487 ROYAL PALMS DR DWAY22-0013 ''- `-, 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
% IS REQUIRED.
Phone: (9044) 247'-5826 Email: Building-Dept@coab.us /�
Job Address: L. P(M ) JP[ermmiit Number: b�LA� ( Z Z—O0( 3
Leal Descri tion 1"�fog
' 3-7 UvLrj Dye
' '`� /A-K9---1 1 RE# 17 �L l 80--0600
Legal P /
Valuation of Work(Replacement Cost)$ I.200 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: Ci New ❑Addition DAlteration DRepair ❑l�Move ElDemo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial f '//sidential
• If an exictina strurture is a fire sprinkler system inctallerl?• IlYes V(—)
• Will tree(s)be removed in association with proposed proiect? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed:
PelktefiVAt OF'CiCI )1(5 A r i\frAA 0:ti,
Florida Product Approval# for multiple products use product approval form
Prope Owner Information
Name Address at/ 1 DI . _
City ;lid ,,r/,i__ , & idState Zip P e 4j
E-Mai 4R/'WI'^ �0�ll� i' pa)
Owner o Agent(If Agen�, Power ofAttorney or Agency Letter Required)
Contractor Infor .tion
Name o om any , ..!✓.II. -ii, ._./A1,14 , /11011LI ,(il• ify1�
n:Agent 1�.._,,L#A4_ % L
Address o r 'f City A a ON _ rC 1- f Zip -
Office Phone Job Site Contact Number
g 2.1 if iItufoo r', /-( iv • '� r
State Certification Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer 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 ",BTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
R . ' r ING YOUR I ICE OF COMMENCEMENT.
11.4 ,.,. I14 _ii
( igna��hof Owner or Agent) (Signatu of Contractor) 2
S' d nd sworn to(or . ed)before me this-7-- day of Si ed a d sworn to(o r -•)before e this :ay of
' _ ate' (I (Si:.
R .w
t s�;,;;•,.., TON)GINDLESPER� 1?8 --
+P'' • mY COMMISSION#GG 353 ............... TONT GI\ �PERGER�
rsonal ly Known OR " EXPIRES:(ktob�t 8'2023 rsonal ly Known OR ''� t*- ,COMMISSION#GG 353178
[ ]Produced Idcatiocati9 •-:!;',.,. ., �nd�rnNNoiscyPublktlnde^ � [ ]Produced Identificatio ft 4: EXPIRES:October 6,20231
Type of Identification: Type of Identification: •.P.• • , . T_
pct .�Piy RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION
City of Atlantic Beach HIGHLIGHTED IN GRAY IS
li
- 800 Seminole Road,Atlantic Beach, FL 32233 REQUIRED.
oaS
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address 1 � >P� Doie,S �
Permit Number b f\L( 2 Z-0013
Contractor Information
`
Company idt,h t I (,�K- I(m Qualifying Agent Pitairee41 tdfrac
Add resL'7 LV ` i treepf City State, p.Zip32.2.3?-,
Phone �� ��?�3 Email 4 tax p(,r i(�L(�IV_Win
State Certification/Registration# f 3A,?.'(
Architect Phone Email
Engineer Phone Email
Workers Compensation Insurer OR Exempt 1piration 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 'tof Atlantic Beach .r Florida Department of Transportation Standards and be performed under the
�Asupervision of At _',i /11 /AA (Project Superintendent)
with(Company Name) MVP / //1rri lj{r• % ' rW/ I 'hone ,1 �i /f3
• All materials and equipment shall be subject to inspection by the Public Works Director. r
• 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 t0 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
d indemnify,defend and save harmless the City of Atlantic Beach from and against any and all loss,damage and cost of
e nses arising in any mann of the exercise or attempted exercises by the holder of the aforesaid rights and privileges.
• Th u lic Works Directors X11 be notified 24 hours prior to starting work and again immediate) upon completion. ,
trtJ Date/tom,/
Permittee(si ne i presence of Notary Public) CCC
STATE CF FLORIDA,COUNTY OF DUVAL
The foreuo"ng instrument was acknowledged this Z q day of F ,20 ?.
by �Q/V\ ,who personally appeared before me and
(printed name of Permittee) Y "n�P'' TONI GINDLESPERGER
ackno IliPed that h- ign: the instr ent voluntarily for the purpose expresse r. �"'`5:--..`�, • ct,. MY COMMISSION#GG 353178
!.!%'-'• EXPIRES:October 6,2023
e. ._
!.i, ° Bonded Thtu Notary Public Underwriters
• / .H'�ersona
Signature of Notary Public,State of Florid [ ]Produced Identification(Type)
H:\Applications&Forms\Word&Excel Document Originals\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
. REVOCABLE ENCROACHMENT AGREEMENT
r" I� City of Atlantic Beach **ALL INFORMATION
`f HIGHLIGHTED IN GRAY
‘11111111,1,
800 Seminole Road,Atlantic Beach, FL 32233
IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and
ex' ting under the lawLt ,'r�?4"
of the of Florida, hereinafter referred to as "CITY" and
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 CL ! st rt i(a .,7- .
Any facility maintained, repaired, erected, and/or ined in he exercise of the privilege granted remains subject to
relocation or removal on thirty(30)days' notic b CITY t USER,said n tice to USE shall pe given by certified mail,return
receipt requested,to the following address �"fiyajt Y shall
V e
• 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
iabilities are hereby as ed by the USER. 2
iI, , l , . . 4 rI ii L. ,•A Date 21941, y
Pr. .e Owner/Agent (signed in presence of Notary Public)
STA` E OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this ( day of re...6 , 20 2Z__
by RL.4114.4 ,who personally appeared before me and
alk ed name of Signer)
ackno -.ged t Athk. . he A e signed the instrument voluntarily for the purpose expressed in it.
Y% TONI GINDLESPERGER
C - 14111111' ' ' MY COMMISSION 1I GG 353178
- o`: EXPIRES:October 6,2023 Department Approval:
Signature of Notary Public,Sta e • Florid8,�,?'ffN°`•' Beaded Thn,Noisy Pubic undewrtters
4-rPersonally Known
[ ] 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
;iP `�. ' 1Y ays.wa
SHEFFIELD &BOATRIGHT s � 1., `V °M M_
TITLE SERVICES, LLC i
8101 Gazebo Park Place N.Suite 101 '
Jacksonville,Florida 32257 ; ,
904-733-7900 t \ . ,4
PROPERTY ADDRESS:487 ROYAL PALMS DRIVE,ATLANTIC BEACH,FLORIDA 32233 SURVEY NUMBER:F12101.0827
F12101.0827
BOUNDARY SURVEY2 rrr `"i`A!' p'stie
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SURVEYORS C C. tip ATION: POINTS OF INTEREST:
1.4'CHAIN LINK FENCE OVER 5'DRAINAGE AND UTILITY
D f•9Cy I hereby certify that this Survey of EASEMENT
'--(11' g$ �, described hereon was made under irec
7�,f•, t. F.eR supervision,and to the best of my
6132 and belief is a true and accurate talion
of said lands h in Cha pte Standards of through
.
Practice set forth in Chapter 5J-15.050 through
.B 5J-,5.053,Florida Administrative Code, ,EXACTA
I.i pursuant to section 472 027,Florida Statutes. . um's...rwauc Hxarta Land Surveyors.LtC
;\ ;i% This survey is not valid without the signature and L�e�
O.a� /4,- original raised seal of a Florida licensed surveyor o:866.736.19161 t.866.744.2682
A� BTATE OF 11940 Fairway Lakes Onlv.,Sulo 1 I Fort Myra,FL 33913
ass\ FLORIDA i and mapper,except when the electronic
\.1qy d./ signature and seal of a Florida licensed surveyor
!c s_. and mapper is affixed hereto. s: Florida Lan' AFFILIATE
RAYMOND J.SCHAEFER Title Association
Saw aHonda PM..o,e,Sumac.and Wow MEMBERS
LWaal nM
l U
DATE OF SURVEY:01/15/21
FIELD WORK DATE:1/12/2021
PAGE 2 OF 2 FOR LEGAL DESCRIPTION
PAGE 1 OF 2-NOT VALID WITHOUT ALL PAGES
REVISION DATE(S):(REV 1 1/15/2421)
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