351 SEMINOLE RD DWAY21-0055 1
l'---- Building Permit Application Updated 10/9/18
)i City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
,'; IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us In c�
Job Address: -,`SII (3e.�,r (///UO�� / Permit Number: ` '4 JT 'i Z l - C>05
Legal Description )O 15 )6 ZS `z(v See_ 2 J0. (40.-,c-- RE# 1 70 4-3z1 000 5
Valuation of Work(Replacement Cost)$I./ OCO Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition IaAlteration ❑Repair ove ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial PJ Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes eNo
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed:
01(2-k QK CrLIU / 11°/4n0
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Nam el ( kOCS14-- Address -5 �.t plc' _
City State Zip 3223 Phone qlq� 386 f1 ' -2 8
E-Mail '-.Ci� oXj‘0--Rv.y . c o v/.
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Informa ,n
Name of Com.any 'a a ielD( c.I L / Qualifying A:enti'Jv
Address , t-.3 L 4.-fCity a State*_. Zip 32.2
Office Phone 4.111 0 1.11 61. Job Site intact Number o 2.j "1,t_ _
State Certification Registration#C ,o�$3$ E-Ma' r_ ✓l• ‘10.‘10. _A.._ 44.L I. - f_
V � ai
isk
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempts 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 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 P!GP 'TY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LEND 0-' Ar ,TTORNE BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
t_
s1
(Signature : owner or Agent) (Signat ,of Contractor)
' ed and sworn to(or affi m-d)before met is Z Dd. of Signed and sworn to(or affi m;d •-f• • m4his _JAW' •ay of
0 ,b 'tr .4. i r1 , ..1 • ' ii, ___„!1:4,_• I/ 'a to
If, a fof No! • ign. u - • <tary)
TONT GINDLESPERGER
Produced
y Known OR wt .; ' sonall Known r vnu TONI GINOLESPERGER
[ ]Produced Identifi¢8f On �� ;: MY COMMISSION#GG 353178 y :3s *' '; MY COMMISSION#GG 353178
I °, EXPIRES:October 6,2023 [ ]Produced Identific qr{ •t
Type of Identificatiort, ^� • . Iderviters Type of Identification: '-,s",:,:. �Lt. EX�iRES Cctoher 6,2023
• on, e, i 4` Bonded h u S.i.0 P[ter 6,2023 4e �(
a ' 6 y'F'reriseti,iara•esmmi¢uwe: wr
_,LAn , REVOCABLE ENCROACHMENT AGREEMENT
,'t \\ **ALL INFORMATION
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
L x,
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida,a municipal corporation organized and
existing under thU�the l ,ts of theS ate of Florida, hereinafter referred to as "CITY"and
2.. J ' - 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 t U (.t.) �1L'�` P4 77 .
Any facility maintained, repaired, erected, and/or insta led 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 35 3 c-fr(//OnL.a ao .
• 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.bg_____
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.
G Date -Pec. ' 1 ° 1 k
Property Owner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this Z day of e_c ,20 2 ( ,
by .$ 7 /Q KW O( 7 ,who personally appeared before me and
printed name of Signer)
ackncc(
wedged hat he he signed the instrument voluntarily for the purpose expressed in it.
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'"''' TONI GINDLESPERGER Department Approval:
Signature of Notary Public, ]of Floridan l',, :.: MY COMMISSION#GG353178
.1 J 'i;w� '.„y':o
Personally Known :,,f�,J Personally :,,f�,- Q;. EXPIRES:October 6,2023
q.:?r,P?;°• Bonded Thru Notary Public Underwriters
[ )Produced Identification(Type) Scott Williams, Public Works Director
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
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NOTICE OF COMMENCEMENT
State of l Tax Folio No. 7 04 4 - 00 D 5
County of U\f.
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713
of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEN►�IVT. �2 £T
Legal Description of property being improved:. t0-15--I( 02-3- :i 2c �
Address of property being improved: ? ( (J i-1 POO 019
General description of improvements: 7 JAG CYZkl�E=Z , 13/41?0-62tCK, Cf/OfA-)
Owner: C r 1v9c L\:\, Address: 5 1 �`^'�-�y-a •t'
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: ®'L (406)1--S 1k,C _
Address: LKS3 (
Telephone No.:]0Q t:'7 Lam-- Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may
be served:Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b), Florida Statues. (Fill in at Owner's option)
Name: _
Address:
Telephone No: Fax No:
Expiration date of Notice of Commen ment jthe expiration date is one (1)year frorIate is
specified): ' �tf`'1tc' TONI GINDLESPERGER
�A L2 `: MY GUMMISSION#GG 353178
.•.•c7: EXPIRES:October 6,2023
THIS SPACE FOR RECORDER'S USE ONLY OWNER •"••Fa....cr Bonded ThruNotary Public Underwriters '
Signed: /!��'�� Date: _Dec 2 v- 2aZ
Doc#2021334469,OR BK 20065 Page 1100, Before me this 2 CU day of C. 207 ( in the County of Duval,State
Number Pages:1 Of Florida,has personally appeared FAQ kHz'J''!
Recorded 12/20/2021 01:06 PM, Notary Public at Large,State of Flor.• ounty of 0 val.
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL My commission expires:
COUNTRECORDING
Personally Known: �C ' ' , / or
RECORDING $10.00 Produced Identification: �� 4