408 IREX RD DWAY22-0014 Yoh- �', Building Permit Application updated 10/9/18
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• Y 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
408 IREX RD ATLANTIC BEACH FL 32233 ��{�LI ZZ - C5�'j14
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Job Address: I Permit
Number. 1
Legal Description Ou CL,[ pct`.61 S( �ry. t Z\ I Lbk• Z 1 K l (, RE# f 7 1 44 lot - 0000
Valuation of Work(Replacement Cost) S i r)/00 CD Heated/Cooled SF Non- Heated/Cooled
• Class of Work: . New :Addition DAlteration i =Repair Move [Memo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• If an existing structure, is a fire sprinkler system installed?: L.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:
REMOVE CONCRETE DRIVEWAY & REPLACE WITH PAVERS
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name RALPH ISLEY Address 408 IREX RD
City AI LANTIC BEACH State l-L Zip '2,211 Phone (904)246-2997
E Mail RISLEYJRL#AOL.COM
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Earthscapes Design Build Qualifying Agent Michael Serig
Address_151 College Drive,Orange Park FL 32065 _City State Zip
Office Phone_904.620.0626 Job Site Contact Number _904.620.0626
State Certification/Registration # E-Mail mike@earthscapes.earth
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer_ _ OR Exempt o 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
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
RECORDINy N9VCE OF COMMENCEMENT. t ^�`
(Signature ofOwnef or Agent) l (Signature of Contractor)
ST
Signed and sworn to(or affirmed)before me this a day of Signed and sworn to(or affirmed) before me this ( day of
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✓" OLUBUNMII.EYIMU
COLLEEN HICKEY '•.
•• • = MY COMMISSION#HH 203374 `•' ••• Commission HH 182228
.f• •f1 7 p Expires October 6,225
P rsonally Known iR " = Personally Known OR !ro;`or•
ff r,•o: EXPIRES:November 30,2025 Banded Thu Troy Fein Insura..;e R045.7010
N.I roduced Identification "••',o':F:O Bonded Tin Notary Public Underwriters Produced Identification
Type of Identification: I'r1 oe of Identification: L (- t /✓c;•-- 5 t r`{Ct
1=�'''� ,. REVOCABLE ENCROACHMENT AGREEMENT
4\ **ALL INFORMATION
City of Atlantic Beach
%� 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
/� IS REQUIRED.
\.moi g9%
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
RALPH ISLEY 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 REMOVAL OF CONCRETE DRIVEWAY&REPLACED WITH PAVERS
Any facility maintained, repaired, erected, and/or installed 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 aos IREX RD,ATLANTIC BEACH,FL 32233R
• 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 assumed by the USER.
'4.P4(/ �^ Date 1\1 c,rcih D 40 d
Property OwnerrfAgent(signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this day of P*w--C\ , 20 'a -)-
by 1 P Lei) S LI / ,who personally appeared before me and
(printed name of Signer)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
,,.0':':',;,, ,.. COLLEEN HICKEY
1 \ J�
L �i i., ,, MY COMMISSION#HH 203374 Department Approval:
< . EXPIRES:November 30,2025
Signature of Notary Public, State of Florida ''Z fr:f:?P,; Bonded rnruNotary Public Underwriters
( I Personally Known
,Produced Identification(Type) \T \sr— LI(. (,\ ,___ Scott Williams, Public Works Director
H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
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ALL AMERICAN SURVEYORS, INC.
LAND SLOVEYARS - 84J1 BAYNEADONS NAY - JACKSONVILLE, FLORIDA, 32215 - 904/731-0722
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