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2139 SEMINOLE RD DWAY23-0008 %S``'�%,� Building Permit Application Updated 10/9/18 o 'I City of Atlantic Beach Building Department **ALL INFORMATION ow trstp IN GRAY 800 Seminole Road, Atlantic Beach, FL 32233 ss1�`• IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: 2.139 SES M, CI C.) l e' P\O R.i3 FL 3113"S Permit Number: DLI :,"), R�23 OOC) Legal Description /-- 25- 2_9E ,7-1-i(4 RE# /G 75-5-- O5195-‘ Valuation of Work(Replacement Cost) $ g can" Heated/Cooled SF Non-Heated/Cooled i • Class of Work: ❑New ElAddition ❑Alteration �epairrEMove ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial IdKesidential • If an existing structure, is a fire sprinkler system installed?: ❑Yes [ lo • Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) LANo Describe in detail the type of work to be performed: c--- _,),.: ���_� V- V 1, l v-- l V"t'_ L- �-C - / Florida Product Approval# for multiple products use product approval form Property J Owner Information Name //1- 'T A cLovi S Address Z139 5-4.44,4 4)44 i2.0 City kiJa/► .PC 914ci, State FL- Zip 3z.2--35 Phone .5--Z4,-- Y-20- 1q3.' E-Mail li/,',41/ 7yahzav • (-G"4 Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company Qualifying Agent Address City - State Zip Office Phone Job Site Contact Number State Certification/Registration# E-Mail Architect Name& Phone# Engineer's Name&Phone# Workers Compensation Insurer OR Exempt 0 Expiration Date Application is hereby made to obtain a permit to d 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. )OTICE: 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 F L CING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORD oveR NOTICE OF COMMENCEMENT. --- ature of Owner or Agent) (Signature of Contractor) j ned and sworn to(or affirmed before me this day of Signed and sworn to(or affir ed) before me this day of r' k ZOO by-% ,4,>7 r//.‘ Arj s Y (Signature of Notary) (Signature of Notary) f -_;cam f[ ]Personally Known O 114'; ''''''- i ON1 c-NDLESPERGER [ ] Personally Known OR .. MY..OM!�ISSION#00 353178 [ ] Produced Identification [ ] Produced Identifica ;yam ;oma; �. P EXPIRES:Octobe . Type of Identification: Type of Identification: o 0 .EXPIRES: ru otap'Public Underwriters REVOCABLE ENCROACHMENT AGREEMENT JSP City of Atlantic Beach **ALL INFORMATION r r 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY IS REQUIRED. cut REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and existing under the laws f the State of Florida, hereinafter referred to as"CITY" and of Atlantic Beach, Florida, hereinafter referre 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 4-As c.,r_)a 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 7,,1q inn,A/rli�r �p r F/_ 32-2-37 • 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 liabili re hereby assumed by the USER. Date --3/Z 7 Lj Prope 0 %'`-r', Agent(signed in presence of Notary Public) STATE OF FLORIDA, COUNTY OF DUVAL \ The foregoing instrument was acknowledged this G day of IN , 20 G by 6441111.e...- ,who personally appeared before me and (printed name of Signer) acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. Ni "n�P TONI GINDLESPERGER Department Approval: ature of Notary Public,State of Florida t . ,., :� MY COMMISSION#GG 353178 Personally .%•P.` Known `"a•. `�.a EXPIRES:October 6,2023 1 ''...0.F;;`;`?..' Bonded Thru Noter+Public Undecv+riters [ ]Produced Identification(Type) Scott Williams, Public Works Director H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18 Owner Builder Affidavit **ALL INFORMATION HIGHLIGHTED IN City of Atlantic Beach Building Department GRAY IS REQUIRED. 800 Seminole Rd, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/ BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU, AS THE OWNER OF YOUR PROPERTY, TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. . III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA"CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904- 247-5826 OR BUILDING-DEPT@COAB.US ) IF IN DOUBT. V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. Job Address: 27 347 5, ,/t0 �Ly Owner Name: (74714////-e r-Ot,L,47 S Phone Number: 5--?0—5'7‘,.—f9" P' Mailing Address: Z%15'7 6.yr,�/OL +4, City: /�- 1' State: ,'G Zip: j LZ 33 Notarized Signature of Owner .1.# 112.i Thd oing insttument was acknowledged before me this, '12) day of ,I` 2023n the State of Florida, County of41144 Signature of Notary Public e 4_. . ] Personally Known OR Produced Identification I Type of Identification: Updated 10/24/18 '' TONI GINDLESPERGER MY COMMISSION#GG 353178 EXPIRES:October 6,2023 Sonded Thru Notary Public Underwriters : I 1 11 f. II>r Il o a N P 1 1 W N r.r 1`.• g 2 nor ew aNML v 1.os - _ - --- Z a61..1rw r.r....r Ilk r" 030 4 ....:::THREE STORY n+ ,go*.w,•. TAX PARCEL NO. TOWNHOUSE d F F —•r.r .. , 1 695 15-0500 NO. 2139 •• Z WESTERLY AT RIGHT ANGLES TO SEMINOLE ROAD RIGHT OF WAY 226.00' (D) -III' THREE STORY Johnrill TOWNHOUSE —" '� TAX PARCEL NO. •• NO. 2137 � ^ 169515-0510 .... .:.... r EASTERLY AT RIGHT ANGLES TO SEMINOLE 1 ` '.- r I ROAD RIGHT OF WAY 226.00' (D) 1 / 1 I THREE STORY I °tri la. TOWNHOUSE NOM!MR �F I NO. 2135 j . i j I i 1 Ii ,_.__ SITE VIAN 2 we HMI —__—. sa►i:r.I A301 A 1 1 1 , , f I I I 1 AS TO PARCEL MEINEt SMSISOSI MAP SHOWING BOUNDARY SURVEY OF: PARCEL 3 BEING A PART OF GOVERNMENT LOT 1,FRACTIONAL SECTION 9,TOWNSHIP 2 SOUTH,RANGE 29 EAST,DUVAL COUNTY,FLOROA,MORE PARTICULARLY DESCRIED AS FOLLOWS: ' EOR A POINT OF REFERENCE COMMENCE AT A PONT ON THE NORTHWEST COINER OF LOT BPA,AS SHOWN ON NMP OF NORTH ATLANTIC BEACH UNIT 3,R{-IFS CORPORATION,ACCORDING TO NAT RECORDED N PIAT BOOR 15,PAW 93,Of THE CURRENT PUBLIC RECORDS OF CANAL COUNTY,SAID CORNER NTNG THE INTERSECTION OF THE NORTH UNE OF SMD LOT BDA WITH THE EASTERLY RIGHT-Of-WAY UNE OF SEMINOLE BEACH ROAD(COUNTY ROAD NO.ISDN; THENCE RUN NORTHERLY ALONG SAID EASTERLY RIGHT-OF-WAY UNE OF SAID SEMINOLE ROAD,A DISTANCE OF 22230 FEET TO THE RACE AND PONT OF BEGINNING. RICH THE POINT THUS DESCRIBED,THEIR RUN EASTERLY AT RIGHT ANGLES TO SMD RIGHT-OF-WAY UNE,A DISTANCE OF 226.0 FEET;THENCE RUN IN NORTHERLY DIRECTION AT RIGHT ANGLES TO THE PREVIOUS COURSE AND PARALLEL WITH SAD EASTERLY RIGHT-CF-WAY OF SAID SEMNO.E BEACH ROAD,A DISTANCE OF 27 30 FEET;T1MIR RUN WESTERLY AT RGHT ANGLES TO THE PREVIOUS COURSE,226.00 FEET TO THE EASTERLY RIGHT#WAY UNE OF SAO SEMINOLE BEACH ROAD,RUN SOUTHERLY ALONG SUM RNAR-OFWAY LTE 7730 FELTED THE RAO AND PONT OF BEGNMNG. - TOGETHER WITH AND SUBJECT TO A NONNEXCLUSIVF EASEMENT FOR INGRESS AND EGRESS,MORE PARTICULARLY DESCRIBED AS FOLLOWS. - FOR A PONT OF REFERENCE MBNeR2 ATA PONT ON THE NORTHWEST COINER OF LOT BOAA,AS SHOWN ON MAP CIF NORTH ATLANTIC BEACH UNIT 3,R{-0-5 CORPORATION ACCORDING TO RAT BECOOFD N PLAT BOOR 15,PAGE 93,Of THE CURRENT PUNIC RECORDS OF RRNM COUNTY,SAID COMER BONG TIE NR66EC71ON OF THE NORTH LEE O SAID LOT 90-A WITH THE EASTERLY MORTON-WAY LRE Of SEMINOLE BEACH ROOD(COUNTY ROAD NO.6011); TIME RUN NORTHERLY ALONG SAID EMMA',MG HT-OF WAY LEE OF SARI SIMMO E BEACH ROAD.A DISTANCE OF 17520 FUT;MINCE RUN EASTERLY AT RIGHT ANTES TO SAID RIGHTOF-WAY LINE,A DISTANCE OF 100170 FOR A PUCE AND POM OF BBNINK FOR ENO(AMORE. FROM THE PONT O BEliB1 B THUS 013011®RUN NORTHERLY PARALLEL WITH SND SEMINOLE BEACH ROAD,NEO FEET;TENO RUN WESTERLY AT BEGAT ANGLE 10 THE PREVIOUS COURSE,10020 FEET TO THE AFOREMENTIONED EASTERLY LIFE OF SEMINOLE BEACH ROAD,PENCE RUN NORTHERLY ALONG AIM WITH SAID EASTERLY UNE OF SNMNOE IRA01 ROAD,A DOTANR Of 20A0 FEET;THENCE DEPARTING FRONS SRO NOHT-OF-WAY UNE RUN EASTERLY AT MGM ANGLES THERETO,AC6TAIR OF 12520 FEET,THENCE RUN SOVTE Y ATRGHT ANGLES TO THE PREVIOUS COURSE AND PARALLEL WITH SEMINOLE BEACH ROAM A DISTANCE OF 69.00 FEET TO THE SOUTHERLY BOUNDARY OF THIS PARCEL;THENCE RUN WESTERLY AT RIGHT ANGLES TO THE PREVIOUS COURSE,2500 FEET TO THE PONT OF 11[15111110. Nm Pool NWRORn 109515-0510 BEING A PART OF GOVERNMENT LOT 1,FMCTONAL SECTION 9.TOMRCNIP 2 SOUTH RANGE 29 EAST,MORE PARTICULARLY DESCRIBED AS FOLLOWS: FOR PONT OF REFERENCE,COMMENCE ATA PONT ON THE NORTHWEST CORNER OF LOT BOA AS SHOWN OR MAP OF NORTH ATANTC BEACH,UNT 5 RIBS CORPORATION,ACCORDING TO RAT RECORDED IN PUT BOOR 15,PAGE 93, O THE CURRENT PUBLIC RECORDS OF DUE Al COUNTY,FLORIDA SAO CORNER WOG THE INTERSECTION OF THE NORTH UNE OF SAID LOT ROA WITH TIE EASTERLY RIGHT OF WAY UNE OF SEMINOLE BOAOI ROAD(COUNTY ROAD NO. ' GOO THEM RUN NORTHERLY ALONG SAO EASTERLY MIT O WAY UNE OF SND SEANNOEE ROAD,A MANCE OF 2025 FEET TO THE PLACE AND POINT OF INGI NRB.FROM TEE PONT TRIS DESCRIED.STENO RUN EASTERLY AT RIGHT ANTES TO SAID RIME O WAY LEE A DISTANCE 02210 FEET;MICE RUN W A NORTHERLY DIRECTION AT RIGHT MIRES TO THE PREVIOUS COURSE MD PARALLEL WEIH SAID EASTERLY RIGHT OF WAY UNE Of SAID SEMINOLE REACH ROAD,A 06TANCE OF 20.0 FEET;TOME ION WESTERLY AT MR ANGLES TO THE PREVIOUS COURSE,226 FEET TO THE EASTERLY RIGHT Of WAY UNE OF STUD SEMNONE BEACH ROAD;TRICE RUN SOUTHERLY ALONG SAID RIGHT OF WAY UNE 200 FEET TO THE NICE MIDPOINT OF BMBNNI6. SUBJECT TO AND TOGETHER WITH AIRSN' LUSIVE EASEMENT FOR INGRESS AND EGRESS MORE PARTICULARLY DESCRIBED AS FOLLOWS, FOR PONT OF REFERENCE,COWNBQ ATA POINT ON THE NORTHWEST CORNER O LOT BPA AS SHOWN ON MAR OF NORTH ATANTRC BEAM UNIT 3,RC-64 CORPORATION,ACCORDING TO RAT RECORDED N PUT BOM 15,PAGE BS, _ OF THE CURRENT P UBUC RECORDS OF DUVAL COUNTY.FLORIDA.SAID CORNER BONG THE INTERSECTION OF THE NORTH UNE OF SAID LOT BOA WITH THE EASTERLY RIGHT OF WAY UNE O SEMINOLE BEACH ROAD(COUNTY ROAD NO. MR THENCE RUN NORTHERLY ALONG SAID EASTERLY RIGHT O WAY UNE OF SOD SEMINOLE BEACH ROAD,A DISTANCE O 175.0 FEET;THENCE RUN EASTERLY AT RGNT ANGLES TO SAID RIGHT O WAY UNE.A DISTAILL M 1000 FEET FORA PIAL AND PORT OF BEGINNING FOR THIS EASEMENT FROM THE PONT OF BEGINNING THUS DESCRIBED,RUN NORTHERLY PARALLEL WIN SAO SEMINOLE BEACH ROAD,49.0 FEET;THENCE RUN WESTERLY AT RIGHT ANGLES TO TIIIINEV XS COURSE,1010 FEET TO THE AFOREMENTIONED MOTELS WE O SEMINOLE BEACH ROAD,THENCE RUN NORTHERLY ALONG AND MIEN SAID EASTERLY UNE OF SND SEMINOLE BEACH ROAM A DVTNECE OF 20.0 FEET: 91EBR DEPARTING FROM SAID RIGHT O WAY UNE,RUN EASTERLY AT RIGHT ANGLES THERETO,A DISTANCE Of 123.0 FEET;TOM RUN SOUTHERLY AT RIGHT MOLES TO THE PREVIOUS COURSE AND PARALLEL WITH SEMINOLE BEACH ROAD•A DISTANCE O 69.0 FEET TO THE SOUTHERLY BOUNDARY OF THIS PARCEL;THENCE RUN WESTERLY AT RIGHT ANGLES TO THE PREVIOUS COURSE,25.00 FEET TO THE POINT OF BEGINNINS. s nov v. crosweKNr SOI. •.A w:AV tInSEL C Z saint ALY AV[AST, aIHAL Ea.YrY,namE wNEILY IR NNWINYa JR BYMNL NOW Hoff d A 0R) n M111,1"01.E 25.P'CFH/ esmnM.r,NaSG �° w,7AA1[ J i"L - E'1 n11� MKT a2'RN;t7.e•NJ .,. 1 _ I I _'--„-- .. — k 11 No,'saw 2i.J�{EN„� --- u _ _ aRI4L POINT OF B[OIN NIN O— -_�lT�— NP¢naRr 7 a W. CORNER tO F TA% —� TAY PTE- M0. I , IDBI�OI� n/ I US P_ARCEL 0.169516—0600 �� --r..� Neu-0Rm ; 1161NB ,.I •? ��'' A SYR RWININIE TO Mow rrr...— /�A ` , J - Y B RRW 11111E-0 0►NW aRRB(PO SevwWNti 216.72•+'N1 ^it �'A TAX PARCEL NO I I NO.1137 • M71J'.11Y M00'(140-..... /`� A 6a515-03/0 \ I I, -� O r BB WI MO TSV AR•/ ERIN,7 N NMF MANS TO SI NYRE `1 -. �,,,I I p e i //' IoW HEIR OF OR MAW WTI 56BVA7uw 725.72'( ) .1'.. —_ $ y MREE STORY WU POINT OF EF[OINNINO la �✓9R'Mi'� TORR NO.2135 i S.W. CORNER OF TA% I IjI PARCEL 0.169515-0610 4 — Y A a 2 `=! `� I —MO.1,10T .216.2169.B 'IEA() P x gE !iv 1 s1 ail III. 04 o 1 1I� ==Me o100•00 WOW _— -_ ORR- ......RW.- z 11 ;�-om_-I1 0111•0•1110:0310,0100,4A, RWIB .8-.- WY RR IMINARCROCIMNA 111N0000 ORWINKIT ORM DE NRROVIORIR W IRA t T_26 — MR�R�B1.�N—�:RNB�:�W • F+ �B W � .moi .M.11ZreY.�- R 'I=� POINT OF COMMENCEMENT INTERSECTION OF THE NORTH LINE OF LOT 60—A WITH THE EASTERLY RIGHT BEACH ROAD—Y LINE OF SEMINOLE COUNTY ROAD O. 606 CORNER MONUMENT NOTE. .— RECOVERED CORNERS ALE 1/1'RION EVES AD.IUCABUL,UNLESS OTHERWSE NOTED. NO P.C)'S WERE RECOVERED UIAING TH69RNRY. SITS OCT•ENS 11105 e�;p:,eaw Po a,,, .,2' Lr..•.dor iltware...... zerms NoNSRPORN Gar® .L _ _ ,, , Er=0_ am 4m•MMYNmmoneyy• — . — ( CHARLESE.oPORf Rtit,mommmemamm � • ..BBB.1T..S.SWS,f+,a moon v mom co anew moms out ARE +IN.f..— .0 / --. _ 1/ gN ZOw>� 8 �D ATLANTIC BEACH TOWNHOUSE INTEGRATION W 2 ' �+ T TOWN HOUSE OAIEIDIBM W nB9.wN'ATN&Dw4. O R� 1.1921 REBggNS t d 7 W 11120.0 POW ISSUE 21W 59NIOE ROAD-NO6OMlf,RONDA 32233 RaPIin�R.,Ryy W— /`CAME EEENNNEMI WM BiAooON / ._la /