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295 Belvedere St Driveway Submittal Building Permit Application Updated 10/9/18 t.-• City of Atlantic Beach Building Department **ALL INFORMATION i 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: 2 rj f5 /v' feifj s-f v-147 Award is L4 tj, Permit Number: er: X Legal Description I04 /+P-2S - 21r • 1 7-2 I kA'S(o,Z Lo{' VY Xi/2 RE# /Valuation of Work(Replacement Cost)$ 2. 3 60 - at) Heated/Cooled SF N • Class of Work: ❑New ❑Addition DAlteration fi9Repair ❑Move ❑Demo ❑Pool :lit. ..". i ..". lot 2022 • Use of existing/proposed structure(s): ❑Commercial EResidential rr���� • If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No By: • Will tree(s)be removed in association with proposed project? ❑Yes(must submitlseparate Tree Removal Permit) ko Describe in detail the type of work to be performed: �'/ror,i'' VI,' 4 r !O ad/i. i? 607i. YOGIC Florida Product Approval# for multiple products use product approval form Property Owner Information MC..-1-,Qu h'l r �� Name Jct»i,z r ik>,'Y14 Address 'ZC%_� bc'I Jidi C S'1Y-Ke-t City Ariorrii i (ai , State ft.. Zip 522,3S Phone r'71'-(!2D -20 E-Mailer CoUrv-OLvr�d c- rvri f. (0,-).--)(0,-).--)Owner Agent(If Agent, Pb bf Attorney or Agency Letter Required) Contractor Information Name of Company DQ,r,c,2, , LAoc.4-(q./, L.LI, Qualifying Agent L,r,.i,y/ L jc.,,;A'r��p Address /0(.0'f M(4// /((1 p✓/4t City .ouX v ,(- ,//( State r--c... Zip 377_,-Z,-5 Office Phone cloy-cp.?- 7....2:24.1 Job Site Contact Number ":71".1i- 634.2 -22Z y State Certification/Registration# tljpc E-Mail Ipf© �dar 5 . ,?2k. (47.7 Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Insurer )'I4 r -fid I inCI fei ,(t OR Exempt 0 Expiration Date _;16// 20.2.2. 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 NICE OF COMMENCEMENT. (Sigrure of Owner or Agent) (Signature of Contractor) Si ned and sworn to(or affirm d)before me this 3 day of 'g'ec and sworn to(or affirm-.)before me this Zy of tS 20zZ,b /rG11iu hItr , Q Z-r-by • ' .. , G- r Si nature of Notary) ( ' ature � r i ( g 1 [ ]Personally Known OR t:4th•. CHRISTIAN GILES I ?gam ally KnoINDLE PE' R [ oduced Identification ��. • MY COMMISSION#HH 117153 pin: �a iION#1:I 353 8 Type of Identification: :'":-.,.f:,:?.-.-- ..,' EXPIRES:April13,2025 ' Petkii4-ififica . . _ _ _, FL - b • •-.9.F,;° Bonded Nu Notary Public Underwriter! Fok,F Bonded mN Notary Public Underwriters �n,r. .fir *or a*�Yct RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION 4-4 ` City of Atlantic Beach HIGHLIGHTED IN GRAY IS ‘vE I 800 Seminole Road,Atlantic Beach, FL 32233 REQUIRED. PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job Address 2C* gel octie(/ 5-frz4'AFS .557-33 Permit Number Contractor Information Company a1511, 11,inat ('.-ifi,. L1-(-- Qualifying Agent /22n 1/ K.06/...i/VebeL`-j Address 13,5'1 /14c1 //Of(U jJr1 N-C City jolGion frill, State FC. Zip...-7Z22.5 i Phone �j0� � 22 r -9(e -- Email 1&?.ID�OG/c a ,,/ ,t��,� ,24 0)4. i State Certification/Registration# ,J/A J Architect Phone Email Engineer Phone Email Workers Compensation Insurer re'opera f(el //7 j(.4runCC OR Exempt El Expiration Date 3/..31/2UL'Z • 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 1:1044,f 1 (lod e',,Kt.c (Project Superintendent) with(Company Name) at 05(el ICwridsfor 1 U,,(, Phone 404-y(p2-222, • 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 arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. • The Publi r s irector shall be notified 24 hours prior to starting work and again immediately upon completion. Date f3/a a- Permittee(signed in presenc f Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument was acknowledged this 3 day of Feb(r(/1 of ry ,20 202-2,- by fibli rile-la fA�Y1lin ,who personally appeared before me and (prd name of Permittee) 'sir`'!. CHRISTIAN GILES acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. ''�' V--. CHRISTIAN MY COMMISSION#HH 117153 _ "•:?;;; ,"-� -;AEXPIRES: XPIRES:Apri113,2025 G. ✓VJ [ ]Personally Known :° Ba1dAdTMu"N'otu' yPublicUncle iters _ Signature of Notary Public,State of Florida [v(Produced Identification(Type) )-L- D . L _ H:\Applications&Forms\Word&Excel Document Originals\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18 •EXACTA r-1L , I - .1 . Land Surveyors,LLC - 1 ..ww..4 t.l.nocom omow eaie rse are I No,066.7442002 PROPERTY ADDRESS:295 BELVEDERE STREET,ATLANTIC BEACH,FLORIDA 32233 SURVEY NUMBER:2104 6e74 2104.6874 The undersigned hereby acknowledges that this BOUNDARY SURVEY document has be�r ceived,sipqA4@d app vgd / DUVAL COUNTY / and accepted on, V. r9$ }�r r --...,,... / \444 / ` ',:So. 4:526817;47.,,,,,_^7 e/ /4 7'6126/2.4140140041 \ ,,,, o ?4g 44,(..".41.) / �$ /a R)' .1',...-1:. ;-x'46:,.. cc,0'} -r. r 2 - 4 s �A o • lp z56 \ 4.v..-4,,,,..-,..,...4.,,.411...4r �Y 4�,cF \` T455 ep'', Wg 4/4902d `w a, r; ;---- co Cq,S ,,,,73-3. o r 1h r� �'�4j� RfA(giyOF y YE 0,, •L.. 2 ( T/� ---.-,4/ 'O//ApT /-R°` ' '4'.,, (0T h) cGt op,: A SURVEYOR'S NOTES. 30 N 15 30 FENCE OWNERSHIP NOT DETERMINED. (pT/� GRAPHIC SCALE(In Feel) 1 inch=30 II SURVEYORS CERTIFICATION: POINTS OF INTEREST: NONE VISIBLE •l&VN661 NCN,ii` I hereby certify that this Survey of the lands '.-C.F,N Uy� aN described hereon was made under my direct '�~" �°' supervision,and to the best of my knowledge 6132 \ '•` and belief is a true and accurate representation ', I of sad lends end meets the Standards of 4„f„........../.../$a,4.74"._, Practice set forth in Chapter SJ-15,050 through A .r SJ-15.053,Florida Administrative Code, r pursuant to section 472.027,Florida Statutes. / A TA ba..-54.eeYv.11C t: This survey el not valid without the signature and . Lana sw...wn uc .r WI SCJ' STATE FLOAI AP fir•. onginal raised seal of a Flonda licensed surveyor tea a +sell,r.Lell.i ewy Se,714 266 and mapper,exceptne^v eo-.a.aa ante".+.IL,r:, /T ronic 41 IAVE'i°�` signature andsealala Honda licensed surveyor , RAYMOND J.SCHAEFER and mapper is affixed hereto Florida Land �.atae..b.. Title Association AFFILIATE te.re.lAxrosr eta Lx.tla Land ea-mom LLC I La l -FL'-TA MEMBERS DATE OF SURVEY:05/05/21 ' FIELD WORK DATE:5/3/2021 SEE PAGE 2 OF 2 FOR LEGAL DESCRIPTION PAGE 1 OF 2-NOT VALID WITHOUT ALL PAGES REVISION DATEISI:(REV 16/23/20211(RENO 5/5/2021) "^A' %,,, REVOCABLE ENCROACHMENT AGREEMENT `Sii.� City of Atlantic Beach **ALL INFORMATION ; HIGHLIGHTED IN GRAY 15 . - 800 Seminole Road,Atlantic Beach,FL 32233 IS REQUIRED. REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and exi t" ''ng under the laws of the State of Florida, hereinafter referred to as"CITY" and ) ,1h1 (r It 1.-Mit9 k1 I cc-) of Atlantic Beach, Florida, hereinafter referredjo as "USER". I ���JJJ 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 C z'A vt Gtr '` i , 1., , 10 ; -i a. _,. /1 _/, 4' A Any facility maintained, repaired, erected, ..d/or installed ii the exercise . he privilege granted remains subject to 3 relocation or removal on thirty(30)days'notice by CITY to U ER,said notice to USER shall be given by certified mail,return receipt requested,to the following address 2'5- ,°)V(o(7°Q7 t1J • 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 liabiliti- . ereby assumed by the USER./ / Date �l 3�� 2— Property Owner/Age (signed in presence of Notary Public) STATE OF FLORIDA, COUNTY OF DUVAL The foregoing instrument was acknowledged this A day of 1-ebruary , 20 ZZ , by 61(11/ 0— LaVl 1(1) (,/ , who personally appeared before me and (pri to name of Signe acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. 6),//r/4, —,— ��w I Department Approval: Signature of Notary Public,State of Florida [ ) Personally Known �""""" :; CHRISTIAN GILES ;,: • MY COMMISSION#HH 117ig3 {Produced Identification(Type)F L- 0• I- 1.,•;;-:-:a,= EXPIRSS:April 13,2025 Jco1 Williams, Public Works Director �•.EOF O�Q?. Bonded Thru Notary Public Underwriters K H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18