1875 HICKORY LN RFNC22-0023 e-/%,...
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
moo,_I�/ IS REQUIRED.
ii Phone{{: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: I�-1_5- tt\ XL ( L /J Permit Number: 'fme...mZ C ooZ 2 J
Legal Description $7-Z' oq-ZS-Z1C-Stc✓A✓vMINA I/"i1 2-C, e i'.if L.pr ILI RE# 171010 - IyR)
Valuation of Work(Replacement/ Cost) $ �p70j Heated/Cooled SF Non-Heated/Cooled
• Class of Work: Z1 ew Addition Alteration ERepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial 211-esidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes INo
• Will tree(s) be removed in association with proposed project? ❑Yes (must submit separate Tree Removal Permit) 2190
Describe in detail the type of work to be performed: 6 'TA t_v FC NGS 6w 4S) `-U G C ) N 5.1', i-t--L,›
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name{7-03EQT 4- In T&.41.► few.:-` Address i 3-'75 N tc-fr4...9zi LN
City LA's i k_(„ L44- State FL- Zip 32L33 Phone 33-Z, Z(vZ- a71/443-
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company 4E5 F,`n4- DcCK+PERG-oZA Qualifying Agent h: "") 'P',72-0 Li 4‘-j '
Address 9.1P-1 /Vl,4Z-c�I(G nPSS De- Art_City - I!c� 6 .. - Z�
-4 State Zip 32
Office Phone q04 5738- `35-", Job Site Contact Number
State Certification/Registration 44 E-Mail .3EA0+G S 7=-D (' )6- /22 A' L . L,,-fr.--1
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer 4/m7'�J5 r' OR Exempt ❑ Expiration Date 1/r/Z 3
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 FINANCI G, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RE I ' 9 ING YOUR ilp ICE OF COMMENCEMENT. �J
7 XA 1.14 h./vM r
/ (Signature of Owner or Agent) (Signature of Contractor)
Melon 'Wi Le, $$'-&1/ n (-61^EeAmt, r)•<-Signed a sworn to (or affirmed) before me this 3 day of Signed and sworn to or affirmed)before me this 3 day of
MA/CA/ , Ada, b - ; • / r AlCrr�'l ,�v •
��_ - 75e_SslcglA .(Sud 2'
• - • , � ' (Signature of Notary
49401Neis Notary Pubilc State of Florida • •
• Jessica A Dolquist
' My Commission HH 142217.,4
Notary Publ'�c State of Florida
[ i Personally Known OR I Expires 06/1412025 [ 1 Personally Known OR +p Jessica A poiquist
'tow My Comm!ssion HH 142217
[ ] Produced Identificati•�J [ I Produced Identification / Expires 06/14/2025
Type of Identification: Type of Identification: �~
.i it REVOCABLE ENCROACHMENT AGREEMENT
4' t
City of Atlantic Beach **ALL INFORMATION
,r 800 Seminole Road,Atlantic Beach,FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
;sig-'
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
P06e4 i T gxL E 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 eif}Ck' iP.0 FEAUC .
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 1 g 7 r ttu..KowtY 6N,rlTt.itA)1lc, h&eyst f t FL ;z2 33
• 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.
i2Obegf Pt kk a Date $(4S 42-
Property Owner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this day of 1./IGtrch , 20 LZ. ,
by Mein°...c-
by
F
by bec-4-RI Ge. ,who personally appeared before me ani!" ' �-"e"``—
(printed name of Signer)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
��+ ro00Poe DONNA A MILLER
d:/f ci — , ;;* Commisslon GG 318151
, .�l, Department Approval:
Expires July 29,2023
Signature of NotaryPublic,State of Florida qr Paof FoBonded
Dry Budget Notary Servtoes
Personally 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
#E4ri- Fence Addendum Updated1/14/2021
r
ff City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233 PERMIT#
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
1375- 14 is eay L, 313 /
r N �z
Property Type: Lot Type/ Features:
Residential ja'One Street frontage (interior lot)
❑ Commercial ❑ More than one street frontage (corner lot, through lot,
etc.)
❑ Swimming Pool
Fence Material: Fence Height (select all that apply):
Wood ❑ Four Foot (4ft)
❑ Chain Link 12f Six Foot (6ft)
❑ Vinyl E Other
❑ Block/Stone (Plan details required for footings and/or
retaining walls)
E Other
Fence Location:
Please submit an accurate and current boundary survey showing all existing improvements (including building footprint,
driveway, swimming pool, etc.) and location of fence/wall and any gates. Plan details required for block wall footings and/or
retaining walls and any portion or fencing above 6ft in height.
Will the fence be built in an easement?
?Yes (must submit separate Revocable Encroachment Agreement)
❑ No
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
9 No
Conditions of Approval:
• Roll off container company must be on City approved list. Roll off container cannot be placed on City right-of-way.
• All old fencing and debris must be removed from job site by contractor or homeowner.
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.
■
MAP SHOWING BOUNDARY SURVEY OF
LOT 14, SELVA MARINA UNIT NO. 12—C REPLAT,
AS RECORDED IN PLAT BOOK 37, PAGE 29, OF THE
CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
t ROBERT W. PRICE, ,JR. AND MEGAN L. PRICE
ROBERT W.PRICE, A/K/A ROBERT W.PRICE, SR. AND BARBARA F. PRICE
BANK OF AMERICA. N.A.
OSBORNE AND SHEFFIELD TITLE SERVICES, LLC
N.
FIRST AMERICAN TITLE INSURANCE COMPANY
TALC wcroF0 ) 179
SELVA MARINA UNIT 12-8 1
PLAT BOOK 36. PAS 64 tk,
LOT 14
1
N 89'35'07" E 100. 0' (PLAT)
N 89'35'07" E 99.7 (MEASURED)
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S 88'56'45" W 99.86' (MEASURED)
as S 89'35'07" W 100.00' (PLAT) LOT 10
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LEGEND_ DALE LANE
—2— =WOOD FENCE (60' PRIVATE RICHT OF WAY)
T j..2..) = CONCRETE
07 - SET 1/2"REBAR STAMPED P9M#6146
• = FOUND 1/2"IRON PIPE NO IDENTIFICATION
(UNLESS OTHERWISE NOTED)
.,-L.4-CONCRETE MONUMENT PC = POINT OF CURVATURE PRC = POINT OF REVERSE CURVATURE
4/C AIR CONDITIONER PT = POINT OF TANGENCY PCC = POINT OF COMPOUND CURVATURE
REVISIONS
1. 3EAR:WGS APE BASED ON THE __ PEAT___ BEARING OF __N_$3'35'0_E___ ALONG THE
NORTHERLY BOUNDARY LINE OF SUBJECT PARCEL. DATE DESCRIPTION
2. DV GRAPHIC PLOTTING ONLY THE CAPTIONED LANDS LIE WITHIN FLOOD ZONE Y_" _, AS SHOWN ON THE
NATIONAL FLOOD INSURANCE MAP DATED NOVEMBER 02, 2018, COMMUNITY NUMBER 120077, PANEL _0_497-1—
3. THIS SURVEY REFLECTS ALL EASEMENTS Ac RIGHTS OF WAY AS PER RECORDED PLAT b./OR TITLE COMMITMENT OR
OTHER DOCUMENTS PROVIDED BY CLIENT, IF SUPPLIED. UNLESS OTHERWISE STATED, NO OTHER TITLE VERIFICATION
HAS BEEN PERFORMED BY THE. UNDERSIGNED.