C UNTY GOVERNMENT F I. 0 R I A

Transcription

1 C UNTY GOVERNMENT F I. 0 R I A SHORELINE ALTERATION/DREDGE AND FILL PERMIT APPLICATION (In Accrdance with Orange Cunty Cde, Chapter 15, Article VI, and Chapter 33, Articles II and IV) Mail r Orange Cunty Envirnmental Prtectin Divisin Deliver T: 800 Mercy Drive Orland, Fl (407) , Fax (407) **Enclse a check fr the filing and advertising fee f $ payable t The Bard f Cunty Cmmissiners** **Prcess Fee fr Appeals and Variances - $409.00** SECTION 1 OWNER(S) OF THE LAND Name: Nilkanth Kapadia Title and Cmpany: Address: 8801 Charles E. Limpus Rad City: Windermere State: FL Zip: Telephne and Fax: ENTITY TO RECEIVE PERMIT (IF OTHER THAN OWNER) Name: Title and Cmpany: Address: City: State: Zip: Telephne and Fax: AGENT/CONSULTANT AUTHORIZED TO SECURE PERMIT Name: Sheila Cichra Title and Cmpany: President, Streamline Permitting, Inc. Address: 2154 Oak Beach Bulevard City: Sebring State: FL Zip: Telephne and Fax: (407) sheilacichra@gmail.cm CONTRACTOR (IF DIFFERENT FROM AGENT) Name: Rn Tegeler Title and Cmpany: President, Creative Deck and Dck Address: 636 Butler Street City: Windermere State: FL Zip: Telephne and Fax: (407) RnTeg@earthlink.net Applicatin fr Shreline Alteratin-Dredge & Fill Rev dcx Page 1 f 4

2 SECTION 2 - GENERAL INFORMATION: LOCATION OF PROPERTY Street Address: 8801 Charles E. Limpus Rad Tax Parcel ID (s) LEGAL DESCRIPTION FROM SW COR OF NW1/4 RUN NORTH 910 FT TO CENTERLINE OF CHARLES LIMPUS RD, TH N E FT ALONG CENTERLINE, TH N E FT ALONG CENTERLINE FOR A POB, TH N W FT, TH N W FT, TH NORTH FT TO NW COR OF S112 OF NW1/4 OF NW1/4, TH E FT TO CTR OF RD, TH S W FT ALONG CENTERLINE TO POE (LESS ELY 30 FT FOR RD RNV PER DB 815/188) IN SEC Name f water bdy: Lake Butler Nrmal High Water Elevatin (NHWE): msl Descriptin f Wrk (This shuld include mitigatin, including re-vegetatin): Cnstruct a s 7' vinyl seawall with a cncrete cap at the NHWE. Rip rap will be installed in frnt (water-ward) f the wall in a 2:1 rati as shwn by the attached plans. Justificatin fr the alteratin: T replace the existing seawall, which is deterirating. REQUIRED ATTACHMENT(S): Three (3) cpies f the Shreline Alteratin Plans that include the fllwing: (A Prfessinal Engineer must prepare and sign the plans) The current and Nrmal High Water Elevatins (NHWE). Lake Name. A nrth arrw. Bttm elevatins r water depths. The dimensins f the prperty (including ttal linear feet f shreline at the NHWE). Existing structures and prpsed alteratin areas with dimensins in feet r square feet. The lcatin f the requested wrk with respect t the upland wner's prperty and adjacent prperties. The wner's name and site address must be n each page f the plans. A descriptin f sedimentatin and ersin cntrl measures used during cnstructin. A prperty survey r have the alteratin areas drawn t scale n a survey. A descriptin f vegetatin types identified prpsed fr alteratin. Cmplete mailing address f all prperty wners within 500 feet f the prject s that Orange Cunty may ntify them f the Public Hearing. As f January 1, 2009, the attached disclsure frms are required with all permit applicatin submittals. The frms listed belw must be cmpleted and ntarized. AGENT AUTHORIZATION FORM Click here t submit RELATIONSHIP DISCLOSURE FORM-DEVELOPMENT RELATED SPECIFIC EXPENDITURE REPORT FORM ere t submit Click here t submit Applicatin fr Shreline Alteratin-Dredge & Fill Rev dcx Page 2 f 4

3 PERSON AUTHORIZING ACCESS TO THE PROPERTY MUST COMPLETE THE FOLLOWING: I either wn the prperty described in this applicatin r I have legal authrity t allw access t the prperty and I cnsent t any site visit n the prperty by agents r persnnel frm Orange Cunty, Flrida necessary fr the review and inspectin f the prpsed prject specified in this applicatin. I authrize these agents r persnnel t enter the prperty as many times as may be necessary t make such review and inspectin. Further, I agree t prvide entry t the prject site fr such agents r persnnel t mnitr permitted wrk if a permit is granted. Nilkanth Kapadia z-/ Typed/Printed Name Signature Date Crprate Title (if applicable) By signing and submitting this applicatin frm, I am applying fr the permit identified abve, accrding t the supprting data and ther incidental infrmatin filed with this applicatin. I am familiar with the infrmatin cntained in this applicatin, and represent that such infrmatin is true, cmplete, and accurate. I understand this is an applicatin and nt a permit, and that wrk cnducted prir t apprval is a vilatin. I understand that this applicatin and any permit issued pursuant theret, des nt relieve me f any bligatin fr btaining any ther required federal, state, water management district r lcal permit prir t cmmencement f cnstructin. I agree, r I agree n behalf f my crpratin, t perate and maintain the permitted system unless the permitting agency authrizes transfer f the permit t a respnsible peratin entity; I understand that knwingly making any false statements r representatin in this applicatin is a vilatin f Sectin , Orange Cunty Cde. Sheila Cichra Typed/Printed Name f Applicant 2//y Signature f Applicant/Agent President, Streamline Permitting, Inc. Date Crprate Title (if applicable) Applicatin fr Shreline Alteratin-Dredge & Fill Rev dcx Page 3 f 4

4 AGENT AUTHORIZATION FORM FOR PROJECTS LOCATED IN ORANGE COUNTY, FLORIDA ORAN C uniy GOVERNMENT I, I I) :1 I/WE, (PRINT PROPERTY OWNER NAME) Nilkanth Kapadia, AS THE OWNER(S) OF THE REAL PROPERTY DESCRIBED AS FOLLOWS, 8801 Charles E. LiMIDUS Rad, DO HEREBY AUTHORIZE TO ACT AS MY/OUR AGENT (PRINT AGENT'S NAME), Sheila Cichra, TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE APPLICATION APPROVAL REQUESTED AND MORE SPECIFICALLY DESCRIBED AS FOLLOWS, Seawall Permit, AND TO APPEAR ON MY/OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY CONSIDERING THIS APPLICATION AND TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THE APPLICATION. Date: 777,(314 ) C),9 I [CA A.-1-1, KcLit(cli Signa1(Ii f (Dperty Owner Print Name Prperty Owner Date: Signature f Prperty Owner Print Name Prperty Owner STATE OF FLORIDA COUNTY OF ORANGE I certify that the freging instrume as acknw ged befthrne this YO Pc -lay f ltki, 2014 by Ail I Ka Aft% Xetp"-,--e He/sh persnally wn t me r has pr uced as identific nd di ' -nt n ath. Witness my hand and fficial seal in the cunty and state stated abve n the Or\CAI, in the year 2014 LL 71 Signature f Ntary Public )1-- ) day f My Cmmissin Expires: CATHERINEGELER Ntary Peek, State Rws Cmmissin N. FF9827 Expires 5/27/2017 Legal Descriptin(s) r Parcel Identificatin Number(s) are required: PARCEL ID #: LEGAL DESCRIPTION: FROM SW COR OF NW1/4 RUN NORTH 910 FT TO CENTERLINE OF CHARLES LIMPUS RD, TH N E FT ALONG CENTERLINE, TH N E FT ALONG CENTERLINE FOR A POB; TH N W FT TH N66- :10-39W FT TH NORTH 12 BC) FT TO NW (OR OF st OF NW1/4 OF NW1/4, TH RR -4A-4CIF R52 cl, FT TO CTR OF RD, TH S W FT ALONG CENTERLINE TO POB (LESS ELY 30 FT FOR RD R/W PER DI 815/1138) IN SEC; 1U-24-28

5 OC CE FORM 213 FOR DEVELOPMENT-RELATED ITEMS (Nvember 5, 2010) Fr use after March 1, 2011 Fr Staff Use Only: Initially submitted n Updated n Prject Name (as filed) Case Number RELATIONSHIP DISCLOSURE FORM FOR USE WITH DEVELOPMENT RELATED ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT This relatinship disclsure frm must be submitted t the Orange Cunty department r divisin prcessing yur applicatin at the time f filing. In the event any infrmatin prvided n this frm shuld change, the Owner, Cntract Purchaser, r Authrized Agent(s) must file an amended frm n r befre the date the item is cnsidered by the apprpriate bard r bdy. Part I INFORMATION ON OWNER OF RECORD PER ORANGE COUNTY TAX ROLLS: Name: Nilkanth Kapadia Business Address (Street/P.O. Bx, City and Zip Cde): 2018 S. Chickasaw Trail, Orland, FL Business Phne ( ) Facsimile ( ) INFORMATION ON CONTRACT PURCHASER, IF APPLICABLE: Name: N/A Business Address (Street/P.O. Bx, City and Zip Cde): Business Phne ( ) Facsimile ( ) INFORMATION ON AUTHORIZED AGENT, IF APPLICABLE: (Agent Authrizatin Frm als required t be attached) Name: Page I 1 f 3 Sheila Cichra Business Address (Street/P.O. Bx, City and Zip Cde): Streamline Permitting, Inc Oak Beach Blvd., Sebring, FL Business Phne (407) Facsimile (

6 OC CE FORM 2D FOR DEVELOPMENT-RELATED ITEMS (Nvember ) Fr use after March 1, 2011 Fr Staff Use Only: Initially submitted n Updated n Prject Name (as filed) Case Number Part H IS THE OWNER, CONTRACT PURCHASER, OR AUTHORIZED AGENT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES X NO IS THE MAYOR OR ANY MEMBER OF THE BCC AN EMPLOYEE OF THE OWNER, CONTRACT PURCHASER, OR AUTHORIZED AGENT? YES X NO IS ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? (When respnding t this questin please cnsider all cnsultants, attrneys, cntractrs/subcntractrs and any ther persns wh may have been retained by the Owner, Cntract Purchaser, r Authrized Agent t assist with btaining apprval f this item.) YES NO if yu respnded "YES" t any f the abve questins, please state with whm and explain the relatinship: (Use additinal sheets f paper if necessary) Pa.re I2 f 2,

7 OC CE FORM 213 FOR DEVELOPMENT-RELATED ITEMS (Nvember ) Fr use after March 1, 2011 Fr Staff Use Only: Initially submitted n Updated n Prject Name (as filed) Case Number Part HI ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that infrmatin prvided in this relatinship disclsure frm is true and crrect based n my knwledge and belief. If any f this infrmatin changes, I further acknwledge and agree t amend this relatinship disclsure frm prir t any meeting at which the abve-referenced prject is scheduled t be heard. In accrdance with s , Flrida Statutes, I understand and acknwledge that whever knwingly makes a false statement in writing with the intent t mislead a public servant in the perfrmance f his r her fficial duty shall be guilty f a misdemeanr in the secnd degree, punishable as prvided in s r s , Flrida Statutes. Signature f nowner, ()Cntract Purchaser r Authrized Agent Date: 2//? Print Name and Title f Persn cmpleting this frm: Sheila Cichra STATE OF FLORIDA COUNTY OF ORANGE : I certify that the freging instrument was acknwledged befre me this 2 3 dday f.1-14 e, by Sheila Cichra. He/she is persnally knwn t me r has prduced as identificatin and did/did nt take an ath. Witness my hand and fficial seal in the cunty and state stated abve n the 2.7 r4 day f,r(-t c, in the year 2014 apt-el-e_ais-t)-1.- Ntary Public State f Flrida Signature f Ntary Public ( P,Natad elk ri 555)tE Ntary Public fr the State f Flrida Expires 03/03/2017 My Cmmissin Expires: 3/3/2017 Staff signature and date f receipt f frm Staff reviews as t frm and des nt attest t the accuracy r veracity f the infrmatin prvided herein. frm c ce 2d (relatinship disclsure frm - develpment) I Page 13 f 3

8 ORAN E 'NT' s t) 1:11:\ 11 IN1 ORANGE COUNTY SPECIFIC PROJECT EXPENDITURE REPORT This lbbying expenditure frm shall be cmpleted in full and filed with all applicatin submittals. This frm shall remain cumulative and shall be filed with the department prcessing yur applicatin. Frms signed by a principal's authrized agent shall include an executed Agent Authrizatin Frm. PART I (Please cmplete all f the fllwing) This is the initial Frm: This is a Subsequent Frm: Name and Address f Principle (legal name f entity r wner per Orange Cunty tax rlls): Nilkanth Kapadia, 2018 S. Chickasaw Trl, Orland, FL Sheila Cichra Streamline Permitting, Inc Oak Beach Blvd., Sebring, FL Name and Address f Principal's Authrized Agent. if applicable: List the name and address f all lbbyists, cnsultants, cntractrs, subcntractrs, individuals r business entities wh will assist with btaining apprval fr this prject. (Additinal frms may be used as necessary). -*/ 1. Name and address f individual r business entity: Are they registered Lbbyist? Yes Nn 2. Name and address f individual r business entity: Are they registered Lbbyist? Yes Nn 3. Name and address f individual r business entity: Are they registered Lbbyist? Yes N 4. Name and address f individual r business entity: Are they registered Lbbyist? Yes Nn 5. Name and address f individual r business entity: Are they registered Lbbyist? Yes N 6. Name and address f individual r business entity: Are they registered Lbbyist? Yes N 7. Name and address f individual r business entity: Are they registered Lbbyist? Yes Nn 8. Name and address f individual r business entity: Are they registered Lbbyist? Yes N Specific Prject Expenditure Reprt Frm

9 FYN I MI 1:1AMEN I PART II EXPENDITURES Fr this reprt, "expenditure" means mney r anything f value given by the principal and/r his/her lbbyist fr the purpse f lbbying, as defined in sectin 2-351, Orange Cunty Cde. This may include public relatins expenditures including, but nt limited t, petitins, fliers, purchase f media time, cst f print and distributin f publicatins. Hwever, the term "expenditure" des nt include: Cntributins r expenditures reprted pursuant t chapter 106. Flrida Statutes; Federal electin law, campaign-related persnal services prvided withut cmpensatin by individuals vlunteering their time; Any ther cntributin r expenditure made by r t a plitical party; Any ther cntributin r expenditure made by an rganizatin that is exempt frm taxatin under 26 U.S.C. s. 527 r s. 501(c)(4), in accrdance with s , Flrida Statutes; and/r Prfessinal fees paid t registered lbbyists assciated with the prject r item. The fllwing is a cmplete list f all lbbying expenditures and activities (including thse f lbbyists, cntractrs, cnsultants, etc.) incurred by the principal r his/her authrized agent and expended in cnnectin with the abve- referenced prject r issue. Yu need nt include de minimus csts (under $50) fr prducing r reprducing graphics, aerial phtgraphs, phtcpies, surveys, studies r ther dcuments related t this prject. Date f Expenditures Name f Party Incurring Expenditure Descriptin f Activity Amunt Paid TOTAL EXPENDED THIS REPORT $0.00 Specific Prject Expenditure Reprt Frm (

10 Part III I hereby certify that infrmatin prvided in this specific prject expenditure reprt is true and crrect based n my knwledge and belief. I further acknwledge and agree t cmply with the requirement f sectin f the Orange Cunty cde t amend this specific prject expenditure reprt fr any additinal expenditure incurred related t this prject prir t the scheduled Bard f Cunty Cmmissiner meeting. In accrdance with s , Flrida Statutes, I understand and acknwledge that whever knwingly makes a false statement in writing with the intent t mislead a public servant in the perfrmance f his r her fficial duty shall be guilty f a misdemeanr in the secnd degree, punishable as prvided in s r s , Flrida Statutes. Signature f Prperty Owner Cntract Purchaser X Date r Authrized Agent Print Name and Title f Persn cmpleting this frm: Sheila Cichra Business Address (Street/P.O. Bx, City and Zip Cde): 2154 Oak Beach Blvd. Sebring, FL Business Phne: (407) Facsimile: STATE OF: FL COUNTY OF: ORANGE The freging instrument was acknwledged befre me this 2 t-dday f C by Sheila Cichra, as an individual/fficer/agent, n behalf f himself /herself r n behalf f, a crpratin/ partnership/ limited liability cmpany. He/she is persnally knwn t me r has prduced as identificatin and did/did nt take an ath. WITNESS my hand and fficial seal in the Cunty and State last afresaid this 2 3 riday f c, Ntary Public Renea Andersn ftect. Ntary Public State f Flrida Renea Andersn.11Ay Cmmissin EE treallixpires 03/03/2017 My cmmissin expires: 03/03/2017 Specific Prject Expenditure Reprt Frm

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13 KAPADIA SEAWALL CHARLES E. LIMPUS RD CONCRETE CAPPING BEAM 3000 PSI W/(2) #5 BARS CONT. 16" 12" FINISH GRADE (t Michael Thmpsn, MSc, P.E. (#47509) 5200 Vineland Rad, Suite 250 Orland, Flrida Ph: Fax: Certificate f Authrizatin N ' MAX TURBIDITY BARRIER ± 2' NHWE LAKE POCKET (c9 RIPRAP > 6" 2:1 RATIO if 1/2" THREADED ROD NOTES: 2X2X2 CONCRETE DEADMEN 5'-10' LANDWARD OF THE SEAWALL 10'-15' O.C. W/ #5 BARS 12" O.C. E.W. 1. DESIGN WIND PRESSURE IN CONFORMANCE W/ ASCE 7-10, 140MPH Vult REGION, PER FBC CONCRETE SHALL BE DAYS 4' MIN CMI SERIES SG-425 VINYL SHEET PILING 3. REINFORCING STEEL SHALL BE GRADE 60 WIND DESIGN CRITERIA: WIND VELOCITY 140 MPH Vult IMPORTANCE FACTOR 1.0 EXPOSURE CATEGORY