2317 BAREFOOT TR DWAY22-0049 ,. .,-,-"'6,,, 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
▪ °i3�pr IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us p
Job Address: '7/ 7 ore ov> //QCT Permit Number: 12,L1.7 ALI Z.Z -do 49
X Legal Description 77/ O!`' 9,5"- I f, J7 -a f E��/'• � J( RE# /C 7YC30 G-121?
Valuation of Work(Replacement Cost)$1 O0i� Heated/Cooled SF // Non-Heated/Cooled
• Class of Work: Jew ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial..>4-esidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s)be removed in association with proposed proiect? ❑Yes(must submit separate Tree Removal Permit>46o
Describe in detail the type of work to be performed:
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i"cil c_7(-,j yr'/_Ja /I 1-7.
Florida Product Approval# / /fr multiple products use product approval form
Property Ownrr Informa '/n
Name _J7/,lie •
2 a,5...f- Address 2J/711_4' 7,,f/
City //.,<c /q c i /, State F/ Zip .1 ?JJ Phone -'0V 57/L 5 p/c'
E-Mail ,57ie ' c.g6-q.t:r. ...2e 7/
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information w r e A
Name of Company /€,t." o . j,9„— Qualifying Agent /V/kip&-/ /i/,Qt-n.4_,
Address cry �Td,9a,s L City 34< iegl_che State F[. Zip 322 cJ
Office Phone 9o/-qt y;r/ Job Site Contact Number
State Certification/Registration# E-Mail /14vie.44.0 !91, i./•E7
Architect Name&Phone#
Engineer's Name&Phone# --
Workers Compensation Insurer OR Exempt(Exp�i ation D ( cl/ ( 4/ Z> )
Application is hereby made to obtain a permit to do the work and installations as indicated. I ceftify that n or4nstallation 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 YZICE OF COMMENCEMENT. /,
/
(Signature of Owner or Agent) / (Signature of Contractor)
(Sired a d sworn to(or :ffir ) efore me , is:1 +ay of Sig and wn to(or of i‘) •efore me hi • day of
0 Om ?Q� 7,b -,OR. - k ��a�, 1,oroZ7,b AL A44%41 elv'
�a�.. ✓ �-
.-‘=:,;1; ;!'64;,.. TONI GINDLESPERc -�� ' • ! ��► -•�
�•, eV
MY COMMISSION#GO =1st rgna • e of : .ry] ,� .
="••.��.:o EXPIRES:October 6,2023
,re° °` Bond '+ hr a No,. Public Underwriters ,FY TONI GINDLESPERGER
n -* [ ]Personally Known OR ..° c•,
[ ]Produced Identification . [ ]Produced Identificatio 1:.; tk.1:1MY COMMISSION#GG 353178
Type of Identification: t� •\ .__ Type of Identification: '=v' EXPIRES:October 6,2023
'7,,;-.;,;,•'' BOnded inw Notary r-UoucUud?rwilteia
•
DBA.WING FILE NO. 41 S '
..• , MAF) SHOWING BOUNDARY SURVEY OF
LOT 60,OCEANWALK UNIT TWO, AS RECORDED IN PLAT BOOK 42,
' •
N d %r PAGES 13,13A THROUGH I3D OF THE CURRENT PUBLIC RECORDS
° � gg94., /.x OF DUAL COUNTY, FLORIDA.
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NOTES : O T I O
•
BEARINGS ARE BASED ON THE NORTHERLY LINE OF LOT 60 G I 'se/v. y CERTIFIED TC
AS BEING S.78.25'10"E.BY PLAT. / teB66o5�'`�_� Qi F«ET,
NO BUILDING RESTRICTION LINE BY PLAT,BUT THERE MAY BE I v /--/.esrf
RESTRICTION LINES OR EASEMENTS THAT AFFECT THIS
PROPERTY BY ZONING OR RECORDED IN THE PUBLIC RECORDS OF THIS C;‘,//r/.57
COUNTY THAT ARE NOT SHOWN ON THIS SURVEY. I
THIS PROPERTY LIES IN FLOOD ZONE"X"BY FLOOD MAPS
REVISED 4/17/1989,COMMUNITY PANEL NO.120075 0001 D. D pRDEN LAND
SURVEYORS INC. -----'��2
LB 6645 PROFS SIO I
1 103 SOUTH THIRD STREET DATE: M a
JACKSONVILLE BEACH, FLORIDA 32250 SCALE--12..2__°
(904) 249-7261 FAX (904) 241-1252 .
THIS MAP OF SURVEY IS NOT VALID UNLESS IT IS SIGNED AND HAS THE ORI,
v�Ci..s.r .i�.. /_rl.l_GA•,d—..ii' .r.,....,....../..._./_.-...�c ,u"cNfrn 1 liAlf1 C,I0I/CV/1D wunc'r AAUP• IC Dotiarrr UCDC/11.1
;1�L1;, RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION
'S r; City of Atlantic Beach HIGHLIGHTED IN GRAY IS
r" 800 Seminole Road,Atlantic Beach,FL 32233 REQUIRED.
PERMITTEE RESPONSIBLE FOR NOTIFYINGNO811 AND OBTAINING UTILITY LOCATES
Job Address 2J/ 7 Ace L:-/ 7;a: Permit Number
Contractor Information ,,�
Company h//Gni �„4IJc, •✓ j%/i Qualifying Agent C�.4.e/ 4�/�c..%✓
Address SYY 3Y'4 J1, S. ,TA-, /3ca/ City T1? t3LL State f-74- Zip >?Z-cU
Phone 70Y- VZ Yf- r/% Email /116-WRGr.-1.v ® Al. n/CT
State Certification/Registration#
Architect Phone Email
Engineer Phone Email
Workers Compensation Insurern OR ExemptnExpiration 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 (Project Superintendent)
with(Company Name) Phone
• 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 ir tor shall be notified 24 hours prior to starting work and again immediately upon m letion.
ti%���=✓
Date f oe-2
Permittee • ned in presence of Notary Public)
STATE OFF FLORIDA,COUNTY OF DUVAL g lday � -� �-
The fore oin instrument was acltnowle ed this of Y ,20
by QS C� (1 1`q S ,who personally appeared before me and
(printed name of Permittee) F wnaarrs�s a tea. :.
ac nowled d t t h shesigned the instrument voluntarily for the purpose expre . ...r TONT GINDLESPERGER
MY COMMISSION#GG 353178
'�
;,.: N, EXPIRES:October 6,2023
r.I '••,cc d�4•; Bonded Thru Notary Public Underwriters
[ ]Per iftlf Cft-fSvi
Signature of Notary Public,State of F rida [ ] Produced Identification(Type) •
H:\Applications&Forms\Word Documents\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
'`-'�'`ifi REVOCABLE ENCROACHMENT AGREEMENT
',-'' L` . **ALL INFORMATION
..(t,..j
` , City of Atlantic Beach
'+ 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and
existing un .exta laws of t /State of Florida, hereinafter referred to as"CITY" and
c of ,A h fgJ.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. //
•
This work is generally described as /-et/eef'le, / o 77;.-.7.0/7 Gr-el i 1I IL faq✓Gr-f .
Any facility maintained, repaired, erected;and/or installed in the exercise of the pr. iler4 ge granted rerpains subject to
relocation or removal on thirty(30)days'notice by CITY to USER said no :.,77.USER shall be given by certified mail,return
receipt requested,to the following address --'/7 / o _ .
• 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.
/er
Date f/22
Propert owner/Agent (signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this ( day of <�EP 1 , 20 L L,
by � ,who personally appeared before me and
(printed name of Signer)
ackn•wJedged-that\ne/sine signed the instrument voluntarily for the purpose expressed in it.
S — ro.�YPc. c.i TONI GINDLESPERGER Department Approval:
Signature of Notary Public,State o arida °a; ,;," :. MYCOb1PdISSION#GG 353178
+a`'s. :' EXPIRES:October 6,2023
[ ]Personally Known \ Fo:.F�P;
tJ _Bonded i hru Not2ry Public Underwriters
[ ]Produced Identification(Type) L .cott Williams, Public Works Director
H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18