1865 HICKORY DR RFNC23-0122 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
CAMPBELL WALTER 1865 HICKORY LN ATLANTIC BEACH FL 32233-4548
COMPANY:ADDRESS:CITY:STATE:ZIP:
BEACHES FENCE DECK &
PERGOLA LLC 844 MAJESTIC CYPRESS DR JACKSONVILLE FL 32233
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
172020 1432 SELVA MARINA UNIT
12C R/P
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1865 HICKORY LN RESIDENTIAL FENCE ONE
STREET FRONTAGE
Install 6' tall and 5' tall
fences $2468.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
ZONING FENCE PLAN REVIEW FEE 001-0000-329-1003 0 $35.00
TOTAL: $35.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
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.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 2Issued Date: 12/19/2023
PERMIT NUMBER
RFNC23-0122
ISSUED: 12/19/2023
EXPIRES: 6/16/2024
RESIDENTIAL FENCE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 12/19/2023
PERMIT NUMBER
RFNC23-0122
ISSUED: 12/19/2023
EXPIRES: 6/16/2024
RESIDENTIAL FENCE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
s 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
Phone: (904) 247-5826 Email: Building-Dept@coab.us
IS REQUIRED.
Job Address: 1 'LD` I -+Gv,U 10 L- Permit Number: ia NC2? -._0( 22-
Legal Description 37-71 09-.1s .y6set v4 mAel"141./A/+ 1"f ZGK'GP&r T RE# 17Z / —(43Z-
Valuation of Work (Replaceent Cost) $ 2-y Heated/Cooled SF Non-Heated/Cooled
Class of Work: JdN ew Addition Alteration Repair Move Demo Pool Window/Door
Use of existing/proposed structure(s): Commercial 2Residential
If an existing structure, is a fire sprinkler system installed?: Yes Ga1Vo
Will tree(s) be removed in association with proposed project? Yes(must submit separate Tree Removal Permit) IGmlo
Describe indetail the type of work to be performed: .. N n CL i /Q1...,. ki? TALL €.-& L ir;.Ac i_(...(r- L
5 '`111 L.L. 5 t `UCS R Ot`i7-C
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name 1/4 e.'Z g-c /`l LL Address ( L 4r C. (7 ti L i\.)
City 4r/.4Nt "C.. >°(kl State .C-.-- Zip .Z 4317 Phone (7( 9 c-'C-'7q!
E-Mail
Owner or Agent(IfAgent, Power ofAttorney or Agency Letter Required)
Contractor Information
Name of Company '& At LS "FiE"(...C Dce-14 FE is„l1 Qualifying Agent s d 1,-) 1)(9Z4,2.L/,S
Address {l W1 ES t LC. L a' City ,A'C ,-,1lLC,LState PC_ Zip 3.2_2.53
Office Phone (31)24 $ 9S,`b, Job Site Contact Number
State Certification/Registration# 3-3 I -7(,J 1 E-Mail 13140 E.5 c DQ C-1vl!\I L . (-(.T'"1
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer j4 M`r C l% i OR Exempt Expiration Date 1 / Z c(
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 ofall the laws regulating
construction in thisjurisdiction. 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 ofthis
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 theforegoing information is accurate and that all work will bedone in compliance with all
applicable lawsregulating 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
RECO; ING YOUR NOTI E OF MMENCEMENT.
0
Signature of Owner or Agent) Signature of Contractor)
Vetl 51,nco-ceps9-;h c,
Signed and sworn to(or affirmed) before me this 1 1 day of Signed and sworn to(or affirmed)before me this II day of
OeCe/nb.r, aG,2_ ess, A-1 lc r 1)0Lembn 3oa 3, by 73 .. ..'I:. • c ,
7&d•e /'i '
Si nature of No : Signature of N. ary)
Notary ; :isu!f°•.,d0>!iso "
i: Jesse AA Dcdqust Notary Pu0'slate of FurfdaJPersonallyKnownORguyCc. mea. . i:H¶42217 Personally Known OR Jessica A Dtiquist`
Expires •• My Conxr t 142217
Produced Identificatio Produced Identification \Fd Expires Ott/14/2a
Type of Identification:pe of Identification:
Fence Addendum(Updatedl/14/1021
City of Atlantic Beach Building Department
j" 800 Seminole Road, Atlantic Beach, FL 32233 PERMIT# r-RNC23-C(22
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
1 '1 a-( IC Le,( L—i\) 2/if /z3
Property Type:Lot Type/ Features:
VResidential jZ One 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):
Wood Four Foot (4ft)
Chain Link Z.Six Foot (6ft)
Vinyl E Other
Block/Stone (Plan details required for footings and/or
retaining walls)
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?
V 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)
jd 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.
REVOCABLE ENCROACHMENT AGREEMENT
Cityof Atlantic Beach ALL INFORMATION
HIGHLIGHTED IN GRAY800SeminoleRoad, Atlantic Beach, FL 32233 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
d41:- 4--4- LEA^'t L(I4 M Qof 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 \hE t '_ G A-71 J..1
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 thefollowing address ISSIU C \Ck.O2 '
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 oradding
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 tothe 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.
tl P f ( Date /a) 1 'I
Property Owner/Agent (signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL IITheforegoinginstrumentwasacknowledgedthist ( day of `x(10 20
by 1--0-/a N j U2— .AVIApY.I\ \printed name ofSigner), who personally appeared
before me and acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
TONI GINDLESPERGERid •MYCOMMISSION#HH 407122
EXPIRES:October 6,2027
Department Approval:
Signature of Notary Public, State of Florida )
Personally Known
Produced Identification (Type)Public Works Department Date
Revision Date:05/09/2023
17: 7"`.
MAP SHOWING BOUNDARY SURVEY OF
LOT 15. SELVA MARINA UNIT NO_ 12-C REPLAT, AS RECORDED IN I
PLAT BOOK 37. PACE 29. OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY. FLORIDA.
CERTIFIED TO:
WALTER W. CAMPBELL AND LEA ANNE CAMPBELL
T1COR TITLE INSURANCE COMPANY
JAX NAVY FEDERAL CREDIT UNION
3USCHMAN. AHERN. PERSONS AND BANKSTON
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NOR:::_RLY U'CJNDAR1' LIN.. OF SUBJECT PARCEL DATE DESCRIPTION
2. DV L...PHIC PLOTTING ONLY T.15 CAP-MINED LANOS LU: WITHIN FLOOD ZONE X AS SHOWN ON THE
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3. THIS :.URVEY REFLECTS Mt EASO4ENTS & RIGHTS CF WAY AS PER RECORDED PLAT A:/OR TITLE COLIMITIIENTIFSL:•PLUED. UNLESS OTHERWISE STATED. NO OTHER TITLE VERIFICATION HAS BEEN PERFORMED BY THE UNDERSIGNED
4. 1-11_. :.URVEY NOT VALID V,1T40UT THE ENBOSSFD SEAL OF THE CERTIFYING SURVEYOR.
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