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870 Seminole Rd DWAY24-0008 Application -s,L,f,, BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY i2 City of Atlantic Beach Building Department PERMIT# WA Zy— o� 5,;-' fl l� H 800 Seminole Road, Atlantic Beach, FL 32233 **ALL information required to process ' 9.' Phone: (904) 247-5826 Email: Building-Dept@coabb.us Job Address 270 Se mjnole rd , A'1-Iqn--ic f) c& FL, 3 ?.)33 RE# ( 7C — 0000 Legal Description .ael - 1 7 lc - as - a 9 E S e. I t)ci Nlci r)yla 1) -3 Lo4- 1 BL f\ 7 Valuation of Work(Replacement Cost) it 13,1 1.6 Heated/Cooled SF Non-Heated/Cooled SF •Class of Work: ❑ New ®Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial ®Residential • If 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) © No Describe in detail the type of work to be performed: Re. - out', e—xls-t-iiqj SO t , ]h .54II ►^oG}rc,ligzi.)gy L.✓i• block bo1.46r Florida Product Approval# (For multiple products use Product Approval Information Sheet) Property Owner Information Name Chia 5-r 0 p he,v- 4 Ir0 1,U 5 J('i Phone Address g 70 5 6.4111 01016 i"d J City 4-k v4 (G State pc. Zip 3c).,:)..33 Email arts bLA!co i.,w5k1 O,wnf or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company Roc,kgWct/ thc, Phone Address S)1 5 (,X 4 547 City ,-qy(•/-/c L o4\ State R. Zip 32 33 Qualifying Agent GI^G3 8(4115 hrtV•-. 1 - State Certification/Registration# Email Z61u41-Aeo r.,:ch-Q,,,rviA,,:,;,,1Qb Site Contact Number 109--775—-0.23X Worker's Compensation Insurer App •+' 5O.I e OR Exempt ❑ Expiration Date 7— I—aoa9 11.6..)co3y1744?4rt. Architect's Name Email Phone Engineer's Name Email Phone 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 city/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 YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE SITE OF THE IMPROVEMENT BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. d 'IA-4e,-44- . 3cickalk-,- -uejl. (Signature of Owner or Agent) (Signature of Contractor) Asi Signed and sworn to(or affirmed)before me this 2 day of Signed and sworn to(or affirmed)before me this 2 day of F-610N1Ut, , 20 Z`l by J I' r I kers .13,V1:P"SEG i FelOrt.1t l , 2C244 by 7 _ , 4?. ._ k C Signature of Notary Signature of Notary /� [ ] Personally Kn. n OR [.4- •roduced Identification [ ] Personally Known OR kerlcoduced Identification Type of Identification: TSL OL-- Type of Identification:.t(._ 0L— �pf!i1.i�' .t11' Pl4. a• VANESSA ANGERS `^"':e4='• VANESSA ANGERS - :* MY COMMISSION#HH 244118 t: ° MY COMMISSION#HH 244118 -.---,-1,-.<7.:' ••;.. "...e. EXPIRES:March 23,2026 ` •��•o; EXPIRES:March 23,2026 -s=."1 r;,, RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION \• „i City of Atlantic Beach HIGHLIGHTED IN GRAY IS 800 Seminole Road, Atlantic Beach, FL 32233 REQUIRED. r" PERMITTEE RESPONSIBLE FOR NOTIFYING( ,,, 811 AND OBTAINING UTILITY LOCATEST� �/ Job Address 8 v 1(noU.. 'a d • 1'TTI�JU 11(Cid)1 Permit Number WA 2y- D��� Sa23� Contractor Information �n �( Company taw n G• Qualifying Agent C r U VI► '�r(��� i r� v Address 1,�/ ��"" �Jl� i City /tea ,�.f,�, ��p�,�,,� State �I Znlp�,,,3,P-2-33 Phone D"l •8 3 ' (o 51� Email 74.W t f a e1o.%f�Cil.1/� li(�('/�1,L�('I State Certification/Registration# Architect Phone Email Engineer Phone Email Workers Compensation Insurers A131) t SOUYC& OR Exempt]Expiration Date 1- • I •ZN We e3 -& 19 FL- • Permittee declares that prior toliling 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 ttn)LI /''(GSSG,' (Project Superintendent) with(Company Name) ILoc.IPlwgy To co, Phone 4011 -775-i 36 • 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 CO 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. • T e Public orks i iirrector shall be notified 24 hours prior to starting work and again immediately u on completion. • ( .�%� (i- Date a, *,/c2 Permittee(signed in presence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument was acknowledged th•is 2k6 day of F t V1_ Lvtr� 20 7y by iris- tA. ( M • -guico .Sle-I ,who personally appeared before me and (printed name of Permittee) acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. , ;=ot""•':'• :;,••; : VANESSA ANGERS * r MY COMMISSION#HH 244118 fi '.' OF F,o,:,: EXPIRES:March 23,2026 ' — `— [ ] Personally Know Signature of N u lic,State of Florida [4oduced Identification (Type)FL b 1.. H:\Applications&Forms\Word Documents\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18 REVOCABLE ENCROACHMENT AGREEMENT 1-t" **ALL INFORMATION City of Atlantic Beach r' 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY 0 %// 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 h r15- o flk 4- Q`^lrowS In 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 r Oc- AN, vG Wet1,0 Ni4A 61001r b0,464- 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 70 Sevhia\a)e, ('di .k{-fan4"ic Gcl t, FL. 3233 . • 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. Date o//a/o2,/ Property Owner/Agent (signed in presence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument was acknowledged this 2&C.( day of rep niCk&I , 20 2(4 • by CNrt.5-419k€r NI- i3k#KowSto) (printed name of Signer), who personally appeared before me and acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. t"PY' 43Oti VANESSA ANGERS *i :*E MY COMMISSION#HH 244118 EXPIRES:March 23,2026 FOF,,,, Department Approval: Signature otary Public, State of Florida [ ] Personally Known Aroduced Identification(Type) iL DL_ Public Works Department Date Revision Date:05/09/2023 = OUNDARY SURVEY s (A)= BLOCK ry; r 4J 3 `r s,0 J 3 c CORNER v m 1,3 r7 M --� ,_,Z C�0 FOUND 1 n ,6 0 v X s IRON R01 r a- £ o tD ri 7 tP J z cr - NO I.D. s Q ri _JO off– x az, V1. T � (B)=COVEREDCli CONC. `�� .i S ,LOCK '-® 6 to (C)= CARPORT j S 6.�CORNER � tn S J k`i u o S c, G o S 7 LOT 2 2 - \/ Q :-V v f5 BLOCK i .7112" ' U jI v1 >C ) N N IRS ROD r- 0 275.00 0.2' D I Sa3 42'00"W rA/C 44.0' w li173_ cr) • 26.8N ----- II �, I BUILDING Pi!, Z ao.4'f #a70 w o O CONC. QD 0 Emco o' WALK o r co ii co )61:_;---;) COVERED 5.6' I CONC. 631 'v"" rn L �i 7d is Q B4OCK j w 0.5 w \' A o rn 24.2' 24.T „_ o o 22'x16' :..:5 o;(B)'"CONC. 0.0'oa . I C7 0 0 // BUILDING -..DRIVE' 0.4' Ri // WOOD L 9C�,ti 1 _, _ �� DOCK �10'B S. off . .• 1 Fr — _ 6, LIMITS //3.1' 0.5' 0.4' �r—S83°42'00"W 27f00` -.7‘'–r H.tib...• �� SET 1/2" :� ®r IRON ROD : - II �`o LB#7893 II • _ - - — - - THE PLAZA I cohce 4. -f v 6e II 80' / (IMPROVED) �w�ovcd (aai. g sof+) SURVEY NOTES CONCHE IE(NNE AND CONCRETE WALK CROSS THE PROPERTY LINE ON EASTERLY SIDE OF LOT. THERE ARE FENCES NEAR THE BOUNDARY OF THE PROPERTY. BUILDING CROSSING INTO THE PLAITED 45'BUILDING SETBACK LINE ON EASTERLY SIDE OF LOT. t " ' ° s � I a o TARGET "� � No.6415 'C'' SURVEYORS CERTIFICATE �` I HEREBY CERTIFY THAT THIS BOUNDARY SURVEY W IS A TRUE AND CORRECT REPRESENTATION OF A SURVEYING,PING,T T C SURVEY PREPARED UNDER MY DIRECTION. 1J V 1\r 1.i 1 it 1Jl.J�.i NOT VALID WITHOUT AN AUTHENTICATED ELECTRONIC LB#7893 �m STAT E SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL, goy r- o ORARAISED EMBOSSED SEAL AND SIGNATURE. SERVING FLORIDA �' Kenneth Digitally signed by Kenneth Osborne :: ii : Date:2019.09.06 OSbOrne15:51:50- 04'00'(SGNED) cle..7/,/efarrof. KENNETH J OSBORNEOYCbf1P LTE(1 7 PA�FC STATEWIDE FACSIMILE (800)741-0576 PROFESSIONAL SURVEYOR AND MAPPER#6415 IN I ,(CE II WEBSITE: http://largetsurveying.net \ J IR Rockaway Bukowski Residence 870 Seminole Road Atlantic Beach, FL 32233 Total Existing Impervious Surface: 5,478.4 sqft (20.43%) Total Exisiting Impervious Surface To Be Removed: 221.8 sqft Total Impervious Surface To Be Added: 140.03 sqft New Impervious Surface Percentage: 5,396.63 sqft (20.12%) Install weed barrier,install 1,528.6 sqft of 1" Grey Granite 4" depth Install 145.75 Linear Feet of 4"x8"x12" block as border 161—.111111111