715 Bonita Rd Driveway Submittal .,•,t-- /r,., Building Permit Application
i Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
• `.::i� 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: -7I S CO nits‘... y241 Permit Number:
Legal Description 3(j--(0 j1 -,-n-,q6 etsry Pair,,, Un,'- I Lx>4- /5 Et Q RE# I11 13cl 0.0 A_
Valuation of Work(Replacement Cost)$*hp Heated/Cooled SF n/a Non-H
• Class of Work: ❑New ❑Addition QQAlteration ❑Repair UMove ODemo OPool ❑Winr'
• Use of existing/proposed structure(s): ❑Commercial Residential /��r 9 2�2�
,
• If an existing structure,is a fire sprinkler system installed?: ❑Yes , No BY:
• Will tree(s) be removed in association with proposed protect?OYes(must submit separate Tree Removal Permit) XNo
Desc ibe in detail the type of work to be performe
I ,cp►G(£ c�ctS -�� �c.,irt+e� c��1VGwcy Wla-h cycNt,) Ia(4ra C.1 by (7c.VcrS,
P/c,u- ex►St.,> (o'er-tbn(rtt/ gitit w(.k-w/ ()Aviv% 5ht- d 3150o-ih , O Add rcvcip
Florida Product Approval# forr% r t- /"
multiple products use produc approval form kl f
Property Owner Information
Name 713--3(.,,,\A-i,_ u__(.../-(-wk.� Address a°5s- j3,tatin AVL,
City 44-1 A ,,,-f,' L f3 c(AO-)h State 6_ Zip 1,'2.'z---S3 Phone (C1 O ) l.33–f3 9 ka
E-Mail i-5,l 0(1,1 C75 rn t, t Qty.—
Owner
.wOwner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Ne of Company V • - 10 'av t.ci.....A.„4rn
C----Qualifying Agent
ddress (1 \ -t,c.�.,-f e....1- - 111K), City "S"'&6.4. State F�,. Zip 322
Office Phone L1 u4) 5.6 _ ��3 Job Site Contact Number 9 R,�-t' 2.3-'13
State Certification/Registration# E-Mail t c ('c9. (-err � c
ami
Architect Name&Phone# j
Engineer's Name&Phone#
Workers Compensation Insurer _: Xgx OR Exempt❑ Expiration Date t1^ 1,-‘"Z3
-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 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
RECORDI G , a R OTICE QF COMMENCEMENT. fr ` 1
1111 J
(Si:
�at re o ••wner or Agent)
(SivaTur • Co rac Jr)
Signed and sworn to(or affirmed) before me this lei day of Signed and sworn to(or aff• -• •efore.c this 9 day of
Ni.JLf413 ,, aaa i by -1(cLL S n�
+�� iO� ,�z' ,b C�:\ . Pew S
;iaveyi JENNIFER JOHNSTON
`: Atl'COMMISSION a HH 057579 (Bnature of Notary) t Y.o6 TONI GINDLESPER I - ur wiP.�' '
.. 1,7 EXPIRES:October 27,2024 ;,
••.!os,;o�r Bonded lin Notary Pubic Undenxiii s :*: ��� :,_ MY COMMISSION#GG 353178
=�•.i��• EV IIf S:Oct _r 6,2023
_ , '•'.'Fb ,.�e Ph i"l icUndenvriters
[,Produced Identificatior}_ � �(-t J 9-y
` ,,
Type of Identification: ` ,l L( el1)--( Type of Identification:
REVOCABLE ENCROACHMENT AGREEMENT
City of Atlantic Beach **ALL INFORMATION
HIGHLIGHTED IN GRAY
800 Seminole Road,Atlantic Beach,FL 32233 IS REQUIRED.
<41 u.tas�
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
,-)a✓I 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. .1
This work is generally described as rt p)Atm Gorr r>!tQ. d!l`\.t !
{lr•rei, RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION
1 y� City of Atlantic Beach HIGHLIGHTED IN GRAY IS
IX A ;: 800 Seminole Road,Atlantic Beach, FL 32233 REQUIRED.
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address '71 S 130(10-a- (243 , Permit Number
Contractor Information
Company MO,.c f.t 1 0 VoNtss Qualifying Agent
Address City State Zip
Phone (ei 0y ) ?-u Sr- ?-3--7:Z Email
State Certification/Registration#
Architect Phone Email
Engineer Phone Email
Workers Compensation Insurer OR Exempt❑ Expiration Date
• 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 Public Works Director,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 Public Works Director 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 yY\.r. A c- CRA 0 (Project Superintendent)
with(Company Name) Jlnoo r e \Ci C OPV t-rS. Phone L q Uy ' S-to 2r- -2.-3-7—C
• All materials and equipment shall be subject to inspection by the Public Works Director.
• 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 Public Works Director 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 arisin; n any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges.
• The Pu. 'c W. s Director shall be notified 24 hours prior to starting work and again immediately upon completion.
Date 1\i 1 61/6,...1
Permittee(signe. • presence . Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument
was acknowledged this 141 t day of 14 O.)Lel al--/ ,20 a 1 ,
by —1,( CLC t Sy fact yy ,who pers.--_ - : . -,-•- k�- .-Ji t i STON 1
(printed name of Permittee) `f.,a-%:, 'AYCOMMISSION#HH067579 1
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. ,L. EXPIRES:October 27,2024
••Fags' Bonded Tiuu Nt'.:+y Pubic Under IIS s
[ ]Personally Known rr
Signature of ry'Public,State of Florida Identification(Type) ( L
H:\Applications&Forms\Word&Excel Document Originals\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
MAP SHOWING SURVEY OF
LOT 15, BLOCK 2, ROYAL PALMS UNIT ONE AS RECORDED IN PLAT BOOK 30, PAGES
60 and 60A OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
►
1 I 1
1
LOT 3 I I
I
1 I 1
LOT 2 1
I , LOT 1
' L_ — _ ( S85'?_5'3;'' I
FOUND 1%2" RON o i. — — _ _ _ _ E 80.87' FIELD
PIPE, NO CAP �+�� _ — _ _ — — 1
-=.-�_-� J '20'02"F — - - - -
80.65' -a-2.- 4- _ _
�, 10''FASENENT FOR DRAINAGE AND FOUND -,-/ •-,-IRON - - - —
__ _ -_- __ —1 UTILITIES TIES PIPE, ND c-P
- _ _ - - _ > x= -
z.—__
w I - _ _ _ � al'
I ETI - ---
_ - ---
_
B L_ 1 .21 O C K 2
I Q1
I O i¢ I
OZ1
Prj .Q I o
,„'I► 0 1 PLASTC 0
Li I I I 0 A/C PAD P7
. 1 rn1 ISI o) 9
39.0' 14.7' WI II1
I
g z i
16.4'ILOT 14 1 Iw co 1 STORY BLOto.s' AND FRAME 1. /-5 l rn
r) Ln _L' 1 0 , ' RESIDENCE No. 715 CS LOT 16 'ol`�
81 M I o Q 'e ,�` OD N NN i�
— ,I .cf' I I 39.0' 11 I-i
=� _ 15.1' � �* o�
II z I I BUILDING RESTRICTION LINE 1 t
I ► I �3 6 yt11ow . pm kr/6-1'4X-Favt-• 0im • _ . _ o \
5 I 1' 1 ce w N
0
I 5zQ I •- SI(i- . c0�rr LI N 1 -n
I I I o �37. r
1 • �1 / „T A-.,.- _ l-, _ . - M
I'4ou �U U2""W 8p —�_
N85'20'0 "W 80.67' FIEL4.65 FOUND 1/2" IRON _ _
,�PIPE, NO CAP N 20' 2 48, _
(� ( N85'22'44"W 120.22' FIELD ) PIPE, I CAP
RON
0 N � T A �
60' RIGHT OF WAY PAVED+ ! ° A
NOTES
1. THIS IS A BOUNDARY SURVEY.
2. BEARINGS ARE BASED ON THE SOUTHERLY LINE OF LOT 15,
BLOCK 2 BEING NORTH 85'20'02" WEST, AS PER PLAT.
3. 25' BUILDING RESTRICTION LINE AS PER PLAT.
4. EASEMENTS SHOWN ARE AS PER PLAT.
5. ALL FENCES SHOWN ARE 4' CHAIN LINK.
TI-IE PROPERTY SHOWN HEREON APPEARS TO LIE IN
FLOOD ZONE "X" (AREA OUTSIDE THE 500 YEAR
FLOOD PLAIN) AS WELL AS CAN BE DETERMINED
FROM THE FLOOD INSURANCE RATE MAP
COMMUNITY PANEL No. 120075 0001 D, REVISED
APRIL 17, 1989 FOR THE CITY OF ATLANTIC BEACH,
DUVAL COUNTY, FLORIDA.
THIS SURVEY WAS MADE FOR THE BENEFIT OF
TRACY SYNAN.
e ^.
"NOT VALID WITHOUT THE SIGNATURE AND DONN W. BOATWRIGHT, P.S.M.
THE ORIGINAL RAISED SEAL OF A FLORIDA FLORIDA LIC. SURVEYOR and MAPPER No. LS 3295
LICENSED SURVEYOR AND MAPPER." FLORIDA LIC. SURVEYING & MAPPING BUSINESS No. LB 3672
CHECKED BY: BOATWRIGHT LAND SURVEYORS, INC. DATE:APRIL 1, 2009
DRAWN BY: SWC
FILE: 2009-0180 1500 ROBERTS DRIVE, JACKSONVILLE BEACH, FLORIDA 241-8550 SHEET 1 OF 1