955 SAILFISH DR RFNC22-0113 • k:.'.,,'". ; Building Permit Application Updated 10/9/18
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City of Atlantic Beach Building Department **ALL INFORMATION
15-r800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
�.rm 9- IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us r w 7 J
Job Address: q55 31 1 c `6 p Permit Number: 1 �,ff 1L Z—O( t
Legal Descri tion 0-06 j-/ 'Z9C✓2d l-1�-4'1S N// / L.0 1-? LKZ RE# 1 7 1 zs / — 0000
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Valuation of Work(Replacement Cost)$ 4/3 c b Heated/Cooled SF Non-Heated/Cooled
• Class of Work: Vew ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial 1211esidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes do
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be perform d:/4,5-r•o,_ 4- S ' j�c-L- Fer'--GE B A-1 '6 Pct-L t�C 714T-
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Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name 71463:00.- el -&-,JNe Lc-- Address /&(a57 114/4(.LU 2CA b(2._
City J AGS e'l tit t u: State r----c..... Zip v 2ZZ Phone ci' /4) q/9'v
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information �
Name of Company AiC'/ /n
.
S t'EAz-Gl zatr-p g Qualifying Agent \)€:;"•1 12.9Z-ze,ji 5'--
Address 8q t i j l+4-t5 I^t c-C YPet`-sS `Pe- City J KsDti✓I tate Fes- Zip32 Z33
Office Phone c 1 t'9 ) 77 Job Site Contact Number /7 ��
State Certification/Registration# E-Mair 4 / Fb e'O-04A . C;,7/( i
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer ut9. s7` OR Exempt❑ Expiration Date I f I f Z 3
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
REC 0 RDING YOUR NOTICE OF COMMENCEMENT. ,..7. ...._7
(Signature of Owner or Agent) (Signat e of Contractor)
C he)rt5-c . ,ems v - - ( 91- 5Charfen mne
Signed and sworn to(or affirmed)before me this a da of Signed and sworn to(or affirmed)before me this a day of
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/' (Signature of Notary) I, '' (Si_natur- of No a4
Notary Public State of Florida Jessica Frio et of Fbrlda
[ ]Personally Known ORtiff WciulstHH 142217 Personally Known OR • 4 • My Commission HH 142217
6(Produced Identification Nod` Expires 06f14/2025 i ]Produced Identification ' ng, E3cplr°a06114/2025
Type of Identification: 'a •ype of Identification:_
's~S ,IJ ri Fence Addendum Updated 1/14/2021
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City of Atlantic Beach Building Department
V. :, 800 Seminole Road, Atlantic Beach, FL 32233
�. 0,,,, PERMIT#
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
' Sc5V/t ri 4 ///z/2Z
Property Type: Lot Type/ Features:
)a'Residential i2K)ne Street frontage (interior lot)
❑ Commercial 0 More than one street frontage(corner lot,through lot,
etc.)
0 Swimming Pool
Fence Material: Fence Height (select all that apply):
/Wood 0 Four Foot(4ft)
❑ Chain Link Six Foot(6ft)
❑ Vinyl 'Other 8'0-
O Block/Stone(Plan details required for footings and/or
retaining walls)
O 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?
/Yes (must submit separate Revocable Encroachment Agreement)
❑ No
Will tree(s) be removed in association with proposed project?
O YY s(must submit separate Tree Removal Permit)
No
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.
s=-1;ii4., REVOCABLE ENCROACHMENT AGREEMENT
,A **ALL INFORMATION
��� City of Atlantic Beach
,- j- 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 thh^State of Florida, hereinafter referred to as "CITY" and
�IQ-f-y VC-A": /^/ 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 ç - -
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 9 s $#4/L F! 5 4 .
• 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. I
U Date /
Propertner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this 8441 day of Iv cm,itl i3 EfL , 20 aa ,
by TFt / FEAIM£LC_ , who personally appeared before me and
(printed name of Signer)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
• 4 • Notary Public State of Florida
t d � Jessica A Doquist Department Approval:
Si ature of Notary Public,Stat ofFlorida lAy OEHission 45 142217
t.P FxpNes
[ I Personally Known
N Produced Identification(Type) 1 L Scott Williams, Public Works Director
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
MAP SHOWING SURVEY OF
LOT 38, BLOCK 6, ROYAL PALMS, UNIT 1 AS RECORDED IN PLAT BOOK 30, PAGES
60 AND 60A OF THE CURRENT PUBUC RECORDS OF DUVAL COUNTY, FLORIDA.
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/ / LOT COVERAGE CALCULATION
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LOT AREA = 7,500 S.F.
/ BUILDI
BRICKNGDRIVE&AREA WALK =: 300 S 1,297 S.F.F,
/
COVERED BRICK - 260 S.F.
/ BRICK(REAR) - 196 S.F.
/ A/C PAD .,9 S.F.
NOTES: / TOTAL IMPERVIOUS AREA- 2,062 S.F.
I 1.THIS IS A BOUNDARY SURVEY. \"\ EXISTING LOT COVERAGE ..27.5%
2 BEARINGS NAM ON THE WESTERLY /
RIGHT-OF-WAY LINE OF SAILFISH DRIVE BEING
SOUTH 23'37'33'WEST PER PLAT. •--.„../
1 arum RESTRICTION LINES SHOWN PER PLAT. /
THERESA A. FENNEL
4.EASEMENT SHOWN PER PLAT.
THIS SURVEY IS CERTIFIED T0:
THE PROPERTY DESCRIBED HEREON LIES IN FLOOD
ZONE'X'(AREA OF MINIMAL FLOOD HAZARD)AS NELL
AS CAN BE DETERMINED FROM THE FLOOD INSURANCE
RATE MAP Ne. 12031C0408J,REVISED NOVEMBER 2.
2015 FOR DUVAL COUNTY,FLORIDA.
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'NOT VAUD DI ROUT THE SIGNATURE AND FLORIDA UMW) SURVEYOR an¢i44PPi:R'P['a•L5.293
IHS ORKMAL SEAL OFA FLORIDA II _
MIMED SLIRWYOR AND MAPPER.' FLORIDA UCEHSED SURIEW40 and MAPPNIG DUSUNESS No.LB 3572 '
��D BY: BOATWRIGHT LAND SURVEYORS, INC. °A`.'JkI,., G •
DRAM BY: KJC-P
FILE zoz2-to34 1500 ROBERTS DRIVE. JACKSONVILLE BEACH. FLORIDA 241-8550 511EET I:tet ..1: