257 1st sT DWAY22-0031 revision 9-2-22 j�ySil r
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 {Al / -,
` Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: L>l0Z .-003 i
❑ Revision to Issued Permit OR IsS/Corrections to Comments DateC k l \ 1�;p�,2
Project Address: ct .�C c l S*' P\ ()\")
Contractor/Contact Name At-{ UOQ CQ.jc vete.. ..---..-„-�ji CQ OVA ,LtLGt
Contact Phone:C)04 — `1: tpic43 Email: 1 \'`P`-t\U r C �c-c-se, c c\ ,A;\% csw
Description of Proposed Revision/Corrections:
(4)c--ty `C`r1 .''ti .� t—C hr ve_ 'r rlc 0.--I'1f ,-n'e S
(Pe.r k�•b r'.c & -.4--"Ct. r c ,
I 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?
5s.11,
o ❑ Yes (additional s.f.to be added: )
R Vj/ill proposed revision/corrections add additional increase in building value to original submittal?
o ❑*Yes (additional increase in building valu-• ) (Contractor must sign if increase in valuation)
*Signature of Contractor/Agent: (
a
(Office Use Only)
❑ Approved ❑ Denied ❑ 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
/Tivir,; REVOCABLE ENCROACHMENT AGREEMENT
11 \= City of Atlantic Beach **ALL INFORMATION
') 800 Seminole Road,Atlantic Beach,FL 32233 HIGHLIGHTED IN GRAY
\\)ii
IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida,a municipal corporation organized and
exi g nder the la s of the State of Florida, hereinafter referred to as "CITY" and
liz
21-± (,-.6,/theet n fNNd-- 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 CC:5i-N Ch-e 4 Fgliq"IV
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 CITY to USER,said notice to USER shall be given by certif'ed mail,return
9..a..receipt requested,to the following address 9..a.. ( C'C �2_ce,� ,/� 0 1,3- /N,
• 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
��liabilitiesn_ ieare hereby assumed by the USER. �j�
�2X�t�i t ��L4-v�v`'G%Lt-11-✓L Date [( J�
Property Owner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this1. day ofc4 , 20
by 4L 6f" 'r -i o lily ,who personally appeared before me and
(printed name of Signer)
ack ow edge..th. he/she gned the instrument voluntarily for the purpose expressed in it.
• a— & , C) .-,x _,.
Ny N�„ j:�;;i GiNDLESPERGER Department Approval:
Si' 're of Notary Public,State . lorida3 `�': fJY CO��MISSION#GG 353178
F:::,..,...
,:•:
PersonallyKnown c. : . �. : EXPIRES:October 6,2023
[ I ; .;"2. "'�N Pc1.1ded _ Notary Public Underwriters
[ ] Produced Identification(Type) G.� — ,.�._ Scott Williams, Public Works Director
H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
i-s1 RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION
4 City of Atlantic Beach HIGHLIGHTED IN GRAY IS
�' 800 Seminole Road,Atlantic Beach, FL 32233 REQUIRED.
,H
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address C9 5--/ *& k• E Permit Number
Contractor Information
Company L& C eTh.,1Q e ' - Qualifying Agent
Address t .p03 \ (�' CityC,la CI" StateF-( Zip ��,—�—
Phone (�`t. sac, '-OLQA.- Email 'VZ\L C C.S::)aC_^e-e '. CIfrifyN,'C.:.C''�
State Certification/Registration#
Architect ` Phone Email
Engineer Phone Email
Workers Compensation Insurers OR ExempttExpiration Date
• 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 \t f"\—_T (—CS-- (Project Superintendent)
with(Company Name) y t..._ca. Cr., .lc c'e SCR.O.cs._ Phone C)('Dy 3�g--C1.0k
• 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 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 ®''—i__ ' Date �'C� ( k t �-1
Permittee(signed in presence otary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this \- day of p` -., 2 0 Z _ ,20 ,
./ 1 11
by ` r6(V\C S \ C.t_ 0 (- who personale•, -• •: • - ••-
(printed name of Permittlee) � TO
t , , .mac:, ,Jrllv,IvDLESPERGER
ackno le•:ed that he a si ned the instrument voluntarily for the purpose expressed in ii" ' MY COMMISSION#GG 353178
oQ EXPIRES:October 6,2023
Bonded Thru Notary Public Underwriters
P _ [ ]Personally Known
Signature of Notary Public,State of Flo( [ ]Produced Identification(Type) \�.
H:\Applications&Forms\Word Documents\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
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MAP SHOWING BOUNDARY SURVEY OF
LOT 12, ATLANTIC BEACH TERRACE, AS RECORDED IN PLAT BOOK 15, PAGE 34,
OF THE CURRENT PUBUC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED T0:
FRANK J. AND CLARA S. SCHULTZ
SUNTRUST BANK
STEWART TITLE GUARANTY COMPANY
RICHARD T. MOREHEAD, P.A.
LOT 14
N 6416'54" E
50.00' (PLAT)
N 841734' E
`NO°BEiinCAto 50.08' (MEASURED) *r+ t
30.4•
al
;-
T1N0 ORY
... ....; FRAMESTi ^
A. .;• ADDRESS NOT POSTED e
.. :•• ATLANTIC BEACH
o� . �� Ur v$ LOT 2
fd
. 01,s.•._* LOT 12 1.CB PLA OK 5
BLOCK 30
Z •, ,'• g PAGE 69
STONI
LOT 13 4o.t.•1•• —BTAN1s
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WLS
W 4 .:*•a;:*w .... •V
F. g b ••• •' • FRAME L..°-7-.. - ATLANTIC BEACH
z= '' POSTED / 261 tv LOT 1
1-is , W BLOCK 30
Q / .-... ' i •� ;._, �� PLAT BOOK 5
0 , 24.1' : 1.1, PAGE 69
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S 84'08'54" W
50.00' (PLAT) C�,N
FIRST STREET L"
(VARIABLE MONT OF WAY) 'CC(_
(PLAT- MAC DONNA STREET) 441116
L
NOTE& , ABOTT1TA/Y: (c‘
_ J
LEGEND:
R - RADIUS —X— - FENCE
L - LENGTH Q - CONCRETE
NOREVISIONS
1.WARMS ARE BASED ON THE PLAT EiFARR(G OF S���-E ALONG THE
EASTERLY BOUNDARY UNE OF SUB.ECT PARCEL. DATE OPTION
2.BY GRAPINC PLOTTING ONLY THE CAPTIONED LAOS UE V 1NN F1A00 ZONE x AS SHOMNQ1{/HE
NATIONAL FLOOD Pas/RANCE YAP 0.41E0 APRT.1T. 19Di.C01W41/I41TY NUMBER 120075, PANEL
. THIS SURVEY REFLECTS AL1 EASEMENTS R RICTUS OF WAY AS PER RECORDED FLAT r/OR TITLE COMMITUENT
F SUPPLED.UNLESS OTNERMSE STATED,NO OTLWE TITLE WRWF1CATION HAS BEEN PERFORl1ED BY 111E UNDERSEXED.
4.An SLIMY NOT YAUO 1tll140U1 OiE EMFaOS=SEAL OF 11€CERTIFYING SURVEYOR.
+ess.•c dman. 1....+m•ialt ssett'>y'-d'ireADIA "AM-n -flet fi let:AL.AMEdiiv tLii 14fA',11 Mikes. 1° a 2O'