249 S NAUTICAL BLVD RFNC22-0109 %r` "f Building Permit Application Updated 10/9/18
m.ws City of Atlantic Beach Building Department **ALL INFORMATION
Beach, FL 32233 HIGHLIGHTED IN GRAY
,,,,,,,{ f,f; 800 Seminole Road, Atlantic eac
1.“1 IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us n
Job Address: 249 Nuuk7 t,«) @LJ S Permit Number: 1(=NC ZZ""Ol Oq
Legal Description 0100 S:, 1, rcon!l y __ RE# 00703-037 E(_
Valuation of Work(Replacement Cost) $ L1700 Heated/Cooled SF Non-Heated/Cooled_
• Class of Work: ENew EAddition ❑Alteration N'ltepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial gResidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes .No //
• Will tree(s) be removed in association with proposed project? EYes (must submit separate Tree Removal Permit) �XNo
Describe in detail the type of worts to beperformrd: I\tel,,c v, 4/ii 0 ;H S el OIL Lo.,, k;o,,i
w:--I4 Sawk- IMwfeyici I ‘ H Floridau
Product Approval# _ for multiple products use product approval form
Property Owner Information t
Name 13.e„,, ,Iq,1rJGW) cr`Ck A Address 24`1 /va�+Ic.iL I31vv1 S
City Attutu.tc- f3cc.v+, State Fl Zip 3Z23 ) Phone g0c1 -234- ►62O
E-Mail Roll z RvSc. .. \vuivo . co»1
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company ;rex F � R«!i Qualifying Agent 2_ / 3#l.i
Address 5910 1: Lv� City S z„�.;)%. State FL Zip 32254Office Phone '(o9 cn .399 _Job Site Contact Nimber
State Certification/Registration# ICS 15`f E-Mail Cliff w p ,cl r,J•Jaclsc.+,v u IL .cum
Architect Name& Phone#
Engineer's Name& Phone# ,A
Workers Compensation Insurer L :I c.+y AkkhAO OR Exempt 0 Expiration Date 12.- IS -2-014.--
Application
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Application is hereby made to obtain a permit to do the work and installations asindicated. 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%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 B OR
• ' DING YOUR NOTICE OF COMMENCEMENT. V
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,� (Signature of Owner or Agent) (Sign ure of Contractor) a a,
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W O ?Cilie i and sworn to (or affirmed) before me this2 7 �daN 1F
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y of Signed and sworn to(or affirmed) before me this • ;y f, o
s 22 Pµi,p� DC-it/367Z , .),2- , b ►�le-41I e. • - PA co E E
20 by ��n 0.mcU"A Y �y
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L.• (SignSture o Notary (Signature of Notary) ' t
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ads � �`: •• ., K:
_ Pe onally Known OR [ ] Personally Known OR !uN,s �
r,.uced Identification ,
aN€1 ( Produced Identificatio \
• • Identification: �,t, f' n Type of Identification: �u�•4 �J�A.ts4z1- g k►G..Lv5e,
Aai
e‘.4 REVOCABLE ENCROACHMENT AGREEMENT
n\ City of Atlantic Beach **ALL INFORMATION
)9) 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 under the laws of the State of Florida, hereinafter referred to as"CITY"and
B&-l‘) P 0 bl{ (.t.; ,r 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 FL-vt
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 certified mail,return
receipt requested,to the following address a-t /1!AAT(Uc-t-- , 0 tref-/-ANT_ f3c.- ( %L•
• 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�jassumed by the USER.
r . �r.L.�`�--��,� Date (.0 �7(1-A_
Property Owner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this 2 7 day of(7----2...)034-- , 202 ‘?---
by 1347iJ V r(-17 GJ A ,who personally appeared before me and
rinted name of igner)
ack owl dged t he e signed the instrument voluntarily for the purpose expressed in it.
Th
r' ; 70NI GINDtESPERGER Department Approval:
Signature of Notary Public,Stat�orid :; . �. = MYCOMMISSION#GG353178
71*:[ ]Personally Known .�' EXPIRES:October 6,2023
•'•lFOF d 4;' Bonded 7hru Notary Pubic Underwriters
[ ]Produced Identification(Type) Scott Williams, Public Works Director
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
rs' Fence Addendum Updated 1/14/2021
r City of Atlantic Beach Building Department
\,,: 800 Seminole Road, Atlantic Beach, FL 32233 PERMIT#
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: T Date:
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Property Type: Lot Type/ Features:
fit Residential ErOne Street frontage (interior lot)
❑ Commercial ❑ More than one street frontage (corner lot, through lot,
etc.)
❑ Swimming Pool
Fence Material: Fence Height (select all that apply):
0 Wood ❑ Four Foot (4ft)
❑ Chain Link NrSix Foot (6ft)
❑ Vinyl ❑ Other
❑ Block/Stone (Plan details required for footings and/or
retaining walls)
D Other
Fence Location:
Please submit an accurate and current boundary survey showing all existing improvements (including building footprint,
driveway, swimming pool, etc.) and location of fence/wall and any gates. Plan details required for block wall footings and/or
retaining walls and any portion or fencing above 6ft in height.
Will the fence be built in an easement?
O Yes (must submit separate Revocable Encroachment Agreement)
❑ No
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
P(N o
Conditions of Approval:
• Roll off container company must be on City approved list. Roll off container cannot be placed on City right-of-way.
• All old fencing and debris must be removed from job site by contractor or homeowner.
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 YOUR NOTICE OF COMMENCEMENT.
err► , . ,_.. . .
• MAP SHOWING BOUNDARY SURVEY OF
LOT 6, BLOCK 4, ACCORDING TO THE PLAT OF '11SEASPRAY" AS RECORDED IN PLAT BOOK 35,
PAGES 64 AND 64A, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO: BEN V. PUNDAMIERA, ROSITA P. PUNDAMIERA,
STEWART TITLE OF JACKSONVILLE, -INC. ,
NAVY FEDERAL CREDIT UNION
• ,AND WATSON & OSBORNE, P.A.
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