500 NAUTICAL BLVD RFNC22-0040 revision 5-2-22 Revision Request/Correction to Comments **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: � j\DC2
C904 0
❑ Revision to Issued Permit OR Corrections to Comments Date: `-r /29 / Z
Project Address: r)C> c04teCIL ( I _
Contractor/Contact Name: (—'U Y 1 E 1
Contact Phone: Zq 4 `1 439 Email:
Description of Propo(seedd Revision/Corrections:
c) 0 _ poL.De_rtAmor-
affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• Will proposed revision/corrections add additional square footage to original submittal?
❑No ❑ Yes (additional s.f.to be added:
• Will proposed revision/corrections add additional increase in building value to original submittal?
❑No ❑*Yes (additional increase in building value: $ ) (Contractor must sign if increase in valuation)
*Signature of Contractor/Agent:
(Office Use Only)
Approved ❑ Denied E Not Applicable to Department Permit Fee Due $
Revision/Plan Review Comments
Department Review Required:
Building
Planning& Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services Updated 10/17/18
r` "6 Building Permit Application Updated 10/9/18
p1
City of Atlantic Beach Building Department **ALL INFORMATION
'Ji 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
';" IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 00 . • . _ 1 _ 1 G e A. I ` Permit Number:
Legal Description IV VI 60 0 \LfG,e..Li s1- " '(__e_ i RE# 1 70 7 0 3 - 0 366
Valuation of Wor (Replacement Cost)$ % G Q Heated/Cooled SF Non-Heated/Coole
� 3 C- l0 `-- 1 -7— 2 —(; �'-- t .Sem rG La /- 1/ /5/1-{• Class of Work: KNew ❑Addition ❑Alteration ❑Repair ❑ ve Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial VResidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s)be removed in association with proposed proiect? EYes(must submit separate Tree Removal Permit) 0 N
Describe in detail the type of work to be performed:
P\Gc� 5 \ 04 V{ U.5aee9 Pv t yr c_o Co
Florida Product Approval# for multiple products use product approval form
Property Owner Information ��' 9 / �/�1 /
Name 1 aVY1n.(4 Y 5 -elf- Address E�(.9(_) Akix.4)1 rrV '3l i)o JV
City A --\ .0 , a.' . . .A State Zip 3 2z 33 Phone 01 L(./ 2 q�/L/`/J 9
E-Mail 1 \na,('pc4eir. RA) i'tl ci,n , . COWL
Owner or Agent(If Ag nt, Power of Attorney Agency Letter Required)
Contractor Information p c _
Name of Company FCn�,.tcv 404 J0 1 /f'I Qualifying Agent r
Address `63 01 )03 rd.( 3-4- '3 61 4 ityCk State •t- f Zip 3224 0
Office Phone got 1---) I —0�1 \ Job Site Contact Number
State Certification/Registration# E-Mail -cC.t .0S SVl S Z. l,� CEJ)-y-\
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 OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RE ORDING YOUR NCE�OI F COMMENCEMENT.
(Signa lee of Owner or Aent) (Signature of Contracto
Sioacd and sworn to(or affi es before met•' 2- •ay ofJ ,,SiS ned and sworn to(or affirmed •efore me this day of
A, Z1 by 4 J►_W • t 0 TCS , , by
WISIMBIlk
_....7-019 ..........._�� (Signature of Notary)
. ii ,; TONI GIND __PERGER
g• ''`•,; MY COMMISSIM•GG 353178
[ ]Personally Known OR �: 'I" = Y
,�•o; EXPIRES:October 6, 0 verso :II Known OR
i4' Bonded Thru Notary Public U •-'j.,;(; (.•d Identification
[ ]Produced Identification ( oFF�,:
Type of Identification: ype of Identification:
/t'-7'i ;,, REVOCABLE ENCROACHMENT AGREEMENT
ip, City of Atlantic Beach **ALL INFORMATION
5 800 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
existi under the laws of thState of Florida, hereinafter referred to as "CITY" and
Q Vr Q,�( QS`}fJl of Atlantic Beach, Florida, hereinafter
referred to as "USER". I i
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 k—F-A-1 C__C2. WOO 0)‘ .
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 IIT•�Y�ttoR,said notice to USE shall be giveK7 cep If' mail,return
receipt requested,to the following address �W )�X.,f` kI\c I 3 L:Z
• 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.
,l/-1 Date '79 -
Property Owner/Agent(j):ned in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL �� 7-) i , �
The foregoing instrument was acknowledged this day of �r(- , 20 /_-/ _
by . as (Ws al , 01 il; A ,who personally appeared before me and
ack .inted name of .igner)
edgers P - he signed the instrument voluntarily for the purpose expressed in it.
..............
TONI GINDLESPERGER
Department Approval:
roval:
Signature of Notary Public,State o lorida ---.°=:•• ,,u MY COMMISSION IOPJ#GG 353178
ter.•0: EXPIRES:October 6,2023
1J.
[ ] Personally Known .'-FOF,?\-°d Bonded Thru Notary Public Underwriters
[ ] Produced Identification(Type) L , ,(..._ Scott Williams, Public Works Director
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
MAP SHOWING BOUNDARY
LOT II, BLOCK 3, SEASPRAY, AS RECORDED IN PLAT SURVEY 35PAGES 4 AND 64A,
OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY,
6
FLORIDA.
CERTIFIED TO:
SUNTRUS BAF. ANDN TM FL ARPSTER
STEWART TITLE GUT. ARANTRAN
.
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Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
'I City of Atlantic Beach Building Department GRAY IS REQUIRED.
I: i
2, 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES
OWNER/ BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED
FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU, AS THE OWNER
OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A
LICENSE.
YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF.
YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY
ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS.
THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE
CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH
IS IN VIOLATION OF THIS EXEMPTION.
YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS.
IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES
REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT
SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. .
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING
TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT
TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US ) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: cbv Jt C1,tl+ er I e' 8 , vol AA-1-164►'l41 (' 6ea ii -F 1
Owner Name: tOl \\airy) A \C&v-v � Wei ►r'p -ei Phone Number: goy 29 1.--N3q
Mailing Address: caa /rad )31 OJAI City: 1 6 State: F ( Zip: 322_3-3
Notarized Signature of Owner '"T 5 n
The oregoing i trument was acknowledged before?ne this Z- day of ' 1 1 , 20Z tin the State of Florida, County
of
A. /
Signature of Notary Public-��_ Q-- ' S.---CA/ ----.
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: �---
r'�"`" '=?-1.°"---1L Updated 10/24/18
� :' ,,, TONI GINDLESPERGER
' `. MY COMMISSION#GG 353178
'•` _ .d; EXPIRES:October 6,2023
',F'oFg.60'' Bonded Thru Notary Public Underwriters
C'!r.4 , Fence A en u111 Updated1/14/2021
tCity of Atlantic Beach Building Department
800 Seminole Road Atlantic Beach FL 32233
on��r PERMIT#
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
1J taA126,4f2.c1CJAJ R'f 3 .) U --Z9 - 2Z
Property Type: Lot Type/ Features:
g(Residential 0 One Street frontage(interior lot)
O Commercial tc1 More than one street frontage (corner lot,through lot,
etc.)
KJ Swimming Pool
Fence Material: Fence Height (select all that apply):
Wood 0 Four Foot(4ft)
❑ Chain Link 10,Six Foot(6ft)
❑ Vinyl 0 Other
O Block/Stone (Plan details required for footings and/or
retaining walls)
❑ 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)
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.
NOTICE OF COMMENCEMENT
State of c\DY' \Cl G • Tax Folio No. 1 7 0 7 0 3 —03 G63.
County of D ll,vG(_Jt
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713
of the Florida Statutes,the following information 0
i54t din this NOTICE OF COMMENCE E r�
Legal Description of property being improved:Y G �l i 7— c7 '�
3e y1 r0- r Last- It da< 3Al [ f
Address of property being improved: 5l` ' A/CL,c.•4 %C cti ! V c) A 441 Q n'fj G gee t + 13Z'
General description of improvements: 6_, O'71 2 .S f Cb.0 L)to / i '
.�
� � � Q ltd i—/ j
Owner: al /L. . a . Address: EE1 00...0. (°J6kf \ /(-- AN6
Owner's interest in site of the improvement: P 1(\ nil ft..\ `-es\A 2 v'\r P 3223-
Fee Simple Titleholder(if other than owner):
Name:
Contractor: CC A,4} .•QSc,r ok,v�nt YN ce/ \c_x r-.1 Ct
Address:
Telephone No.: Fax No:
Surety(if any)
Address: Amount of Bond$ _
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may
be served:Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b), Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year fro • • - .•. •• • - - •'• - -• date is
specified): -.;, YPV 2 • TONI GINDLESPERGER
> ;t: a. ;,,; MY COMMISSION#GG 353178
wii
THIS SPACE FOR RECORDER'S USE ONLY OWNS gip,`.-` EXPIRES:October 6,2023
OCF;°‘ :•ndedThruNotary Pu,is nderw
Signed. Pate:
Doc#2022110797,OR BK 20249 Page 1839, Before me this Z`It da f %mei i 10 2.Zn the County of Duval,State
Number Pages:1 Of Florida,has personally appear 0 Q '• i, 1 ' a,(`c5-4-(ir
Recorded 04/29/2022 01:56 PM, Notary Public at Large,State of Fl• ida,Count of .
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL My commission expires:
CROECORDING $10.00UNTY Personally Known: or
Produced Identification: D.l._. .