962 OCEAN BLVD DWAY22-0005 Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Ott IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 6 Z O(5 rSi UD Permit Number: D(,J A t z L `00x3
Legal Description /2_ 7 # A1.nrT OF ,p(1-1 VEINRE# 17D3'13-0100
Valuation of Work(Replacement Cost)$ /9; / y 7 S . ODHeated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition likAlteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial '1Residential
• If an existing structure,is a fire sprinkler system installed?: 6,Yes ❑No
• 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: Ke-nj& E")(I JrC CON caege
P/1._I VentPwl PSD /LW L i-cervLge4T tAii-r44 pAv v-
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name P<}N/tZ t A'M`•l N f1 I VOitSeN Address /6 2- OCfA-N 1 SIG
City A— Tl-AM-L( X3 4 •tC44- State {Z Zip 3 2..2-3'h Phone y oy • 38 6 • 3 2/S
E-Mail /4-M4 - /-0*1 V City L- @ . Co\A
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company /2-I ti 7 rf`1 ?f ' (—S INC. Qualifying Agent MIG/-I-ik- _ -J IM 61V
Address/01/ /IA/DT-OWN P/LWy ff 1 Qs City /t.LEstate 1-L Zi
P 3Z2`/6
Office Phone 90 y. '7 / 0• 07.61 Job Site Contact Number Toy • 7/D • 07&7
State Certification/Registration# 27-52_,/0'127 E-Mail /LCZ.LjJ I V / f PlV 9v.-S g C',M f}/L . Gq'Vl
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Rt.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 1 O7E • MMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEME TS TO UR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING CONSULT WITH YOUR LE DER O' AN ATT•RNEY BEFORE
RE • ' r NG YOU • O OF COMMENCE ENT
Ma AC '\ tE�14
(Si.tur. of 0 ner or Agent) =I (Signature of Contractor)
Signed and s orn to(or affirmed)before ahis 21 day of Sig . and sworn to(or affirmed)before me this day of
11101;) ,by �
�vOYS- 1:t • by c►,ke I rn�nL'
v� __
'• • •u LEEN HICKEY (Signature f BRONSON VEALE
,• '`- MY COMMISSION#HH 203374
n = Notary Public State of Flori
• 5rn
:o; EXPIRES:November 30,2025 Commission#HH 176789
[ J ersonally Known OR ;',F `op;, Bonded Thru Notary Public Underw[it*V sonally Known OR my
Cemm.Expires Sep 20,20
[ roduced Identificatiork — • educed Identification
Type of Identification: rlLti\t4-- Type of Identification: I^[o ,ctcA Ue ier L,tc eilse
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!.A,lt, REVOCABLE ENCROACHMENT AGREEMENT
at` .N City of Atlantic Beach **ALL INFORMATION
I lip
�' 800 Seminole Road,Atlantic Beach,FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
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
4414 17_ 5 AM,4 14/1 LV O/L-S*7U 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 , tA-CEA1`,N"T OF Ek1ST1N 4 CONCILEJ /Du-NEW Pq
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege gran eTF'ltmafi s ufje 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 9b2 CClarN & is / A -pl^T7C 601C-4 .
• 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 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 ssumed by the USER.
1
t/ziilf.v.v
�/�i/S '� Date'. I i?l 20 2-202->Property Owner/ t sig ed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this c:::)-IL day of \c\Jc,r-Li , 20 a-D- ,
by Q-►rv1h-er--k Jo Stc) ,who personally appeared before me and
(printed name of Signer)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
I.T. r�t'• COLLEEN HICKEY
( 1 mak- 1,41 MYCOMMISSKNJMHH203374 Department Approval:
.1,— ,. EXPIRES:November 30,2025
Signature of Notary Public, State of Florida •••!. :0• Bonded TtruNotary Public Unds lens
[ ] Personally Known c��
[1.jIroduced Identification(Type) l-s \KNr LAUr) 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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t•71% RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION
; ' City of Atlantic Beach HIGHLIGHTED IN GRAY IS
R ;, ii j 800 Seminole Road, Atlantic Beach, FL 32233 REQUIRED.
L�
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address 'L 2- OCA /3l vv. A-rE-A•1k71 C Permit Number
Contractor Information
Company /'_l VOL-C/11 / P Ji )L.S /I\fC.- Qualifying Agent
Address/ayS MIDT€I'VN P41A.1' /Skity `f AC(c.-_,$ar iv/LLE State lL. Zip 322/4,
Phone yo'-/ • "710 • O1 61 Email /Zi Lir/Airy PAvJL # (-)/Yl Alc. . ocei
State Certification/Registration # /✓t7 /e-hN 41- Z7 --S Z y 9 7 21
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 Al/C/- E . J/M FV G L (Project Superintendent)
with(Company Name) /I tfQ/1_,C,M-1 p!h/elt-.S Phone gel• 710' M471
• 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 an. ' e -s '. .• land to be entered upon and used by the holder,and the holder will,at all times,assume all risk of
and i oem . , defend an. ave harmless the City of Atlantic Beach from and against any and all loss,damage and cost of
exp: ses : •• ng in any man,er of the exercise or attempted exercises by the holder of the aforesaid rights and privileges.
• Th: b , orks Direc , sh. I be notified 24 hours prior to starting work and again immediately upon completion.
�� ' Date ' / 1 eS/2.-2_
Permittee ;i ?.�; - c: if Notary Public)
STATE OFF •'IDA, • '.TY OF DUVALjh
The foregoin: strument was acknowledged this 1) day of --Jan 1 ,20 22_ ,
by M`��U,e\ 1\ms c\2Z ,who perssen211v-arlap eci-haforP meansJ_ —
(printed name of Permittee) I ro
�
BRONSON VEALE
Ig1eLr
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. I Notary Public-State of Florida I
°•.+� Commission:i'HH 176789
o. ?:. My Comm.Expires Sep 20,2025
i /fli€IAk [ 1 Personally Known
Signature of Notary Public,State of Florida 44 Produced Identification(Type) Floe lac.,�Oft ver Lt CCI► '
H:\Applications&Forms\Word&Excel Document Originals\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
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MAP SHOWING SURVEY OF
LOT 3 AND THE SOUTH 1.5 FEET OF LOT 2, BLOCK 1, ATLANTIC BEACH PARKWAY
AS RECORDED IN PLAT BOOK 15, PAGE 61, OF THE
CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
LOT 1
/ 7
- - 110.5'
4 10 20 40 I / /
0 ./
SCALE: 1" = 20' I O z'" Q�
U1 O REMAINDER OF • `-
o LOT 2 M
LOT 14 ,r (O'
D W 43
m
SOUTH 1.5'
OF LOT 2 I
FOUND IRON
G 0 FOUND 1/2"IRON 85.1 UNDER ASPHALT
PRRNER 15.OQ� '
RPE.NO CAP 6VIN 1 ___ �,7, —o Q U
PROPERMR •
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SEE 8 PLANTER C r 44.2
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0
DETAIL BRICK mil n CONCRETE
m PAVERS /— DRIVEWAY2.3
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CORNER IN 91.6'(PLAT) FOUND 1/2'IRON
FENCE POST �� PIPE,NO CAP
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DETAILN
REMAINDER
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0 6 'WOOD PAVERS - - - -
PLAZA STREET
NOTES:
1. THIS IS A BOUNDARY SURVEY. 40' RIGHT OF WAY PAVED PUBLIC
2. BUILDING RESTRICTION LINES AS PER PLAT.
3. INTERIOR ANGLES PER FIELD SURVEY AS FOLLOWS:
A = 81'44'18"
B = 98'22'05"
C = 89'57'37"
D = 89'56'00" THIS SURVEY WAS MADE FOR THE BENEFIT OF
E = 270'04'0o' DANIEL & AMY HALVORSEN; BANK OF ENGLAND;
F = B9'56'00"
ATLANTIC COAST TITLE AND ESCROW and OLD
4. NORTH PROTRACTED FROM PLAT. REPUBLIC NATIONAL TITLE INSURANCE COMPANY;
THE PROPERTY DESCRIBED HEREON UES IN FLOOD
ZONE "X" (AREA OF MINIMAL FLOOD HAZARD) AS WELL
C\_.-\''--AS CAN BE DETERMINED FROM THE FLOOD INSURANCE
RATE MAP NUMBER 12031C0409J, REVISED NOVEMBER i
2, 2018 FOR DUVAL COUNTY, FLORIDA. DONN W. BOATWRIGHT, P.S.M.
'NOT VALID WITHOUT NE SIGNATURE AND NE ORIGINAL FLORIDA UC. SURVEYOR and MAPPER No. LS 3295
SEAL OF A FLORIDA UCENDD SURVEYOR AND MAPPER.' FLORIDA LIC. SURVEYING & MAPPING BUSINESS No. LB 3672
CHECKED BY: BOATWRIGHT LAND SURVEYORS, INC. DA
DRAWN BY: KLW AUGUST 12, 2020
FILE: 2020-1019 1500 ROBERTS DRIVE, JACKSONVILLE BEACH, FLORIDA 241-8550 SHEET 1 OF 1
I /\ o
SOUTH 1.5' m
OF LOT 2
01 " io I FOUND IRON
Q FOUND 1/2" IRON 85.� UNDER ASPHALT
PROPERTY PIPE, NO CAP 6' VIN 1 �,�.�
0 °
CORNER IN S.00 _ -
FENCE POST — 02'(PLAT) .,��-. .\
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LOT 13 cr
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, BRICK — _ , IREOr' AM r� 0
P AVERS/5n " =G C� B O
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WOOD FOUND 1/2" IRON
" o r 91 1 4� BRICK ANCHOR I P�WGUER PIPE, NO CAP
—' PROPERTY PLANTER PAVERS FOUND 1/2` IRON
CORNER IN 91.6'(PLAT) I PIPE. NO CAP
V
FENCE POST I To
a
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��
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CORNER IN S• XX ��
FENCE POST •
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SEE S PLANTER 44.2 31
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'- — PROPERTY PLANTER PAVERS POtE
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\\// PIPE, NO CAP
FENCE POST rn a
LOT 4 .0
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LOT 12