1769 SEMINOLE RD DWAY21-0039 d. * Building Permit Application Updated 10/9/18
ei.. City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
• wig IS REQUIRED. '
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 176 9 56-o$1130(.4 Iry Permit Number: .‘kJQ-\L(Z — D O 39
Legal Description 20.20 Dg► Z5 -zqe OafifN616.4.G 447. 2 1....7-44/ RE# 16 3l S -r)
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Valuation of Work(Replacement Cost)$je ,,��aao,cd Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition It71Uteration ❑Repair ❑Move ['Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial affesidential
//
• If an existing structure, is a fire sprinkler system installed?: ❑Yes tSNo
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) LH
Describe in detail the type of work to be performed: W pp Vf Z5
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Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name C64I00,z t- ( Te ZZTjry Address J7G9' 5-0,411-H066
City .G . : C State a� Zip 37233 Phone 9L 5r•r' 966g
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E-Mail Gf�+i6h j. Ze)70 ev eir lz4, coo,
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information / I II
N e 1( ')'�2L,{,J�Qualifying Agent _ * A A
Address /16r9" 0¢9.ye6 4,9 YLvi(102d ,u-I- City ..›— State Zip ;;.--,.. ..,
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Office Phone 94947)4 `
{ 7S-S"=)� 1 1 Job Site Contact slumber (c^-�
State Certification/Registration# E-Mail p es;°fl, )e•Del O.•&-y (? /' WIl2 . (ION
Architect Name&Phone#
Engineer's Name& Phone#
Workers Compensation Insurer`1 J !a--)6 1 OR Exempt ❑ 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 regulating
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 that
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 entitles such as water management districts,stat agentip¢,,,'G
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 NOT CE OF COM ENCEMENT '--
49/'(Signature of Owner or)
r Agent), (Signature of Contractor)
r' I
Signed and sworn to(or affirmed)before me this2 day of✓ Signed and sworn to(or . d)before r- this day of
504tEN(t f,r , 2 . ( ,by C I . I) 2.a ScP. , 2,9;k , , E► vim, c7 e_l...0:u
,I4es{v n4 Jacob Kyle Aber-Won • 3 1 'i .rt+"Dt Ai' (S2n�ture/ 4
, i My COM11691CA E>, :r * ‘::.'4. .. ' •• ♦ihq ‘9Il
,
V.. 06/21/2023 ♦ R�An 1
9ikoFiY ID No. 13205991i ♦ �,ig.�t. .�.. .L�a KAtcas - .
,A.,,,,.°'. ...f .1 n r.c nnal Iv V r n no •4�-/.. '•'
.:,,,!,..,,,,,,A,,,,,,,,,:,nowf GINDLESPERGER
? Ni MY COMMISSION#}�6y353 78
i.rne EXPIRES:Octob 023
.l .F t'io:' Bonded Thru Notary Public Underwriters
11Vd it REVOCABLE ENCROACHMENT AGREEMENT
**ALL INFORMATION
City of Atlantic Beach
rz v 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Ittio:411OV IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and
existinglinder the laws of the State of Florida, hereinafter referred to as "CITY" and
ith 4 14 1 J • Z 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 as P , .A � s � k • ,. : _tet
w e,r
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 CITY to USER,said notice to USER shall be given by certified mail,return
receipt requested,to the following address 6 bit ' si P. A 1i.. 1. ' • .� �.....
Yom° 7S '
• 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, Lan
Development Code and all other land use and code requirements of the CITY, including City Code Section 19-7(
which states"Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but mus
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. i[
• 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, publi
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 assumed by the USER.
•
.�, �a✓i�.�. ��:I Date'
_41110111111—
Property Owner/Agent(signed I pres-, e of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this .Z. day of 5 )irjli6P .20Oa
by $`% y ?t z: ,who personally appeared before me and
(printed name of Signer) .r
'9 Jacob Kyle Albertson
acknowled:ed that he/she signed the instrument voluntarily for the purpose expressed in •.?* my.
cnm YIe Expires
\ / � 06� tl2023
AtIle
� __ nj {Of"0 IO No. 132059911
•'5"nr� Jac( .. •n • • - • t • •r• .
Signature of Notary ' blic,S ate of Florida �: '""
oen•
[ ]Personally Known `�; .,4+7 ID N •
[y'�roduced Identification(Type) Prtiir, ''' • Wv• Scott Williams, Public Works Director
H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
MAP SHOWING BOUNDARY SURVEY OF
LOT 41, OCEAN GROVE UNIT NO. 2 AS RECORDED IN PLAT BOOK 20, PAGE 20,
OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
BRENT NARKIEMCZ
WELLS FARGO BANK, N.A.
OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY
RICHARD T. MOREHEAD TITLE k ESCROW, INC.
SEMINOLE ROAD
N 01'24'49* W 61.93 (FORMERLY SEMINOLE BEACH ROAD)
(MEASURED)(CHORD) (100.0 RIGHT OF WAY)
N 00'50'36' W 61.83'
(PLAT)(CHORD) FOUND I/2'IRCN PPE
Fouo 1 PENTIFICASON
L.11.93 PCNT OF TAN DCY -� •
R 17.7 _ _ O N 00'31'00- W
•f.:-r. .`' 376-31'(PLAT)
0 o LOT 41 I 3
CIO' '-4 '.1.fir' Vl
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X PAD 44.1' ,_' TTI
m i -• SECOND STORY
CI
OVERHANG
PLANTER `SECOND STORY I
i i BALCsc
LOT 40
LOT 42 AREA
I �� PLANTER
a THE IMAGE HEREON IS SHOWN FOR CONVENIENCE AND
i ———
_ —
_ SHOULD NOT BE RELIED UPON FOR SURVEY DATA
-- - _ SIDI 44
p jiIc"" —S 03'46'42" E 60 OD. (PUT)— DDIIf1CA
S 03'55'3f E LOT 29
• ;
60.03' (MEASLor2aURED) h.,,.
LOT 27 1 r,PI-'
NOTES ACCEPTED BY: �•��"
X44.".I',•)r •,
JOB # 13-072 I DATE OF FIELD SURVEY: 05-28-13 IDATE OF ISSUE: 05-29-13 I SCALE: 1' = 20'
CLOSING COORDINATED BY: MAP NOTES:
RICHARD T. MOREHEAD TITLE & ESCROW, INC. 1.BEARINGS ARE BASED ON THE _PLAT BEARING OF S 89'29'56' E _ALONG THE
444 THIRD STREET NORTHERLY BOUNDARY UNE OF SUBJECT PARCEL.
2.BY GRAPHIC PLOTTING ONLY, THE CAPTIONED LANDS UE WPM FLOOD ZONE X , AS
NEPTUNE BEACH, FL 32266
SHOWN ON THE NATIONAL FLOOD INSURANCE MAP DATED APRIL 17, 1989, COMMUNITY
(904) 247-5147 NUMBER 120075.PANEL 0001 0
3. THIS SURVEY REFLECTS ALL EASEMENTS R RIGHTS OF WAY AS PER RECORDED PLAT. UNLESS
▪OLD IWWWP(TBI1t' OTHERWISE STATED.NO OTHER TITLE VERIFICATION HAS BEEN PERFORMED BY THE UNDERSIGNED.
•nx�a/•�+acc.s.•-: 4. THIS SURVEY IS NOT VAUD WITHOUT THE ORIGINAL SIGNATURE AND EMBOSSED SEAL OF THE
CERTIFYING SURVEYOR.
CHARLES K. CERTIFICATE LEGEND:
I IADRBY CERTIFY THAT THIS SURVEY WAS MADE UNDER MY RESPDIISIBIJ:CHARDS • - PROPERTY CORNER
EE
AND MTS THE MINIMUM TECHNICAL STANDARDS AS SET FORTH BY THE RORIDA OBSTRUCTED NO EVIDENCE
AVICIIVTOSH III1 BOARD OF PRDF�SIONN_SARS AND MAPPERS N CHAPTER 52-17,FLORIDA FOUND OR SET
ADIIISIRATIIE ME ANT TO SECTION 472.0E4 FIA STAMM
PROFESSIONAL SURVEYOR
& O CONCRETE
MAPPER .5502 J —X— - FENCE
1692 C,VIH.r7N Lp He y - � R . RADIUS
OR:NGC PR RI_FL 32003 CHARLES K. McINTOSH
(P.,..)904-524-3411 REGISTERED SURVEYOR AND MAPPER /5502 STATE OF FLORIDA L . LENGTH