888 SEMINOLE RD DWAY22-0052 It-vir,, Building Permit Application Updated 10/9/18
6 City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
u'; u� IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us /yam
Job Address: 8�b Sunk t� QS) . Permit Number: Rut Zz'WSZ
Legal Description 1...-0T Z,Q L tKlL.11 St✓`-0-k M 4c& ur-yr ' 3 RE# k*--/ I' t 1 R 0 o'XC�
Valuation of Work(Replacement Cost)$ I 0 000 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration PI‘air ❑Move ❑Demo ❑Pool DWindow/Door
• Use of existing/proposed structure(s): ❑Commercial Dftesidential
• 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) 111N-o----
Describe
No'Describe in detail the type of work to be performed: �Z c^00l= \L.,' X bt'' S c c No J O c (LUA )c---u i t?
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Florida Product Approval # for multiple products use product approval form
Property Owner Information
Namel7OtJ Q A-P6-��� Address bbb seiv\tNoLE 't--b
City OTs.-00tiTtL e PcCA-k State ('-L Zip 3 2-233 Phone 9D4-953•-6ts5
E-Mail bA I)C:0 A'T(,-(-7 GD f-%.ci{CT, )i\
Owner or Agent(If Agent, P2s(iver of Attorney oY Agency Letter Required)
Contractor Information
Name of Company i71?-4c( -yDI 'rC)e }
, .-11kC.. Qualifying Agent QR-)pati Sc.C1/4ciy'�w p— Dt/
Address 1225 t'(lc k'v R`-1 '0. L.-.LI, City b44,._,c17- PA 2,i` State cz. c- Zip 3.21E, T
Office Phone Q(Y'i -2 i' ---7-)62(,.5 Job Site Contact Number
State Certification/Registration#CC,-0 5 2 01 t-} E-Mail SQA W[)�coM An-3/
C! 1►A A l-- .C
Architect Name& Phone# J
Engineer's Name&Phone#
Workers Compensation Insurer l3 Gtt -b625 7-6.0C Lt-AAAC(2 01140R Exempt❑ Expiration Date 5 /\2(20 23
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
RDINOTICE OF COMMENCEMENTl' l
0 rte.,- - 4"
(Signatu e of Owner or Agent) (Signature of Contractor) .
Signed and sworn to(or affirmed)before me this I° day of Signed and sworn to(or affirmed)before me this I'D day of
OCTILI R- 7:'^z .. d ./W V4 G-a TT CiC-TAtak_ i "2-022 byq,5,,cps pt.r..A,n
....14% -/ ce» , . . '-
(Signature of Notary) (k atyre,.pfillolarul _ _
( d�jr_r"'i,, LEON SCOTT LANCASTER
r�� Notary Pubhc State of Flonda i _ otary Public•State of Flonda
[ ersonally Kn. �y ersonally Known OR I. "Al)1 Commission a NH 204382
Randall Scott Drawdy ( :" My Comm.Expires Dec t9,2025
[ ]Produced Iden, i � My Commission GG 302645 [ ]Produced Identification Sonata throuph National Notary Assn.
Type of Identified ,n:?o,of Expires O4/21/2023 Type of Identification: _ _ _ a _•
.11j/iP4s. RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION
+� City of Atlantic Beach HIGHLIGHTED IN GRAY IS
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<, -011-1='
C800 Seminole Road,Atlantic Beach, FL 32233 REQUIRED.
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PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address T.E2e0"�'.- -- Permit Number
Contractor Information
Company JQ.AcLiib' C0 lac. Qualifying Agent S c cr '6 t41)
Qualifying
Address 1225 Elc(so 4rCOU LiJ. City D PAAJ5E &ALc_ State F L Zip ?2-673
Phone 9(71t- 2Y 0265 Email `�8-ALLip c o .. ,d MAIL .Co'
State Certification/Registration# C G-C U 520 ILk 0
Architect Phone Email
Engineer (N./R Phone Email
Workers Compensation Insurers 3 u 1Ll)E Q S �f,c4A.r arC 'GC4:0.0R Exempt f Expiration Date,C(I2-ftd23
• 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 S C-CsTt -11Ac-P-1 b j (Project Superintendent)
with(Company Name) g> wC) •SCD. Phone 9O 4•-2(`. -O2&'
• 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 1 L4 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 W s Director shall be notified 24 hours prior to starting work and again immediately upon completion.
---1—s - \\\/ �) Date (D !l k(2Z
Permittee(signed in presence of Notary 'ubI )
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this day of cCTO33(?1L ,20 2 Z ,
in
by 'if— ,S ortDTI/kw D(I ,who personally appeared before me and
(printed name of Permittee)
r'6� LEON SCOTT LANCASTER
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. #4'`:A �T:. NotaryPublic State of Florida
or Commission#HH 109352
va'%'oF e-'571MY Comm.Expires Dec 19,2025
\ _ � Bonded through National Notary Assn.
�3Z�/\ [`j ersonally Known
Signature of Notary Public,State of Florida [ ] Produced Identification(Type)
H:\Applications&Forms\Word Documents\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
MAP SHOWING BOUNDARY SURVEY OF
LOT 2, BLOCK 7, SELVA MARINA UNIT NO. 3 AS RECORDED IN PLAT BOOK 29, PAGE 27,
OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
DONALD A. PADGETT AND MARTHA F. PADGETT
WELLS FARGO HOME MORTGAGE
i
OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY
RICHARD T. MOREHEAD TITLE 8c ESCROW, INC. LOT 3til
Lb
N 83'41'51" E 275.00' (MEASURED)
! `/ l ' 0•r !•r! `! ' . N 83'42'00" E 275.00' (PLAT)
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4CLOSING COORDINATED BY: / /''!/'�/1�/!�/r;//;/r;/r;/rr//�!r S 83'47'59" W 275.00' (MEASURED) S
RICHARD T. MOREHEAD TITLE & ESCROW, INC. I DS'UNE TO L4.E I IA
444 THIRD STREET g8
NEPTUNE BEACH, FL 32266 LOT 1 h 8
(904) 247-5147
• «, OLD REPUBLIC
••
° ' NakxltxMBkImmuneCNmpaer PLAZA STREET
CHARLES [d. ERT#KATE 15-003 DATE OF FIELD SURVEY: 01-17-15 I DATE OF ISSUE: 01-20-15 I SCALE: 1" = 30' LEGEND:
NOTES: 0 >PROPERTY CORNER
�� ®�__J I HEREBY CERWF'Y THAT THIS SURVEY WAS MADE UNDER MY RESPONSIBLE CHARGE 1.BEARINGS ARE BASED ON THE PLAT BEARING OF S 06.1E00'E ALONG THE OBSTRUCTED NO EVIDENCE
LLdJ AND MEETS THE MINIMUM TECHNICAL STANDARDS AS SET FORTH BY THE FLORIDA EASTERLY BOUNDARY UNE OF SUBJECT PARCEL FOUND OR SET
BOARD OF PROFESSIONAL SURVEYORS 01 MAPPERS M CHAPTflt ,FLORIDA 2.BY GRAPHIC PLOTTING ONLY, THE CAPTIONED LANDS LIE WITHIN FLOOD ZONE X , AS a CONCRETE
AOMINISTRAIIVE CODE,PURSUANT TO SECtION 172027, STATUTES. SHOWN ON THE NATIONAL FLOOD INSURANCE MAP DATED JUNE 3, 2013,COMMUNITY
PROFS=?NAL SURVEYOR NUMBER 120075, PANEL 0409 H
A MAf'PER.os Lam
S. �� —X— s FENCE
3. THIS SURVEY REFLECTS ALL EASEMENTS&RIGHTS OF WAY AS PER RECORDED PLAT.UNLESS R . RADIUS
1692 CO VIncron Lanc S.
OTHERWISE STATED, NO OTHER TITLE VERIFICATION HAS BEEN PERFORMED BY THE UNDERSIGNED.
O.,nGE PARK.FL 32003 4. THIS SURVEY IS NOT VAUD WITHOUT THE ORIGINAL SIGNATURE AND EMBOSSED SEAL OF THE r
TP"ONE)904.124.7411 CHARLES K. MCINTOSH CERTIFYING SURVEYOR. L LENGTH
REGISTERED SURVEYOR AND MAPPER 15502 STATE OF FLORIDA
NOTICE OF COMMENCEMENT
State of l-DB—vD..4 Q Tax Folio No. C) I `(On 1 (Doc)c)
County of QUAL
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 stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: I Lr 2. c�C 1L`7, S�?L✓A \A A u a rT 44 3
Address of property being improved: cOS `U /<i LA'. \C R c I L 2,72 33
General description of improvements: Vie(--.c5eLf. nin.)b 6loud Stfc 1100 OP >61:4,Suu4
Owner: �D t.) \?clAne vT— Address: b�� ersi-kNOLE VA, A��AI-Yr C7-t./14-It
Owner's interest in site of the improvement: l n— .S ( . L-f 7-233
Fee Simple Titleholder(if other than owner):
Name:
Contractor: ,� L4N3
Address: ( 2YY 14tCLO COJ G , 6 pA�, ' ?�4 tl - �- 1/47 2...0—)7
Telephone No.: ^2 4g-4 026s Fax No: q l�`t-27 6-0 2*
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 the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY O)IVNER
Doc#2022255865,OR BK 20460 Page 127, n Date: k A°(ZZ
Number Pages:1 fore me this ( day 4! 70113 in the County of Duval,State
Recorded 10/11/2022 08:57 AM, Florida,has personally appeared ON '/�D•err
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL tary Public at Large,State of Florida, ounty of Duval, '
COUNTY
RECORDING $10.00 'commission expires: Z� A �. �'��
•sonally Known: N. Notary Public State o1 Florida •,
..Jduced Identification: `�, Randall Scott Drawdy
y ' My eommissionGG 402a45
7a h/ Expires 04/21/2023