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1912 Oak Circle DWAY22-0042 ,-1'.'''''.), 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 ▪ JL• '19r Phti Oa (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED. Job Address: '1- V C,r Permit Number: E ' Z Z—004Z Legal Description 3C H (`i--Ls-IAe Se hid,e( U pis1 114 1e fJJ RE# I -77.02v-- 12sy Valuation of Work(Replacement Cost)$ " 1 �0 Heated/Cooled SF Non-Heated/Cooled • Class of Work: ❑New ❑AdditioAlteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial veResidential • If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No • Will tree(s) be removed in association with proposed prosect? ❑Yes(must submit separate Tree Removal Permit) fico Describe in detail the type of work to be performed: PI telatc (.,9- ,u k [ 4- LN )dt.,. , tj/r k Pv -' c Florida Product Approval# for multiple products use product approval form Property Owner Information/ r Name �!� t-DDk Address I q FL OGii- Qa'( . City 4 State f L Zip 3Zi 3 Phone E-Mail Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information �/- �� Name of Company X46/� f Qualifying Agent Vat k 49<// Address l��jpopp�,- /d City .40 State P Zip 3LL; 3 Office Phone QO ti r* 37't. 7tt(! Job Site Contact Number )441h k-i1th fog 3 11 /ebb' State Certification/Registration# E-Mail ,/14 At ftl///# i • toss-, Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Insurer irv"trbJ,S1— OR Exempt❑ Expiration Date Sf'_D/Z Z 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 RECO: i- ► . YOUR N•TICE OF COMMENCEMENT. 44•7 -../..-. `a!--- i .01i i1.4 il► ill (Signature of 9wa or9goaE)6,,4„ •gnature of C-emFaetor)--Qb/^tf Sined and sworn to(or a rme,)before me this 2 day of Si d a1nd sworn to(f r a irme• •efore me_thh': -.ay of L £4t�- X21— • ' `.i:._ Ara i, 1 `��, ZO z b ,...\...a..... ®v T� ,...ver,� .tu, .ry) + gnat eo rotary) ak TONI GINDLESPERc ,� nv,i,, TOlvl GINDLESPERGER '1}-Rersonally Known O1 M' C-L---SIGN#GG 3 ' 78 [ I Personally Known OR - MY COMMISSION#GG 353178 [ ]Produced Identification EXPIRES:October 6,2023 [ I Produced Identification, , :x EXPIRES:October 6,2023 c,r=.ded Thru Notary Public Urderxn.ters F��, Type of Identification: ___ _ Type of Identification: , —Sended ihru Notary Public Underwriters NOTICE OF COMMENCEMENT State of torld4 Tax Folio No. 17ZeZa "-" S ti County of DO OA 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 is s ated/in this NOTICE OF COMMENCEMENT._ �/y� Legal Description of property being improved: 3(f �t 1/ 04 - Z5- 14 E ✓'-/ "/44 ( Ute. Address of property being improved: 111 Z OAr rd?, n General description of improvements: N pJI eL , v GtJ r/V.[i.J..._ i/ JA✓ecf Owner: Cop IL Address: 'fa ©ILK 34275 Owner's interest in site of the improvement: _ Fee Simple Titleholder(if other than oowner): \/� _ Name: gelict,,,,; . IVvrContractor: ��yy,, L Address: la /�l p�f �ppf/� �/A 2 izzFy Telephone No.: goy 311 7i26 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 from „_etc ..pTrecof� �;�gp�gg@tkrent "ate is specified): �•''n• . •I .•, MY COMMISSION#GG 353178 1? 'ire ... "•���ro,= EXPIRES:October 6,2023 THIS SPACE FOR RECORDER'S USE ONLY OWNER l� ,+.FOFf`OP BondedThruNotary Public Unde ers .44( o2��gned: � '� /•� �� Date: i r Doc#2022201502,OR BK 20383 Page 1707, !fore me his day of 7 0 2 tin the Coun of'uv I,State Number Pages: 1 Florida,has personallyappeared ('l0(Y1ctS LIG d Recorded 08/02/2022 03:37 PM, )tary Public at Large,State o flori ount D val. JODY PHILLIPS CLERK CIRCUIT COURT DUVAL commission expires: COUNTY rsonally Known: �— or RECORDING $10.00 3duced Identification: L ),;,_, REVOCABLE ENCROACHMENT AGREEMENT r **ALL INFORMATION t/-/ •'‘ City of Atlantic Beach HIGHLIGHTED IN GRAY r: I'1 800 Seminole Road,Atlantic Beach,FL 32233 IS REQUIRED. ''Jif19: 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 the" (00 k 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 . riv /1.LL/k)fdfr. i✓/ /%V Any facility maintained, repaired, erected, and/ I stalled 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 M i Z £'4L G'rltz_ • 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 iabilitie e he -b assumed by the USER. fr11 Date 102/P2-- Prop rty Owner/ gent(signed in presence of Notary Public) STATE OF FLORIDA, COUNTY OF DUVAL The foregoing instrument was acknowledged this Z day of L—T1..3 ,20 �� by \ YNU/YlctS CcCD ,who personally appeared before me and inted name of Signer) ackn�dged t'. he/:. e Signe'the instrument voluntarily for the purpose expressed in it. `j os�wNyv1�c TONI GINDLESPERGER • I : : MY COMMISSION#GG 353178 Department Approval: * 1l° EXPIRES:October 6,2023 Signature of Notary Public,State of F • ida y, p?.= L I ''-Fp;;F;;°p Bonded Thru Notary Public Underelters [ ] Personally Known [ ] Produced Identification(Type) Scott Williams, Public Works Director H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18 -;1, RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION City of Atlantic Beach HIGHLIGHTED IN GRAY IS "' 800 Seminole Road, Atlantic Beach, FL 32233 REQUIRED. i PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job Address I 4tL 04A- (Aid t It Permit Number Contractor Information Vwfle� Company i'\Q/4f Q/It, �C Qualifying Agent JA6_ _ , Address 1Z 0 O1 ' keg) City ,41/4t pt/eat/I. State Zip 3zt53 Phone ?(,y 377— 74 i Email pi f? 1�r //,n I • CIM State Certification/Registration # Architect Phone Email Engineer Phone Email Workers Compensation InsurersTrvs* OR ExemptnExpiration Date 06/2z • Permittee declares that prior to filing this application they have ascertained the location of all existing utilities, both aerial and underground and the accurate locations are shown on the sketches. • Whenever necessary for the construction, repair,improvement, maintenance,safe and efficient operation,alteration or relocation of all,or any portion of said street or easement as determined by the Public Works Director,any or all said poles, wires, pipes,cables or other facilities and appurtenances authorized hereunder,shall be immediately removed from said street or easement or reset or relocated hereon as required by the Public Works Director and at the expense of the Permittee unless reimbursement is authorized. • All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the supervision of 4i giteff (Project Superintendent) with (Company Name) / 0-te4, Tit._ ' Phone 91V 177 /00e • All materials and equipment shall be subject to inspection by the Public Works Director. • All city property shall be restored to its original condition as far as practical, in keeping with City specifications and the manner satisfactory to the City. • A sketch of plans covering details of this installation,as well as a copy of a recent survey shall be made a part of this permit. Calculations showing any increase in impervious area on owner's lot or in the City right-of-way are to be included with this application. • The permittee shall commence actual construction in good faith within (/d days. If the beginning date is more than 60 days from date of permit approval then permittee must review the permit with the Public Works Director to make sure no changes have occurred in the area that would affect the permitted construction. • It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right, title and interest in the land to be entered upon and used by the holder,and the holder will, at all times,assume all risk of and indemnify,defend and save harmless the City of Atlantic Beach from and against any and all loss,damage and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. • k The Public orks p. ect'r shall be notified 24 hours prior to starting work and again immediately upo co pletion. , Permit a(signed in 1desence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL , The foregoing instrument was ac ledged this day of , 20 _ , by 0(Y\Ct L CJ C) �� ,who personally appeared before me and (printed name of Permittee) tprZenlealsevillaCafteanfaiimlilu ,�,, a kn.wle••ed that he he si sed he instrument voluntarily for the purpose expressed in it. --';(;:?(''''' ,"-- 11 TUidl GiNDLESPERGER r, :, MY COMMISSION#GG 353178 °;,_ice•: EXPIRES:October 6,2023 ill f fl F`�,_' BondedhruNo'.aryPub!icUnderwriters [ ] Personally Kh6 ""r `"' / - �' Signature of Notary Public,State of Florida [ ] Produced Identification(Types H:\Applications&Forms\Word Documents\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18 „ ,._„; p f” 1rj ::.4'.7_ '\'-2\‘ CITY OF ATLANTIC BEACH A sir)) 800 SEMINOLE ROAD J ,. <,--- ATLANTIC BEACH, FL 32233 '�1 o ilWr (904) 247-5800 SURVEY AGREEMENT NOTICE All new projects creating more than 250 Square Feet of impervious surface or requiring on-site storm water retention, including swimming pools, will require pre-construction and post-construction topographic surveys, as required by COAB, Section 24-66 and described in Bulletin 2-18, Surveys. The surveys must be new original documents, from a licensed surveyor, signed, sealed, and dated. Other small projects, such as fences and construction less than 250 SF,will not require a new topographical survey, but a current original-size survey with all relevant details is still needed. These surveys, when included as part of a building permit application, must be complete, up-to-date, and original size and scale, as produced by the surveyor. Copies of old surveys lacking details or copies not of original size cannot be accepted. Building permit applications with unacceptable surveys cannot be reviewed and the application will be returned to the applicant. Thank you for your cooperation in this matter. AGREEMENT I have read and understand the Notice above and affirm that the outdated survey I am submitting is still accurate and complete, and all structures and impervious surfaces on the property are shown on the survey. I further understand that, if the survey is found to be inaccurate or incomplete, a $50.00 Plan Resubmittal Fee will be charged; or if the permit has been issued, a Stop Work Order will be posted with the associated $110.00 Fee. JOB ADDRESS l g'Z ci v G((6._ OWNER or CO TRACTOR (Print) (?,M (Cc k- pSi nature (14*.c" gDate 3/ /2-d-- 1 1 I 3/4• w-- /+/r m CERTIFIED TO: �n o a SUeaN40N eavf�our. uwE Lo+ I Y/ ZD O s ilz S.2.0, ' A. ANDREW McALEXANDER, FIRST AMERICAN TITLE INSURANCE COMPANY, ((�� �1 MERRILL LYNCH CREDIT CORPORATION AND I10v�i GI .. ( ,.1- 1, �i5� �-Y WATSON 6 OSBORNE, P.A. NI KSQ— khk Bow s s S ,ic+c. i'tk ) l so• So PaNie_6 7, 1 a. E; `'4r 0 - 0 o Fo`o\ fps���'� Pool �l rv7� -I S U a isi,n ? q r (------,NO_ ` �....,„0...... 'oma %�o\o�J i.^ ?b01 ()Tali o �, '/ / ``�` �o j �o o `j O a o f. - --- LiIL.S _ i F- r , I • °'�.e k1 --.N:): ' 1" _ CL • z0 ' _ :\--fON 0 i--- 1 jill(1 ""'J / \‘‘ zMAII6114's**,,zarirz."-"Aiwitiir -- / '! 7:3 „„....-,---- rauWO 1 2 STORY art INI i_0T i l � _ •_ As. FRAME & STONE ii RESDENCE •a ' ? �. : a • •.c., u + •••••OaN[ a1N o NO. 1912 / all �a. �•� CO 4 Z. so a' 7i, / 3 J aQ a'-�e _o��-ate -\ �4C 7uk) t3. m4. Q_ 1 P r th—n o ..p. >2. Q7 m 4 am' 5r� 1 e Qom_J • \ ; !n y) ° 0 tal - Ne.) fe.' 6420---Fift ,.., ,,, rr • S Ill89.35'07" , 141.70'(R) s q 1 S 89.36' 4 VI, 147 76.(141 • b. i aRI JON av,h Rei C'/ �o w { p �jr�� S d `), / 1 S 6, ct o 20 10 0 20 4-1„, -_-, SCZE IN FEETPi ,\ 1' - 20• •/7- IP T i r.--77%r77777->„„ I.BEAFRINGS ARE BASED aOi1lAL MOKi�P. ' Jo,Pi.a EH. '1 ;f%/•,s\ 2.STRUCTURE NC. �_ SKR& HEREON LIES*THINm ft0ZONE .JL_ AS BEST DETERMINED MOW FI-Y.A. ROCI) MAPS PANEL NO. _ 1 DATED WW1= ASSOCIATED SURVEYORS INC. 3 'HIS TSA SURFACE SURVEY ONLY. THE EXTENT OF UNDERfiROuNO FOOTINGS, Q P,PES AHD UTILITIES. IF ANY, NOT DETERMINED. La i'-',/•'///0 ` /� "i', ..h,! LAND * ENGINEERING SUffYfYS 4 XIIISDICTIO/AL AND/OR ENVIRONMENTALLY SENSITIVE AREAS IF ANY, NOT LOCATED /. •'^% P 0 BOX .5412011 BY THIS SURVEY. % 5915 CEDAR H+LLS BOULEVARD 5.THIS SURVEY PAS BASED ON LEGAL DESCRIPTIONS FURNISHED AND THE • ' , -, .lACKSONNI LE, FLORIDA 32210 DUBUC RECORDS METE NOT SEARO(D BY TNS SURIEYCA FOR EASEMENTS TITLES, %` WA ' 904-771-64-68 CONVENANTS OR RESTRICTIONS THAT Y AFFECT THIS PARCEL. 'J O • CERTIFICATE Of AUTHORIZATION NO. LB 0005488 6 UNLESS OTHERMSE STATED ALL IRON PIPES FOUND HAVE NO 10ENTTRCA7 N '— S s Y I 7.NOT VALA MTHOUT THE SIGNAIIIIK AND THE ORIGINAL RAISED SEAL OF A ROMA UONSED SUIreff0R AND WPM