2305 BAREFOOT TR DWAY22-0001 'j' Building Permit Application Updated 10/9/18
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. City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
'`--,t.7 ft�° IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us '\
Job Address: 2 ;
3G'S ( -I} rr I 1:e Permit Number: bL (Af �Z` UG 0
Legal Description ''1 2 '1.3 eyg--25-11e- Qcrcxi) LA,t„I lc (AA.ri 2.. Lai- ( 2-RE# I(o 14(0 3 -f;(a2 G
Valuation of Work(Replacement Cost)$ L(.?OC-- •`' Heated/Cooled SF Non-Heated IMEivE
• Class of Work: ❑New DAddition DAlteration (iepair ❑Move [Memo ❑Pool DWindow or JAN 1 1 2022
• Use of existing/proposed structure(s): DCommercial (residential
• If an existing structure, is a fire sprinkler system installed?: DYes IgNo B
• Will tree(s) be removed in association with proposed project? DYes(must submit separate Tree Removal Permit) >eNo
Describe in detail the type of work to be performed: t`c:e,C>Ve ` 1 0 c e 4L V
Pr i i ' y wt C
11/) 1-hIItil CL / I ) .— !uL') LGut r 4,5 +L /ayoa
Florida Product Approval# for multiple products use product approval form
Property Owner Information ii
Name /i'�'4eie..i GO r�.71./ Address 21 l3(7"3 cJe-c—c, Yi- -ratt e
City A//,,.,n-/ie a-ec1jj State PL Zip 1_23" Phone
E-Mail b110 t.+%rav ycx�drli , C.i J1--1.
Owner or Agent(If Ag nt, ower of Attorney or Agency Letter Required)
Contractor Information
Name of Company A WA/I. fit eW 4.; C I,-, Qualifying Agent
Address _2/7 a" 'T1 Gt�I, /? (� City I'cmJc f i)J.1t State f(� Zip �ZCi?—
Office
Office Phone C/0'/ -33`1/2€ Job Site Contact Number q01-/ -..?:;47-/2 et
State Certification/Registration# ,G/12 E-Mail r 1VC'Ir vv.c6,--` ic4",s 1140 1 mil 1 •C ip—Architect Name& Phone# JJ /0
Engineer's Name&Phone# /1/ A
Workers Compensation Insurer 2J 7Z1 "e:.uf^//L:L- Lr.r5-- 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 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.
/��
(Signature of Owner orgent) (S :nature of Con - or)
Signed and sworn to(or affirmed) before me this c1 day of Signed and sworn to(or affirmed before m this S day of
0a 2 by 6/'-t��c^� r v , 2`='LL, by affirmed)
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(Si�2ipn re of N ary) (Si:niture o Nota
1 t : , GREGORY LOFTUS ,:i ,� !"''' GREGORY LOFTUS
f :.: A. ,,; MY COMMISSION#GG 249815 i;I.: •j 4.1 MY COMMISSION#GG 2+19815
( ]Personally Known OR [ ] Personally Known OR r,+ .. `" •
': n��o: EXPIRES:August 18.2022 •, w�P.• EXPIRES:August 18,2022
[ I Produced Identification . '''fp•Fc�P' I3ondedmu [ ] Produced Identification :!F:,:v. p 7 NotayPup�U .
„ NotaryPubdcthberwrllers +.�_._.•• --------A_____--
Type of Identification: Type of Identification:
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1RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION
City of Atlantic Beach **ALL INFORMATION
S+l HIGHLIGHTED IN GRAY IS
`7 800 Seminole Road, Atlantic Beach, FL 32233 REQUIRED.
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address 2-o ,/t..-- ,]-+ TcL . Permit Number
Contractor Information
Company /gif/JYt,ft1,j,Y'! 1/t,�S',-. Qualifying Agent
Address /7 4u-7160k t)/z. J City liayileti'c'u Stateft- Zip ?2b
Phone o`I —33y ./yg6, Email rl vev mcty-S 1d-esin@Cf,na1/. <<�-�.
State Certification/Registration # N/1 I
Architect /1/ �A Phone Email
Engineer 'U/711 Phone Email
Workers Compensation Insurer Fl 0191 kl v 614*,!-tre.e 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 -q .u- .- it..94v ek---
"" (Project Superintendent)
with(Company Name) 12- ii 6,7 /144a4_-, (�� Sis- Phone
• 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 t 5 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 arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges.
• Thg_J? aolpirector s .' be notified 24 hours prior to starting work and again immediately upon completion.
Date
Permittee signed in prese - of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL 74'.The foregoing instrument was acknowledged this y day of , 20 Z Z
by Q\vc7� ?4 as ft 0b /``-,, l C re1t" 4J d4 ` l rte(_ ,who personally appeared before me and
(printed r(ahte of Permittee)
?... GREGORY LOFTUS
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. =+?'' ';
�; -'�'—'. :.; MY COMMISSION C Gf3?Asi815
.`•��:� EXPIRES:August 1B.2022
cleia ��BcnAeOTtxuNotary PubicUndetrMl•�sZI 1 Personally Known
Signatoto u IC,State of Florida I I Produced Identification(Type)
H:\Applications&Forms\Word Documents\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
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AS RECORDED IN PLAT BOOK ',' PACES /3-/3'0 OF THE PUBLIC RECORDS OF DUVAL COUNTY. FLORIDA
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NOT VAUD UNLESS EMBOSSED WITH SEAL OF THE UNDERSIGNED. BEARINGS BASED ON I?�ul. LINE AS SHOWN
THE PROPERTY SHOWN HEREON APPEARS TO LIE WITHIN FLOOD HAZARD ZONE X AS SCALED FROM FLOOD
INSURANCE RATE MAP Ctrl FOR ArEelA/r/G 8E4LI-- DATED - 9'77-69
TRI—STATE LAND SURVEYORS, INC.
8411 BA MEADOWS WAY SUITE #2, JACKSONVILLE, FLORIDA J2256 (904) 731-7235
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awc YON RESPONSIBILE
HEREBY CERTIFY THAT THE ABOVE LANDS WERE SURVEYED UNDER MY
• RESPONSIBILE SUPERVISION AND DIRECTION, JHAT THERE ARE NO
•ow Cat ENCROACf/MENTS EXCEPT AS SHOWN AND MAT THE SURVEY SHOWN
(rn WIN w I rr 4140 HEREON MEETS THE MINIMUM TECHNICAL STANDARDS SET FORTH BY
-1't-ma' THE FLORIDA BOARD OF LAND SURVEYORS PURSUANT TO SECTION • """lik
0 NON Oot promo 472.027, FLORIDA STATUTES.
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