1473 LINKSIDE DR DWAY22-0033 (2) sr:"--.'1'r 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
,__„,ii.).,)
'3,~ IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us��j
Job Address: l "C3 L 5iD . , t M3 it- 3"permit Number: l'Lk) ��- Z Z.--003333
Legal Description 01-1-3-3-a �i�V A- �\,) I t W 0,,c0.-- be . RE# /7 3 'C4 -]%00,')
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Valuation of Work(Replacement Cost)$ —k'-3 5° Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition DAlteration ❑Repair ❑Move Io ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial 01<dential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s)be removed in association with proposed project? EYes(must submit separate Tree Removal Permit) O
Descri�b!�jin,cdertail the type1of1wo�rk to be perf r d: N, ] C���
Florida Product Approval# for multiple products use product approval form
Property Owner Information 1^ ` _ \n
Name (` f' \� � _ il" 1 •NR,,� Address LY N►4r—ct r6 E c�N
City Pc 1 -, L L G C- State — Zip c - s.. , Phone
E-Mail (,I,�0CiQI�‘4et 3 G'0 ,,Cf`ik_
Owner or Agent(If Agent, Power o Attorney or Agency Letter Required)
Contractor Information
Name of omp ny T_ Qualifying Agent _
Address LIA (r r� City State Zip c.... ��i--
Office Phone c{U �p(pr —`�. Job Site Contact" cNumber O� —,,`Z�`
State Certification/R istration# OP I 0 . - E-Mail t1�.DSCk_ 10f-tlak;(`�
Architect Name&Phone# ` 1
Engineer's Name&Phone# PPc _
Workers Compensation Insurer . ,_.� _ _ OR Exempt❑ Expiration Date 0 /IAt (9.3
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 FINANCING, CONSULT WITH YOUR LEND ATTORNEY : FORE
RECORDING YOyji NOTICE OF COMMEN MENT.
(Signature of Owner orntnt) '•nature of C.ntracto
i s ed and sworn to ed)bef. e t .2 y of Signed a d sworn to or,affirm,-•)before me thi c 3 day of
2O2 . - by
:iAvd TON GINDLESPER ' 1110 e_ +�
, ignature of Nota },[t •f •• gtai
• r•� •t. MY COMMISSION#GG 353178 g ) :�• „�•, V) JENNIFER JOHNSTON
=i• •IYIf
4,.^` : :.".''!RES:October 6,2023 i:,. i MY COMMISSION#HH 057579
':C0 O ' sc,-,:. .;'; `.yn•PublicUndeiwilters �� $ EXPIRES:October 27,2024
---�-- �, • ` [ ]P onally Known OR '•f QF FLD••• O.._,_,TM, am -' N- �
[ ]Produced Identification - [produced Identification Bonded 1,a� rW�{v R,p,p111
Type of Identification: - Type of Identification: c/
-f,LAP i) REVOCABLE ENCROACHMENT AGREEMENT
**ALL INFORMATION
City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
At9
� IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and
existing under the laws W(7oftheState of Florida, hereinafter referred to as"CITY" and
.b \ E_ L..� O ,�t'R 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 asea - R.%, -t.
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 b CITY to USER,said notice to USER shall be given by certified mail,return
receipt requested,to the following address Ill 43 k- \c_ .S. ) le z3 i. 9.
• 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.
L-C,a_-Q ,-a r( C e tdQl Date S/ac
Property Owner/Agent(signed in presence of Notary Public) 7TT
STATE OF FLORIDA,COUNTY OF DUVAL '`� —� z
The foregoing instrument was acknowledged this 2� day of , 20L U,
by D-E/1(i. e LL( I�rie_ 1kJcy 1a r� ,who person y appeared before me and
(printed name of Signer)
acledged h she signed the instrument voluntarily for the purpose expressed in it.
9
fDepartment Approval:
o,V;::f4 TONI GINDLESPERGER
Signa ure of Notary Public,S of Flo )i.* .,a, MYCOMMISSION#GG 353178
: ,,-,
[ ] Personally Known -;-."��•'s EXPIRES:October 6,2023
[ ] Produced Identification(Type) `SOF•",p Bonded Thru Notary Public Underwriters
Scott Williams, Public Works Director
H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
MAP SHOWING BOUNDARY SURVEY OF
LOT 8/ BLOCK AS SHOWN ON MAP OF
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AS RECORDED IN PLAT BOOK 47 _ PAGES 8 OF THE CURRENT PUBLIC RECORDS OF DUVAL CO., FLA.
FOR. OENTEX //ONES earQaZQA T/O N
NOTE: BEARINGS SHOWN HEREON ARE BASED ON THE ABOVE MENTIONED PLAT. `- -- - --
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I HEREBY CERTIFY THAT THIS SURVEY. PERFORMED UNDER MY RESPONSIBLE DIRECTION, MEETS THE MINIMUM LEGEND:
TECHNICAL STANDARDS FOR LAND SURVEYORS IN ACCORDANCE WITH CHAPTER 21HH-6,FLA ADMINISTRATIVE CODE '
(PURSUANT TO SECTION 472.027.FLORIDA STATUTES).AND FURTHER CERTIFY THAT THERE ARE NO VISIBLE ENCROACH- •
CONCRETE MONUMENT
MENTS UPON THE SUBJECT PROPERTY EXCEPT AS SHOWN ON THIS SURVEY 1/Y FOUND IRON
O 1/2'SET IRON.L.B.1704
FLOOD CERTIFICATE: THE LOT SHOWN HEREON IS IN FLOOD SRI BUILDING RESTRICTION LINE
ZONE x ' AS SHOWN ON THE FLOOD INSURANCE RATE CLARSON AND ASSOCIATES, INC. CENTRAL ANGLE
R RADIUS
MAP. COMMUNITY PANEL No 120075- O41 D DA1ED 4-/7.69 1543 NALDO AVE. JACKSONVILLE, FLA 32207
A ARC DISTANCE
• //� `// CH CHORD DISTANCE
SURVEYED 41/6a5r 26 19 93 _ U. J7 P C POINT OF CURVATURE
/ '���fVV/{{V// ' P 7 POINT OF TANGENCY
SCALE:
/~a 20 .
ISTERED SURVEYOR NO 2Y6/, FLA P C POINT OF REVERSE CURVE
cIDJE ,1/4L L P C C POINT OF COMPOUND CURVE
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FIELD BOOK .5/0 PG. 4/A.. 11