457 SAILFISH DR - FENCE (2) r
��'' - f CITY OF ATLANTIC BEACH
' - c' 800 SEMINOLE ROAD
\� ti
ATLANTIC BEACH, FL 32233
% ice; INSPECTION PHONE LINE 247-5814
FENCE WALL OR BARRIER - FENCE
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: FNCE18-0022
Description: 6' FENCE
Estimated Value: 0
Issue Date: 3/27/2018
Expiration Date: 9/23/2018
PROPERTY ADDRESS:
Address: 457 SAILFISH DR
RE Number: 171374 0000
PROPERTY OWNER:
Name: GUNTHER GREGORY C ET AL
Address: 457 SAILFISH DR
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name:
Address:
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
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 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.
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.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
�51,J- J City of Atlantic Beach APPLICATION NUMBER
is ,. S\ Building Department (To be assigned by the Building Department.)
r ,, 800 Seminole Road I— NCS, 18 _Oo 2 Z
5 : Atlantic Beach, Florida 32233-5445 lJ
Phone (904)247-5826 - Fax(904)247-5845 �/ ( l
A".:611 9'i. E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 'I S-7 `m Pvl L F(S b bi2___De ent review required Yes No
uildiry� !/
Applicant: )(✓l'1\Defe___ anning &Zonin
( Tree Administrator
Project: ( EE1vQ i . Works
Public Utilities)
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: WrApproved. ❑Denied. ❑Not applicable
(Circle one.) Comments: 7
V'a'va .or o �' �xk rnl SS. i‘-‘
BUIL I
PLANNING & ZONING Reviewed by: rn -- Date: 3//21201 r
TREE ADMIN. Second Review: KApproved as revised. ❑Denied. Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: f 7 Date: V2V,01/
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
OFFICE COPY
, ,,„,..r,,„
t CITY OF ATLANTIC BEACH
�� 800 Seminole Road
�' MAR 1 2018 Atlantic Beach,Florida 32233
\J;!!9' _
REVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS
Date 3k (,r Revision to Issued Permit Corrections to Comments/I�/ Permit# FAKE; 1 C0l2
Project Address 'FS 7 -/ 3--4_ Dom. ,-g. ;c ,&a-tc4
Contractor/Contact Name 61,1;0(7' �P�tce. ii- .AL7 v` . C .J 4-7714Pv,
Phone f— 3j f-2-7,c/6 Email71e7c)m4o Dry(�to7-i-"q,(cion
Description of Proposed Revision/Corrections: Permit Fee Due$ •-...n
di e',7- 1,-/C), 1 ej --PetIce_._ .94(4.90-1 4c>v-1 sae • (------ee-e ,(5
C��/ g4 2(/Tl 92�A C C� 6(c/( ' i`7 S efict e47 �jtl�e`2 4.b0//'s -g--) -€-.tVl'� 520IJ7 - L%(-t �e�l , J /
Additional Increase in Building Value $ Additional S.F.
By signing below,I 9/`G•• (9;,t ✓fffiet� affirm the Revision is inclusive of the proposed changes.
(printed name) //
3 ‘7(jr
Signature Contractor/Agent Contractor must sign if increase in valuation) Date
(Office Use Only)
Approved Ar----- Denied Not Applicable to Department
Revision/Plan Review Comments
Department Review Required:
XPi nning & Zoning eviewed By
Tree Administrator
public Works
Public Uti i ies 312 Z/Zo L -
Public Safety Date
Fire Services
1l—ev s7A
Js CITY OF ATLANTIC BEACH
=. 3 SJ\ 800 Seminole Road
•sr MAR 1 6 2018 Atlantic Beach,Florida 32233
15 REVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS
Date 3/6( r' Revision to Issued Permit Corrections to Comments Permit# FAKE; 1-C0l2
Project Address Y5 7 .%45-4_4_ a. 4 lcr=i7„. i\et-c4
Contractor/Contact Nameicro.ov` 4-rc� / c 7 rw�rev` ' C�/'E' C�v�i'77Z v1
Phone 2_0t/— 3/7-7Y1(5 Email 77,t,14vizr .4.4,6(,./c.,01.‘,1
Description of Proposed Revision/Corrections: /Permit Fee Due $
(A /7-5L-4 �l „—r -PPv,cL ,(A5,4,(4„, 4„,/,--A sae . (---eci ce i's
ce,; g A 20-Y 94 L..t c `C _rit' Il=l°i Slr1/,rG,G GICJC 2 4 Lcw,s G 1 G�.
ajec-Ci 5c,11/'b e7 e -l-t -4ec .
Additional Increase in Building Value $ Additional S.F.
By signing below,I �/kG- (4' '1` +ei/\ affirm the Revision is inclusive of the proposed changes.
(printed name) /
Signature c Contractor/Agent Contractor must sign if increase in valuation) Date
(Office Use Only)
Approved / Denied Not Applicable to Department
Revision/Plan Review Comments
Department Review Required: a -
4[Liticig_.____>----,.,nning & Zoning__) Reviewed By
Tree Administrator
(Public Works 3_2 1 (,53.
U
Public Utilities
Public Safety Date
Fire Services
( \S� - City of Atlantic Beach APPLICATION NUMBER
J'f?r �\ Building Department (To be assigned by the Building Department.)
\"J 800 Seminole Road 1- NCE 18 _002 z_
; -•,_, Atlantic Beach, Florida 32233-5445 3/
� Phone(904)247-5826• Fax(904)247-5845 Date routed:
�-5— E-mail: building-dept@coab.us MAR 0 7 2018 8
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: (4 57 SPOLF-(3 >-1 i". (2_De. . i I ent review required Yes No
uildi
Applicant: C_ )(A_Di\Dee____ .' arming &Zonin
Tree Administrator
Project: (a F C,� is Works)
_ Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept.of Environmental Protection
Florida Dept. of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: ❑Approved. I Denied. ['Not applicable
(Circle one.) Comments:
BUILDING
.c
PLANNING &ZONING Reviewed by: 4,ernj��`� 1 6, Date•
TREE ADMIN. Second Review: [)(Approved as revised. 1 (Denied. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
r
PUBLIC SAFETY Reviewed b : - „ ,dY Date 2') ,60
12
FIRE SERVICES Third Review: Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
. ""'7W .
;: ' MAR 21 2018
ti 4 i CITY OF ATLANTIC BEACH
;., - _ ;,4 >-, 800 Seminole Road
s)111,1
M A R 1 n 2018 Atlantic Beach,Florida 32233
-
REVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS
Date 3761,7 Revision to Issued Permit Corrections to Comments X Permit# FAK la 1 oo2-2
Project Address 41.5 7 _.%,45-4. Dom. % 4/7,,,/,',_ /3 c-fit
Contractor/Contact Name 6'pl,f0VN ! CGZG� /t'c17 G4,4meal ' 6;e7 v,-i/Z,, '
Phone aDd--' 3/7-WC J6 Email 77()vt7/47h11/. Gia crfcam' in
Description o/ /flProposed Revision/Corrections: Permit Fee Due $
ct-ibc,1 ,..,-r pevic,„
,,, 4„,„--/-K sae • e--ei ee ;3 fl
Ce,,i g A 2 54 A-1 c slid jeit.7 S ex `s `k,7 ('6-7`.7 t L 11 s - 6-,��.
/
ak, st2oVe7 e- -r-A, _4eel .
Additional Increase in Building Value $ Additional S.F.
By signing below,I (/`G- (Lt +9`iffeV\ affirm the Revision is inclusive of the proposed changes.
(printed name)
„ .‘7(a
Signature Contractor/Agent Contractor must sign if increase in valuation) Date
(Office Use Only)
Approved Denied Not Applicable to Department
Revision/Plan Review Comments
De artment Review Required:
nning & Zoning _) evi•we�By
Tree Administrator
(rublic Works----. ‘f-0Z71
, 10P
Public Utilities 0�J�
Public Safety Date
Fire Services
CITY OF ATLANTIC BEACH
% Department of Public Works
1200 Sandpiper Lane
Atlantic Beach, FL 32233
,'� (904) 247-5834
PUBLIC WORKS PLAN REVIEW COMMENTS
Date: 3/14/18 Applicant: Greg Gunther
Permit#: FNCE18-0022 (DENIED Fence) Address: 457 Sailfish Drive E.
Site Address: 457 Sailfish Drive E. Atlantic Beach, FL 32233
Atlantic Beach, FL 32233 Email: ggunther68@hotmail.com
PUBLIC WORKS CORRECTION ITEMS: APP VED
• A Revocable Encroachment Agreement m st be obtained.
PUBLIC WORKS CONDITIONS OF APPROVAL:
(The following comments will be printed on your permit as Conditions of Approval)
• All runoff must remain on-site during construction.
• Roll off container company must be on City approved list (Advanced Disposal, Realco Recycling,
Shapell's, Inc., Republic Services, Donovan Dumpsters). Container cannot be placed on City
right-of-way.
• Full right-of-way restoration, including sod, is required.
• All old fencing must be removed from job site by Contractor.
Scott Williams, Director of Public Works swilliams icoab.us /904-247-5834
THIS PLAN REVIEW IS ONE OF MULTIPLE DEPARTMENT REVIEWS
Corrections and Revisions must be submitted to the Building Department at 800 Seminole Road.
Revisions may not be submitted until ALL departments have completed their respective plan reviews.
Revisions submitted must respond to each department review.
Submittals that respond to only one or a few correction items will not be accepted.
Resubmittal Notes:
All revisions and changes shall clearly stand out from the rest of the drawing on the sheet as a revision by way of
completely encircling the change with"clouding".The revision shall also be identified as to the sequence of revision by
indicating a triangle with the revision sequence number within it and located adjacent to the cloud.The revision date
and revision sequence number shall also be indicated in a conspicuous location in the title block for each sheet on which
a revision for that sequence occurs. For projects still in the initial review stage and permit pending, all sheets with
revisions shall be inserted into each set of drawings.The original sheets must be clearly marked "VOID" but are to be left
within the set of drawings. Complete new sets of drawings will not be accepted. ADDITIONAL ITEMS MAY BE
REQUIRED DEPENDING UPON NEW INFORMATION AND CLARITY OF FINAL PLANS SUBMITTED FOR REVIEW.
Page 1 of 1
o LAIJ;yr, City of Atlantic Beach APPLICATION NUMBER
r� WA Building Department (To be assigned by the Building Department.)
• 800 Seminole Road 1`(vlJ
C� Cg _ ��
0, =r Atlantic Beach, Florida 32233-5445 MAR 0 7 a01$ / _
Phone (904)247-5826 • Fax(904)247-5845 3/ �P it (�,X11 �? E-mail: building-dept@coab.us D routed: J
City web-site: http://www.coab.us N._
APPLICATION REVIEW AND TRACKING FORM
Property Address: '1S 7 S P-l(,•,(=(3 �l ( De. . . . ent review required Yes No
. j uildin•
Applicant: 0 (ADIvE►Z ' arming &Zonin
--Tree Administrator
Project: �Q Ic3C.__. is Works
cublic Utilities,
Public Safety
Fire Services
Review fee $ iV Dept Signature Xws,\
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: I 'Approved. I 'Denied. Not applicable
(Circle one.) Comments:
BUILDING /
PLANNING &ZONING Reviewed by: �. Date: 3/ / CY
TREE ADMIN. Second Review: ❑Approved as revised. [iDenied. I 'Not applicable
PUB � T 7-OORKKSS Comments:
BLI ~UTf
3-/9'.—/ I'
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
}„,:Y,� OFFICE COP` ,,
Building Permit Application Updated 12/8/17
KCity of Atlantic Beach
V
800 Seminole Road,Atlantic Beach,FL 32233
��� S.---1.C5
�� � /A^ne:(904)247-5826 Fax:(904)247-5845 � �
Job Address: 2. 5 �k%r . /� Permit Number: �I v C�t ES-D vZZ-
Legal Description reG I('e_ (C7 54 C(/ G�c'rr`�CCG�Pi-��c--""P 1'e�16-�RE#
Valuation of Work(Replacement Cost)$ ((( Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one)0 Addition Alteration Repair Move Dem Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of wo k to be performed: / 1
c'uJ re,-I« (10 /l (.L,.g, 54,em G,/,,e)g cePt4 e i -160(.4.6.e-
Florida
P(i'LGL
Florida Product Approval# for multiple products use product approval form
Property Owner Informatio / /i° /
Name: - 9�h�� Address: `7.S� �, (7d Sin D1: r
City A,4 'c_ %3 ,e_.A / State rG Zip 3zZ3 3 Phone 2Q/- 3/7- 7g-10
E-Mail ciii it:.k- <8 & LLc-Ti-Y► =ry", Cc *-i
Owner or�gnt(If Agent, Power of Attorney or Agency Letter Required)
Contractor Informationr `/ /
Name of Company: ._.x.-12.2k',`0V\ t��i4'T Pc-C I / Qualifying Agent: IGf.t71 C.r2"V^S k r(
Address S/l7b 4`�j•cf� e City iG,c(�S-viUY/P State FL. Zip 32.25c/
Office Phone ) — 5,7 •�6-Ave_1 Job Site/Contact Number CC3` C-7q0
State Certification/Registration# E-Mail
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation
Exempt/Insurer/Le e Employees/Expiration Date
Application is hereby made to obtain a permit to do the work an• nstallations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all wo will be performed to meet the standards of all the laws regulationg
construction in this jurisdiction. I understand that a separ. e permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS, • d AIR CONDITIONERS, etc. NOTICE: In addition to the requirements of this
permit,there may be additional restrictions applicab to this property that may be found in the public records of this county,and
there may be additional permits required from oth• 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
RECORDING Y R NOTICE COMMENCEMENT.
(Signature of s -r or Agent) (Signature of Contractor)
(includ • tractor)
�ed and s orn to(or affi •• befor this, / day of Signed and sworn to(or affirmed ore me this day of
201Sby ' VIP 1 . er , by
-.......--- --i, AM
_,: ,u MY COMMISSION#FF•;.' at • o otary) ' (Signature of Notary)
;'•..y ,PF= EXPIRES:October 6,2019
Asa r ota Public Underwriters
[ � •e'Ps@lF�1� Kf'k'i�� ry [ ]Personally Kn n OR
[ •ro•uce• •en i Ica ion [ ]Produced Identification
Type of Identification: Type of Identification:
1t AP 1,
r t AtOr " ' CITY OF ATLANTIC BEACH
'4 �~ 1J%WNER / BUILDER AFFIDAVIT OFFICE COPY
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. TELEPHONE THE
BUILDING DEPARTMENT(247-5826) 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.
1/5 ? 5,7/454 a, 15 201- 3/7- '73-10
ADDRESS PHONE NUMBER
6'1;1 (7—Pc" 16
PRINT NAME //
7/ 7
SI ATURE DATE
Before me this / day of 01 e county of
Duval,State of Florida,has personal y appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate. f r
Notary Public at Large,State of r ( ,County of JU V Q/
o Personally Know '-7 army # S �/
o Produced Identif•. T(� �/6--
=Q. Yev TONI GINDLESPERGER
I Of �, MY COMMISSION#FF 924951
Notary Signatur , ". d_ EXPIRES:October 6,2019
ct,;:i f;4P' Bonded The Notary Public Underwriters •
F:BLDG/Owner-Builder Affadavit REVISED: 4/16/2009 —
Ai g RIGHT-OF-WAY/EASEMENT PERMIT
40211,"i
Permit#Issued by the City of Atlantic Beach
PERMITTEE RESPONSIBLE� FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address W57 . ,'l-CGS i a L 74 13 Phone Za/—3/7 "7310
Permittee 7Al- tori- Email VticilLr7t (r q (,Gcw''I
Requesting Permission to Construct "—eel C 2_
•
Location(Reference to Cross-Street) `/-!-,'1,.S 4 -'-tsixta
• Permittee declares that prior to filing this application they have ascertains 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 Director of Public
Works,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 Director of
Public Works 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 .;4 ( S4; nn (Project Superintendent)
with Company Name 5/061/V00 P-frtce -r/pct;/ Phone 9C - 3/( 700
• All materials and equipment shall be subject to inspection by the Director of Public Works.
• 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 0 days. If the beginning date is more
than 60 days from date of permit approval then permittee must review the permit with the Director of Public
Works 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.
• The Director of Public Works shall be notified twenty-four(24)hours prior to starting work and again
immediately upon compl ti
Date 3�1�(/
Permittee(s' in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL /RC1 �/
The foregoing instrumentwas ac wledged this ' day of it . ,20 / b ,
by .(;:/1 lv� , 1 / , �%/
,who personally appeared before me and
printed name of Permittee)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
4i
Personally Known
Signat of Notary Pu • ,State . Aida 0A Produced Identification(Type) F L &J 4-v 1 L L.0*1,sq
......."•. JENNIFER JOHNSTON
ei. ,•% H_ MY COMMISSION#GG 042984
, ,:o; EXPIRES:October 27.2020
%%r,or���P• Bonded Tru Notary Public Underwriters
e. - ,.
r• \t
`" REVOCABLE ENCROACHMENT AGREEMENT
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach,Florida,a municipal corporation
organizeand existing under he laws of the State of Florida,hereinafter referred to as"CITY"and
5,fte �jv7 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 dleo, -JP€tet C� ;GtS74 •
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
• 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
here ssumed by the US
Date 3 U
Property er/Agent(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL /.,
The foregoing instrument was acknowledged this ((� day of �otvle- ,20 ` (5 ,
i
by C��i'e€ wM P v n 0 ,I o personally appeared before me and
(printefname of Signer)
acknowledged that he/she signed the instrument volun arily for the purpose expressed in it.
I •:R : JENNIFER JOHNSTON
, MY COMMISSION#GG 042984
': ;,`_ EXPIRES:October 27,2020
Sign I e of Not. 'ublic, e of Florida .,gp: Bonded Thru Notary Public Underwriters
JD a •
Personally Known
Produced Identification(Type) FL 6-( ,�4,` s'td-12-113 L -
Scott Williams,Public forks Dire or/
Kayle Moore,Public Utilities Director
H:\Master Forms\Public-Utilities Works Forms\Revocable Encroachment Agreement 2.5.18.docx
Revision Date:2/5/18
BOUNDARY SURVEY
Date Of Field Work-03119/2017 Drawn By-D Order#:1000006973
A 457 Sailfish Dr, Jacksonville, FL 32233 _.
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-ALL ANGLES AND DISTANCES SHOWN HEREON ARE BOTH RECORD AND MEASURED UNLESS OTHERWISE NOTED
SHEET 1 OF 2(SKETCH OF SURVEY)-SEE SHEET 2 OF 2 FOR LEGAL DESCRIPTION.AND OTHER SURVEY RELATED DATA.SURVEY I_S.NOT
COMPLETE WITHOUT ALL SHEETS
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PHONE: 561.508.6272 THE APPEaRT 45NTHISDr. . ENT
NExeiEiNFAX:561.508.6309wnsAUT>-ioiif�D By ,C
LB 8111 ��0. Nr. .L
SURVEYING, LLC. `•.\. SM ;288 `
5601 CORPORATE WAY, SUITE 103 WEST PALM BEACH, FL 33407 9N 3121/2017..
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