737 TRITON RD RFNC22-0070 .,:':• �. Building Permit Application u,)dored,n,,,,,
City of Atlantic Beach Building Department **ALL INFORMATION
��f�� v 800 Seminole Road, Atlantic Beach, FL 32233
HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 7 3 121,-Tdl\ R.1 Permit Number: R ' ' C_ C..z-007
Legal Description O3%'Z 3 Rol Al. PASS V J 1 O2KS 00 2cE# 17 1 I-} I 0000
Valuation of Work(Replacement Cost)$ S000- Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repairr ❑Move ❑Demo ❑Pool ❑Window/Door
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• Use of existing/proposed structure(s): ❑Commercial L esidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ClNo
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) Q'No
Describe in detail the type of work to be performed:
M i )11.-_-- k Gt
Florida Product Approval# for multiple products use product approval form
Propert Owner Information
Name J.JK t`S.' L— Address 73 7 zRc-ccR..-
City
2
City ( -"Z`L• j -ci State J Zip 22-3 3 Phone D y/( ' 0.�
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
�+ /�` (/��
Name of Company COX-S7 L- k ' �1 L- Qualifying A:ent LSM. r A;s k•
Address 7 9.- (-9L-L N. D CityTA4 i State —r1/4. Zip ?2Z
Office Phone 9'Lk Lt(,5 423 .2- Job Site C ntact Number - 3 2
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State Certification/Registration# C CO S 240 Qgang E-Mail 13b 1 qp _ a'a- GGM
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer - OR Exempt Expiration Date 2 2 L 413
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 ' i-RYAN ATTORNEY BEFOR
RECOR? ING YOUR NOTICE OF COMMENCEMENT /� �
(Signature of Owner or Agent) (Sign. • ontractor)
Signed and sworn to(or affirmed)before me this(iay of S ned a d sworn toor affir ed •efore 9a of
JUk ,a-D' ,' ,by ,&ek N ewe ( l _ ZO2 b & • •Asa I2.y Q ,CL
J I '��� !4:!'!p�, TONI GINDL.- '- �tur:y� .
signature of Notary) . i pR" �-,
,: flh ':,: MY COMMISSION#GG 353178 4
, ., �` EXPIRES Octo..r---:,--,-
,�,�,Y e<, L `P €AAs otary Pu,l .tsrs VERGER
o e ANGELA V.SCARBOROUGH =�
[x}-Personally Known OR f;4.. NotaryI �'� ]y''. -' , - I
f Public-State of Florida Produced Identification ., ,GG 353178
[ ]Produced Identification Commission#GG 278185 [ ] P r :er 6,2023
of r .' T e of Identification:
Type of Identification: Yp
YP s j, . , ,,e•: tiu,ely Pubdc Underwriters
Fence Addendum Updated 1/14/2021
f----
_. City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233 PERMIT#
Phone: (904) 247-5826 Email: Building-Dept@coab.us REM- 21- OO2
Job Address: Date:
93n- -R1`wr.\ � -71 k I Z z
Property Type: Lot Type/ Features:
SResidential ❑ One Street frontage (interior lot)
❑ Commercial 1More than one street frontage (corner lot,through lot,
etc.)
❑ Swimming Pool
Fence Material: Fence Height (select all that apply):
❑ Wood ip Four Foot(4ft)
❑ Chain Link 74 Six Foot(6ft)
Vinyl ❑ Other
❑ 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)
14No
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
lik 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.
.-(r..:t�`i; REVOCABLE ENCROACHMENT AGREEMENT
�'t
���+,y City of Atlantic Beach HIGHLIGHTED IN GRAY
`� 800 Seminole Road,Atlantic Beach,FL 32233 **ALL INFORMATION
IS REQUIRED.
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
i3th. N F_Vjl,t, 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 PE k .- .
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to
relocation or removal on thirty(301 days' notice by CITY to USER,said notice to USER shall be given by certified mail,return
receipt requested,to the following address 737 ' V k--c Old\ Ron.0 A t , �L 3.7-33
• 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.
f-N------- -------
Date Jo ti) ►at�a-a
Property Owner/Agent(signed in presence of Notary Public) J
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this 1. day of , 20 rZa ,
by 5e14 Aiel✓e I ` ,who personally appeared before me and
(printed name of Signer)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
v • Department Approval:
Signat b• of Notary Public,State Florid• ,tax"uB... ANGELA V.SCARBOROUGH
''g' �':' Notary Public-State of Florida
kr Personally Known ,:a
�• <_ Commission i GG 278185
[ j Produced Identification (Type) 'Pr' My Comm.Expires Mar 14,2023 . Scott Williams, Public Works Director
H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
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AS RECORDED IN PLAT BOOK 31, PAGE(S) 16,16A,168,16C AND 16D OF THE CURRENT
PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
BENJAMIN NEWELL AND CORRINE VOIGHT,
OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY,
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GIBRALTAR TITLE SERVICES, LLC AND
WHITNEY BANK DBA HANCOCK BANK
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TRITON ROAD
(6.0'R/WJ vamaresemarausnik'',1.5 CURB&GUTTER
FLOOD 2CNE"X"-AREAS OETERMINED TO BE OUTSIDE THE 0.25 ANNUAL CHANCE FLOOD PLAN/FLOOD DOVE"X(SHADED)"-AREAS OF 0.25 ANNUAL CHANCE FL000: AREAS OF IS ANNUAL
CHANCE BATH AVERAGE DEPTHS OF LESS THAN I FOOT OR NTH DRAINAGE AREAS LESS MAN I SWME PALE; AND AREAS PROTECTED BY LEVEES FROM 1S ANNUAL CHANCE FLOCO.
V E Y GENERAL NOTES:
A S 1.BEARINGS ARf BASED OV PLAT B00%31, PAGE IOC
J 2.STRUCTURE NO 737 SHOVM HEREON UES NTR01 8000 ZORE�S BEST DETERIAND
GJ FROI F.E.A.FLODO NAPS PANEL NO.408 DATED 06/03/2013 ASSOCIATED SURVEYORS INC. „�; �„�;„D/CRa MENTALLYEXTENT CC
UNDERGROUND
°ne AREAS IFµY°`,NOT LOCATEDB° 5
/, LAND & ENGINEERING SURVEYS 5.TMS SURIES RASED ON LEGAL DESCRIPTIONS FURNISHED. THE PUBLIC RECORDS WERE
Lu% NOT SEARCHED BY THIS SUR'.EYOR FOR EASEMENTS.DILE,COVENANTS.B.R.L'S
R- 3846 BLANDING BOULEVARD RESTRICTIONS,CLOSURES,THONGS CR ORDINANCES.ETC.
JACKSONVILLE, FLORIDA 32210 6.THE HEAW UNE SHOWN HEREON.MAY NOT REIGATE ACTUAL OWNERSHP.
7.UNLESS OTHERNSE STATED ALL IRON PIPES FOUND HAVE NO IDENTIFICATION.
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904-771-6468AC AIR CERDIT MINER/J j E BST BUILDING RESTRICTION LINE PSN =PROFESSIONAL SURVEYOR I MAPPER
O S 3 V RTIFICATE OF AUTHORIZATION NO. LB 0005488 G NATN BUILDINnicEN R =RADIUS
(C) -COMPUTED FROM RECORD (R) =RECORD
E CAR COVENANTS L RESTRICTIONS RLS =REGISTERED LAND SURVEYOR
HEREBY CERTIFY THIS SURVEY WAS DONE UNDER MY N (R/TYFI -RIGHT
VAY
DIRECT SUPERVISION AND MEETS THE MINIMUM TECHNICAL D CIJIC CANCONCRETE D 0 SET RON PIPE OR WEAR
STANDARDS FOR LAND SURVEYING PURSUANT TO CHAPTER 5J-17.050 COVI) COVEREDEli 'ASSOC AIRY CR L.A.5488
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THROUGH 7.052, FLORA AD INISTRA CODE CHAPTER 472, F.S. ELECTRIC DEN
TRANSFORMER I PAD W POUND IRON PIPE OR PN (IP)
B EJFA ELECTRICH ELECTRIC AUTHORITY ma.i. - -FOUND CCCROSS WTMOR°R41 HOLE
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B LB LICENSED BUSINESS NAIL k GCC
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CH LE B. HAT H- FLORIDA RTIFICATE NO. 3771 V ORB OFFICIAL RECORDS Bon( HMON°n° FENCE
( IRA OFFICIO.RECORDS ASLUNE cu-ora-cu-cu's ct
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CH RLES L. STARL G FLORIDA CERTIFICATE NO. 4579 A PC POINT OF CURVE EIRE HYDRANT
RAYMOND J. SCHA FER FLORIDA CERTIFICATE NO. 6132 1 PEE POINT OF GD PD tD CURVE flRO4 MASER
1 PER PDQ EQUIPMENT PAD RATER METER
PI POINT OF INTERSECTION
JOB NO. 68548 DATE 01/09/2017 0 FLARE POINT DF REVERSE"VE 0 un°P�
PRM POINT[F REFERENCE IONU.ENT _
SCALE: 1" = 20' DRAFTER ECA S PT POINT IF TANGENCY GUY ANCHOR
PLS PROFESSIONAL LAND SURVEYOR �' • CENTRAL ANGLE
NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA UCENSED SURVEYOR AND MAPPER