726 VECUNA RD DWAY22-0043 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
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 7 V e„conA 8d Permit Number: (A3 f\K 2 Z-Vo 21--
Legal Description 314 it-t5-14f je.).i1I1af o,,,�Z4 bol 8ek- 15 RE# 111?5q --DOep
Valuation of Work(Replacement Cost)$ / 0] 00 0 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑NewCer dditior) i4lteration DRepair DMove DDemo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) o
Describe in detail the type of work to be performed:
VAce, / a- eive,cr
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name (ktwj MIAlli>°O-rnS ddress 7 L ee( % L!/t-
City j'L(f VLt u gil State_FL_Zip 3223, Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information L. 7-f-,-,
I/ t�
Name of Company 1 ,tail Yr . t Qualifyin Agent 1 Xeif i
Address J t o pe.l1- lid City A (3 State FL Zip 32233
Office Phone qJ If 311. 1 zz C Job Site Contact Number . • / ,d
State Certification/Registration# E-Mail >f•
n ( ktirt 1 i/1 L • (.0 M
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer Awl/7)n/S c OR Exempt❑ Expiration Date ri 0/ZZ-
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
RECORDING YOU OTIOF COMMENCEMENT. /
B
UVi
(Signat re of Owner or Agent) (Signature of Contractor)
Sikned and sworn to(or aff :d)before this . day of Signed and sworn to(or a -d)bef• = m• 'is day of
U 2 b _i A '� .a..,, I n J�1 AC 41.4.-.Alli _ PT /
WaigillMk /M
�. a � v. .ry) igna • . 'o ary)
*�' TON! �`" .` � TC`dI GINDLESPEr
[ ] Personally Known OR *: � ''' MY OO GADLE.�PERGER [ ]Personally Known OR :*: t� . RGER
[ ]Produced Identificatio ? ''r'�`!•t�,' MMISS'ON#G [ ]Produced Identification ; -- *__ MY CUM dISSION#GG 353178
Type (J\F F F�aP,: EXPIRES:0,-,,,„G 353178 =,� c°, EXPIRES:October 6,2023
T e of Identification: Eo •
•. - er0 • Type of Identification: . ,.,aT„
• �n errifers
c3%)'''lr;., REVOCABLE ENCROACHMENT AGREEMENT
ff '',+ City of Atlantic Beach
1I. *r *ALL INFORMATION
�� I'1 800 Seminole Road,Atlantic Beach,FL 32233 HIGHLIGHTED IN GRAY
;' IS REQUIRED.
`'•iii>i'
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida,a municipal corporation organized and
existing under t e laws of the State of Florida, hereinafter referred to as"CITY" and
4 Y1 V I i(d*'i 5 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. k�Gn
This work is generally described as Dn�L kiltP-tp41.,,frie,„1- '' , t •
Any facility maintained, repaired, erected, and/or in ailed in the Eercise of the privilege granted re sins 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 '774 UGWnk Rood .
• 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 herebyassumedby the USER.
D?AAo,-,.� �� �/z /d" Date 9)/51Z`2-
Property Owner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this day of PcL) ,20ZZ
(.5
by aY \QS €_. . r 1 lj�(_ k Q0.r, ,who personally appeared before me and
pr. ted name of Signer)
ackno, I-dged that he/. a sig -d the instrument voluntarily for the purpose expressed in it.
TSN' h'�icSPERGE;, Department Approval:
wlY COMFvtISsp lV#GG 353178
Signature of Notary Public,State of Florida ,; -'<'• ••F` EXPIRES:Ccfober8,2 23
.::A F��' Bonded Thru ,
[ I Personally Known ---�- No.arypublicunderwriters
[ ) Produced Identification(Type) --'tott Williams, Public Works Director
H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
.-it.11,Tr-•,, RIGHT-OF-WAY/EASEMENT PERMIT APPLICATION **ALL INFORMATION
/° � City of Atlantic Beach HIGHLIGHTED IN GRAY IS
�, a -' 800 Seminole Road,Atlantic Beach,FL 32233 REQUIRED.
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address L Vt(4)n4 (20,d Permit Number
Contractor Information �„
Company KV/V-6P/ f Qualifying Agent ,/# /I��C�' !
Address 1 b ri XI City /4,6 State pi- Zip 31213 3
Phone `07 311, itiC Email InPb Atitt/1//el C , CD/'')
State Certification/Registration#
Architect Phone Email
Engineer Phone Email
Att1.%/rPliSci
Workers Compensation Insurers OR ExemptElExpiration Date 1/10/7-1,
• 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 ity of Atlantic Beach�� or Florida Department of Transportation Standards and be performed under the
supervision of U� u,[/P/e/rl (Project Superintendent)p
with(Company Name f1 4j. ...c.-71,C, Phone goy 317 /OOCi
• 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. ��n
• The permittee shall commence actual construction in good faith within Ce 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.
• The Public Works Director shall be notified 24 hours prior to starting work and again immediately upon completion.
) I Date �s (22
Pe mittee(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL ( -' 7
The foregoing instrument was acknowledged this -� ) day of O ,20 2 C.�
flit l k
by A // V/ � r h who personal) .9.ppepled b
(printed name of Permittee) ;41 ;;;dl GIND•_ESPERGER
#• .•. idY COMMISS,ON#GG 353178
ackn• •: d that h she sign the ins ument voluntarily for the purpose expressed in it. E I`-: ::.__ EXFiRES:Cc,ober 6,2023
::� .'cF FAQ-� Bcn�e�Thru Ne',ary Public Und etwnters
• L— [ ]Personally Known
Signature of Notary Public,State of Florida [ ] Produced Identification(Type) b ...L
H:\Applications&Forms\Word Documents\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
(---
'''` CITY OF ATLANTIC BEACH
-, x , ) 800 SEMINOLE ROAD
. ` ATLANTIC BEACH, FL 32233
(904) 247-5800
'------ JS
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 774
Vec,..ivia, Ad
OWNER or CONTRACTOR (Print) LI/IaSL /'27 / )/L -cr, 5
Signatureill be ch Date Poi 51 ---1
1
4% i 4C-1,
MAP SHOWING BOUNDARY SURVEY OF
LOT 19 BLOCK 15 ACCORDING TO THE PLAT OF
I ,OYAL PALMS UNIT TWO A
AS RECORDED IN PLAT BOOK 31 PAGE(S) 1, 1A, 1B, 10 Sc 1D OF THE CURRENT
`G '2 PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
?VV-11‘°,-J % SCOTT L. SHOLTES.
BANK OF ENGLAND.
SI COMMONWEALTH LAND TITLE INSURANCE COMPANY.
II AND GIBRALTAR TITLE SERVICES.
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CHANCE WAIN AVERAGE DEPTHS OF LESS THAN 1 FOOT OR WITH DRAINAGE AREAS LESS THAN I SOUARE MILE: AND AREAS PROTECTED BY LEVEES FROM IX ANNUAL CHANCE FL000.
V E Y 0 GENERAL NOTES:
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2.STRUCTURE N0.226 SHOWN KREON LIES WHIN R000 ZONE E AS BEST DETEAIINED
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Lj FROM F E.Y.A.FL000 MAPS PANEL 110 DATED 06-03-2053 -
A SSOCIATED SURVEYORS INC. ] UIS is A SURFACE SURVEIL ONLY 1E EXTENT OF UNOCRGRdUNO 1001X6 PIPES AND
u hunts,iF ANY.NOT DETERwNED.
001 O 4_A)RISDIC11CIAL AND/OR ENNRONYE)ITAur SEN9YVE AREAS P ANY.NOT LOCATED BY
LAND & ENGINEERING SURVEYS NIS SURVEY.
W 5.THIS SURVEY BASED ON LEWL DESCRIPTWNS FURNISHED TIE PUBLIC RECORDS WERE
r / 3846 BLANDING BOULEVARD NOT SEARCHED BY MS SURVEYOR FOR EASEVCNrS.PRE,COVENANTS.B.R.L'S
S JACKSONVILLE, FLORIDA 32210 RESTRICIONS,CLOSURES, TAKING OR ORDINANCES,ETC.
6.UNLESS OTHERWISE STATED ALL NON PIPS FOVND HAVE NO IDCNTTRCATMN.
904-771-6468iJ/W.?'
AC AIR CONDITIOKR
LEGEND/ABBREVIATIONS OFESS1CA./ LAND SURVEYOR
S S V CERTIFICATE OF AUTHORIZATION NO. LB 0005488 401101NG RESTRICTIEW LINE PSR PROFESSIONAL SURVEYOR A NAPPER
( _ BT BUILDING TIE R RADIUS
BTN BETVEEN IR) RECORD
I HEREBY CERTIFY THIS Sy1RVEY-WAS'DONE UNDER MY EBR cOVCNANTt B 7ESrRICT1O4 PLO REGISTERED LAND svRvcrO
CM CHORD PLO RIGE< DAY
DIRECT SUPERVISION AND'411 TF'T1/E MINIMUM TECHNICAL 1cNR) CAN NOIICROT READ 0 SET IRON POR REBAR
COIL CCTIE
STANDARDS FOR LAND SURYEI NGi VRSUANT 0 CHAPTER SJ-17.050 CORD COVERED
-ASSOC SURV OR LB. 5188
• FOUND RON PIPE DR PIN (1P)
THROUGH 17.052, FLORIDAADMIICISTRATIVE CO(ir`CHAPTER 472, F.S. EB ELECTRIC BRANSFIFNER B PAD • •MARV CONCRETE MONUMENT(CM)
/ = ` JEA UACKSDIV ILLC ELECTRIC AUTHORITY d CROSS Q1T pt DRILL MOLE
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I !!,//// LB IICENSCD BUSINESS —X—X-1—X—X—%—%—CHNN LINK FENCE
BY: LS LICENSED SURVEYOR
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A I I ) LICENSED —6.--ii--II—If
n n BRE FENCE
CHARLES B. HATCHER FLORIDA CERTIFIC• E NO. 3771 '0 NAILOFF Al,I1SC !RECODS BOOR nIWITI FENCE
CHARLES L. STARLING FLORIDA CERTIFI•ATE NO. 4579 Ory OFICIAL RECORDS VaUN - -•J-d-OwmEAD uTRJTY
;ECC
C POINT D1 CURVE 8160 HYDRANT
RAYMOND J. SCHAEFER FLORIDA CERTIFII ATE NO. 6132 PEC POINT DF C14 IND CURVE PHONE RISER
PCD PEER COUIPIENT PAD ® WATER METER
JOB NO. 63786 DATE 02-19-2015 RE PI POINT CF INIERSEC1 ION m UTILITY P01
PPOINT OF REVERSE CURVE B �. - �. - DIAMETER
SCALE: 1" = 20' DRAFTER WF PTT POINTPONTPERMANENT
TANGENCYANEREFERENCE IIQAAENT F • - - OJT ANCHOR
NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER