card(PRC) The PRC accessed below reflects property details and values at the time of Tax Roll Certification in October of the year listed. 2017 2016 2015 2014 •To obtain a historic Property Record Card(PRC)from the Property Appraiser's Office,submit your request here: + More Information ontact Us I Parcel Tax Record I GIS Map I Map this property on Google Maps I City Fees Record https://paopropertysearch.coj.net/Basic/Detail.aspx?RE=1695061628 6/22/2018 ri--Lvf_ City of Atlantic Beach APPLICATION NUMBER Building Department /'� (To be assi ned by the Building Department.) (--- If: - 800 Seminole Road EEJV lcsol ff OQ3e . , Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845., (uN 1 9 2018 Date routed: �I ��/0 cj;;��%- E-mail: building-dept@coab.us City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 13cI 2O:-E1 s r De.artment review required Yes No c1: ' _I i n• &Z.,••g Applicant: •iinistrator Project: bride 14J0-1-1LAJa / krAf441 CZ - I;P • . A • 1111111.1111111 g '6 ick Public Safety _- (�%� Fire Services Review fee $ .Z Dept Signature 24._(,.---., Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By 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 of Alcoholic Beverages and Tobacco Other: APP CATION STATUS Reviewing Department First Review: Approved. ❑Denied. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by: oir S Date: ZC (k' TREE ADMIN. Second Review: ❑Approved as revised. ( IDenied. ❑Not applicable PU WORK$ Comments: UBLIC UTILITIES G—ZL — er PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ['Not applicable Comments: Reviewed by: _ Date: Revised 05/19/2017 1) 0RIGHT-OF-WAY/EASEMENT PERMIT� Q► Permit#Issued by the City of Atlantic Beach 12z yOf S-, �b30 PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job Address L13 q Tk grkep a Phone 6'3/ 300 9--773- v Permittee g-f-t_ 4• "Ni SS rIj O l0 Email SSSS pi ci Ol0 e /. . co_r, Requesting Permission to Construct Re1 k- pc,„,,, ,cpnr,,,,,v Location(Reference to Cross-Street) tAkit- O P --- ,r)-)11-1 6 /t_ 604(/ • Permittee declares that prior to filing this application they have ascertained the location of all existing utilities, both aerial and underground and the accurate locations are shown on the sketches. • 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 said poles,wires,pipes,cables or other facilities and appurtenances authorized hereunder,shall be immediately removed from said street or easement or reset or relocated hereon as required by the Director of Public Works and at the expense of the Permittee unless reimbursement is authorized. • All work shall meet City of Atlantic Beach or Florida�Department of Transportation Standards and be performed under the supervision of i, , `i11�i�jr o��l (Project Superintendent) with Company Name t' eA/ I G, Phone ?(9 y 3 7 7 /Do 8- • All materials and equipment shall be subject to inspection by the Director of Public Works. • 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. • 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. • The permittee shall commence actual construction in good faith within 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. • 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 immed. tely upon corn letion. . () % witA -��/7 iL 7 Date -/9 /<1 Permittee igned in presence f Notary u�i ) STATE OF FLORIDA,COUNTY OF DW / The foregoi g instrument was acknowledged this / day of J(s,LQ ,20 ti) , •�by l ca. �.e0 y [) ��// ,who personally appeared before me and rn (punted name of Peuttet,� ackno ,..ed t . - she signed the instrument voluntarily for the purpose expressed in it. C / A I\ PersonallyKnown � ril1F-• `otary • I i,State ofFT'da ' •., •-• ' .tion(Type) t L C, - b II +i TONI GINDLESPERGER , ;'__ MY COMMISSION#FF 924951 1..b EXPIRES:October 6,2019 �%'r,i is... Bonded Thru Notary Pubic Underwriters • a :11 tbithANN r fliw REVOCABLE ENCROACHMENT AGREEMENT REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach,Florida,a municipal corporation organized and existing under the laws of the State of Florida,hereinafter referred to as"CITY"and ° .1); ririga It 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 for the purpose as described in the City of Atlantic Beach. ,,/��� This work is generally described asRefkiiiCon-rf /A/P*t1/'�An facili maintained re aired erecteand/ r installed in the exercise of the ilea remains subject to Y h' P � g grantedJ relocation or removal on thirty(30)days' notice by CITY to USER,said notice to USER shall be given by certified mail, return receipt requested,to the following address "13Q Z 7k ze.40- • 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 easement or property of the CITY,the USER shall replace at the USER's sole expense, any 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 use 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." • The USER,prior to making any changes from the approved plans and/or method,must obtain written approval from the City of Atlantic Beach Public Works Department,for said change within 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 easements, public right- of-ways and other public land. USER further agrees that the CITY and its officers and employees shall be saved harmless by the USER from any of the work herein under the terms of this permit and that all of said liabilities are hereby sumed b / y th USER. • /Oa l!� Al Date /-.-/ i_i f Property ner/Agent(signed in pres a of Notary Public) lJ STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument was acknowledged this 9 / day of JUil.(Q ,20 / , by -.'sl (4. rn•e i 1 +f r)d ,who personally appeared before me and i ted name of Signer) ackn. -•ged tha fish: signed t instrument voluntarily for the purpose expressed in it. 04 4IWc Signature of Notary - • • ic,State of Flori Department Approval: Personally Known Produced Identification(Type) N C — �(� Scott i iams, Public I orks 11', ctor / Kayle Moore,Public Utilities Director H:\Master Forms\Public-Utilities W - — -'.ca no- �spgfa�§reem_ t 2.5.18.docx Revision Date:2/5/18 `'"''Pfd' _'4' : MY COMMISSION#FF 924951 ber 6,2019 y ./,. :as EXPIRES:OctPeek Underwriters 4WIt;,•'�, Bonded Tnru Notary s=_ 7/74, TREE & VEGETATION AFFIDAVIT FOR INTERNAL OFFICE USE ONLY �1 % City of Atlantic Beach PERMIT# Re50/8`U038 .9 Community Development Department -5--. 800 Seminole Road Atlantic Beach, FL 32233 r \O;t >� v (P)904-247-5800 SITE INFORMATION ADDRESS 13 q 70 T1‘ SFC, IF SUBDIVISION Ai +-e vai^'1-2 BLOCK LOT Gq RE# /6qS-06 ._ /o---zoc :2 ! PENTIAL ❑ COMMERCIAL ❑ OTHER APPLICANT INFORMATION NAME ---Sp55 ` ai PHONE# 11 a 7/ 700 1775- ADDRESS 77sADDRESS I I CELL# 1 CITY ( 1 STATE ( 1 ZIP CODE ( 1 EMAIL eS95 l ' Ig_r- a YN..e_ , (fCv-• WNER ❑ LEGAL AUTHORIZED AGENT I affirm that I have reviewed the provisions of Chapter 23, "Protec ion of Trees and Native Vegetation", of the Municipal Code of Ordinances for the City of Atlantic Beach Florida and/or I have participated in a pre- application meeting with the Administrator of those regulations. Subsequently, I affirm that no regulated trees and no regulated vegetation will be damaged, destroyed and/or removed from the above-described property and/or adjacent properties including right-of-way. I HEREBY CERTIF HAT ALL INFORMATION PROVIDED IS CORRECT:Signature of Property Owner(s)or Authorized Agent 11 I �QSCI(1( 0l- IIr1�^ j�1 (i./i ��/fig -G IA 1F -P'LI AI PR INT OR TYPE NAME DATE SIGNATURE OF APPLICANT(2) PRIN OR TYPE NAME ,� DATE Signed and sworn before me on this_0_ –EJ day of L1 �lQ by State of ( County ofnuc,.....� ( Identification verified: y . ic__ ��� CI- Oath Sworn: Ye ❑ .• t?'>y - TONI GINDLESPERGER !� `�- `*: _ * MY COMMISSION#FF 924951 (T---- Notary Signature EXPIRES:October 6.2019 %.„,r—...,•:,9-.1 ---'4,;,F F Bonded Thru Notary Public Underwriters My Commission expires 04 TREE AND VEGETATION AFFIDAVIT 03.01.2018