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1831 Selva Marina Dr DWAY19-0045 Circular a } "v'!l.., DRIVEWAY PERMIT PERMIT NUMBER CITY OF ATLANTIC BEACH DWAY19-0045 ' v ISSUED: 10/16/2019 '-':',-{,u111!)- 800 SEMINOLE ROAD ATLANTIC BEACH. FL 32233 EXPIRES: 4/13/2020 y 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. 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. JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK: DRIVEWAY SINGLE OR TWO 1831 SELVA MARINA DR FAMILY DRIVEWAY ADD CIRCULAR DRIVEWAY $3500.00 TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION: CONSTRUCTION: NUMBER: GROUP: 172020 0768 SELVA MARINA UNIT 10B COMPANY: ADDRESS: CITY: STATE: ZIP: OWNER: ADDRESS: CITY: STATE: I ZIP: SCHMIDT LORRAINE M 1831 SELVA MARINA DR ATLANTIC BEACH FL 32233-5619 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. L LIST OF CONDITIONS 1Roll off container company must be on City approved list . Container cannot be placed on City right-of-way. I 1 PUBLIC WORKS DRIVEWAY APRON INFORMATIONAL Notes: All concrete driveway aprons must be 5 inches thick,4000 psi,with fibermesh from edge of pavement to the property line. Reinforcing rods or mesh are not allowed in the City right-of-way. I ' 2 PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL Notes: Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line(904-247 -5814)to request an Erosion and Sediment Control Inspection prior to start of construction. Issued Date: 10/16/2019 1 of 2 i DRIVEWAY PERMIT PERMIT NUMBER CITY OF ATLANTIC BEACH DWAY19-0045 � �"� ISSUED: 10/16/2019 800 SEMINOLE ROAD ,':f-4.-611)9 ATLANTIC BEACH. FL 32233 EXPIRES:4/13/2020 3 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL Notes: Roll off container company must be on City approved list(Advanced Disposal,Realco Recycling,Shapells, Inc.,Republic Services,Donovan Dumpsters, Phillips Containers,JDog/Dennis Junk Removal,All American Roll Off,WCA Waste Corporation). Container cannot be placed on City right-of-way. 4 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL Notes: Full right-of-way restoration,including sod,is required. 5 PUBLIC WORKS RUNOFF INFORMATIONAL Notes: All runoff must remain on-site. Cannot raise lot elevation. 6 PUBLIC WORKS CIRCULAR DRIVEWAY INFORMATIONAL Notes: Maximum circular driveway width within the City right-of-way is 12 feet. 7 PUBLIC WORKS OTHER PUBLIC WORKS CONDITION INFORMATIONAL Notes: Asphalt must be repaired where it matches up to the pavers. 8 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL Notes: Any damage done to infrastructure must be repaired by Contractor. _..p._ ., ,— FEES . .y ,. DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00 ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $100.00 TOTAL: $125.00 Issued Date: 10/16/2019 2 of 2 i �L�7City of Atlantic Beach APPLICATION NUMBER rj Building Department (To be assigned by the Building Department.) 800 Seminole Road c �n�( 9 O�iis Atlantic Beach, Florida 32233-5445kJ t (JLt'�)� Phone(904)247-5826 Fax(904)247 5845: E-mail: building-dept@coab.us Date routed: I al 9 4 1 9 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: l V t. S G LV A- Alt A R(,&).,Department review required Yes No f.uIi 4 Applicant: 0 (ADr3GIt� _- a_nnin. Zoning lj Tree Administrator Project: e„ , 12--Q.-0 1,,,(A-{ nL_ �, "t*..�e.._. LPublic Wo—��Vs"----_, Public Utilities {Th 12-(v Eur Pk- ! Public Safety Fire Services Review fee $ Dept Signature c Q Review or Receipt Date �`` Other Agency Review or Permit Required of Permit Verified By Florida Dept. of Environmental Protection © Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers U Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: nApproved. Denied. ❑Not applicable (Circle one.) Comments: BUILDING �leecl Tce.� f}-.6f er ire//'1,?- PLANNING &ZONING Reviewed by: Date: (0— I G— I cl TREE ADMIN. Second Review: roved as revised. Denied. pp ❑ ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES 56a,(14.i li-e d 1 ce A-6,'dam.,i- PUBLIC SAFETY Reviewed by: i Date: (D-( i — I C FIRE SERVICES Third Review: nApproved as revised. ❑Denied. !Mot applicable Comments: Reviewed by: Date: Revised 05/19/2017 Revision Request/Correction to Comments **ALL INFORMATION �It'bL�''':;� HIGHLIGHTED IN r, City of Atlantic Beach Building Department GRAY IS REQUIRED. -' 800 Seminole Rd, Atlantic Beach, FL 32233 v wow. Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: D L i 1 00' 5 • L'J Revision to Issued Permit OR ❑ Corrections to Comments Date: *07 Project Address: 4 I I7e/d fr/ - i t_ /C te -i 7--,,:i'-' -,-„ TREE & VEGETATION AFFIDAVIT FOR INTERNAL OFFICE USE ONLY r SJ City of Atlantic Beach PERMIT# ,s-,? Community Development Department 800 Seminole Road Atlantic Beach, FL 32233 `�!Y11tl>'' v (P) 904-247-5800 SITE INFORMATION ADDRESS /23/ SOLI/ /j/f�.e(,44 ��/.(47-2. 4-Ari7c i¢/'Az/,F? 3 2_253 A/ - / /4Lor-A /kJ- BLOCK , v� LOT OT SUBDIVISION ,_.5e---6. �/ /K ,ej4,11 RE# 4,QC 7 1dIL- /7.2 D,zO-a7(,8, -RESIDENTIAL E COMMERCIAL ❑ OTHER APPLICANT INFORMATION NAME Z3' //1-2/ 7 c C/ oichL(= PHONE# 7`Q(`7 oU 72/3 ADDRESS /83/ __S-c 7 gf 7/ 4, ,.. /,t 2 CELL# ; ' r r if CITY /71--4s✓7-i, /5L-7--410/1/ STATE /L ZIP CODE ,.?1 Z_3_3 EMAIL /' r�C-/'KU" 1i V o /1. l- , Cc)4/ d NER ❑ LEGAL AUTHORIZED AGENT I affirm that I have reviewed the provisions of Chapter 23, "Protection of Trees and Native Vegetation", of the Municipal Code of Ordinances for the City of Atlantic Beach Florida and/or I have participated in a pre- application meeting with the Administrator of those regulations. Subsequently, I affirm that no regulated trees and no regulated vegetation will be damaged, destroyed and/or removed from the above-described property and/or adjacent properties including right-of-way. I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT:Signature of Property Owner(s)or Authorized Agent 7 ,,a/ ,,,,k_. - ;r(74,c74 ,15//itAtylk--_,, /4.1,r S GNA"I•E OF APPLICANT PRINT OR TYPE NAME DATE #1.,„z(' �G �'�L of, 1/1- C - ZC�.�IL-� � / c //TURE OF APPLICANT(2) PRINT OR TYPE NAME C3 ATE/ Signed and sworn before me on this f 0 day of 0 0931-( , OVJ by State of F I ; ael CD( ,0.(\ bkaActAt A(J k- iQ') )\C&C I1-_ County of QLAJ‘I) Identification verified: L d( i J ( c L.. n S -t - n Oath Sworn: U Yes Moo Yp; JENNIFER JOHNSION e',.. • MY COMMISSION#GG 042984 Notary S dtU *, +aN ` EXPIRES:October 27,2020 -''i=A Bonded Thru Notary Public Underwriters My Commission expires 04 TREE AND VEGETATION AFFIDAVIT 03.01.2018 ;;., City of Atlantic Beach APPLICATION NUMBER ',g. Building Department OCT1 2019 (To be assigned by the Building Department.) 800 Seminole Roadi 1 � . " Atlantic Beach, Florida 32233-5445 [�y. � (/ � ' O�S v Phone(904)247-5826 • Fax(904)247=5845 / '''.V tic.. E-mail: building-dept@coab.us Date routed: I d6 L L9 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: I g - l JE LV-4- 1 V l4 R( 0a , De• -rte ent review required Yes No i • f . Applicant: 0 bo t.D-(L. �_'annin."'": Zoning—) Lao Tree Administrate Project: t_ (2-.. e_of,Da, Public Worcs Public Utilities 6Th 12-1 v 61A-3 P1/4-,--( Public Safety Fire Services Review fee $ Dept Signature .01 Q Review or Receipt `` Other Agency Review or Permit Required of Permit Verified By Date e Florida Dept. of Environmental Protection eO 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: ‹proved. ❑Denied. Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING /....61,/,,,AriY/Xev----Zate: /67"/� �j �TREE ADMIN. JReviewed by; Second Review: Approved as revised. ❑Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: I 'Approved as revised. I iDenied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 _s . Building Permit Application Updated 10/9/18 4 r City of Atlantic Beach Building Department **ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 7 HIGHLIGHTED IN GRAY � �' IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us �" .,.,.��` ,32153 ���(� ) Job Address: 7,j/j / S2,Zg�/ylr Piii,4 f 7ZMI 7(evict Permit Number: —( l - OCAS Legal Description Ic-AlaQJi 7L-Dire../... ,41IL7i LOr3 se ,i 1,;( 4 UAlfT RE# PIA 7L lf( 6/311,7,W Na is Valuation of Work(Replacement Cost)$ 46-00 Heated/Cooled SF on-Heated/Cooled • Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial ❑Residential • If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No z • Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) C1No Describe in detail the type of work to be performed: coAJ j r21/c/ €C/u At" /4-'7r4 C� n TJ . ---X 7750/04/6--- cegM•,,,06COf c'r'l/2,4wr-'A�Q6fL i 772 x4tb- hf./ 7,zGL Re-rewYZOJJf - a0'x a ",� a ncP ,,C 1.00-�rr z . en,.v4 , Florida Product Approval# for multiple products use product approval form Property Owner Information t ot'iw A e. SC-ken 64:-€ / _\ Namee74 Q Lam/ Pc-4i7Ot/E" Address /r3/ S l/ wAeiiV,7 2 city 47-t.11/t17 f C ICj¢ail State iL Zip ..3L233 Phon *Q/ 0 744/3 i E-Mail A/; —0W .'• /✓ al '+/ C.i Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company Fa(,s4 /1A-50/vog ie,,,[le,Q '7"E Qualifying Agent Address J 72/ f4- A W P• City lila SON-044 A'/Atate /=L Zip , .52 Office Phone 9?it 4/2,4'2 g--72:0 Job Site Contact Number ? / 2422 27.20 State Certification/Registration# ay /8020111802 E-Mail Mft/l25/y1,�0A//Pyt9'49 Cofr'1 e72 QG,0.4a.. C 04/ Architect Name& Phone# Engineer's Name&Phone# Workers Compensation Insurer OR ExemptAl Expiration Date 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 RECORDING YOUR NOTICE OF COMMENCEMENT. (Signatureof Owner or Agent) (Signature of Contractor) igne and sworn to1( a firm=d)before me this day of Signed and sworn to(or affirmed)before me this day of �0 , •. : ° • SA,.4:s _I. c , by a' . . a� \ (Signature of Notary) TONI GNDLESPERGER +� r. ;,; MY COMMISSION#GG 353178 s.".+`'^,,'O ZI ar�6' [ ]Personally Known OR 2023 so,,M1�t �����de�r�M�ars Produced Identification Type of Identification: ' -T `.) Z—0(0 —4 5-33 2- ?f Identification: NOTICE OF COMMENCEMENT ('� / State of /1/(V/0/4" Tax Folio No. 7 �J` O Z 0 `� 76) County of >044L To Whom It May Concern: The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT. rile" Legal Description of property being improved: /YQ�T� //1-/� 2f J T-2/ lfU- '` (/,d/r /C/6 /0--LS - 'Ars Xerifiebeb /N "2-4-7-1504' 3G f/V'4/ lkr/ -Ar7—Zav %&k Address of property being improved: / r�/„S-i!�/#/1/9e/`1//¢ b/d. ,17' �77C 25'LC/ -322-33 General description of improvements: e/RCr//. / ,b ei j 4--4 , -,z_ e`",'7 --- ./GIIc � X000-- To • /y4r���/ 217 /I,e X/,z x 6/Peer de Owner:�,e(D.�' /1s}i/✓ ,'L/tt�Ck Address:/13/ �G�,¢/�j�<�1��/P',17U-I)t1C j 32z3 N Owner's interest in site of the improvement: ` Sj/XPLt (�-1 Fee Simple Titleholder(if other than owner): /V/i1— Name: .�. Contractor: '� E3 A// VA/y/Cy fLailO�e6-5" — Address: /?2'/ f"--x/go-,t/ Telephone No.: ?"%'/24 77 Fax No: Surety(if any) Address: Amount of Bond$ — Telephone No: Fax No: Name and address of any person making a loan for the construction of the improvements Name: /,r ' Address: Phone No: Fax No: Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may be served: Name: Address: Telephone No: Fax No: In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.06(2)(b), Florida Statues. (Fill in at Owner's option) Name: Address: Telephone No: Fax No: Expiration date of Notice of Commencement(the expiration date is one (1)year from the date • rrnirtiV unlerom, - - 1 specified): • ;r ' ' MYOOWMISSI N-1633S317E EXPIRES:October 6,2023 THIS SPACE FOR RECORDER'S USE ONLY OWNER / rFOF f'O� Borxled 71Vu No O Rtic Doc#2019233003.OR BK 18961 Page 1373, SignedLL11*.• 1 -t Date: /4.)Number Pages: 1 Before me this day of i•• ZO t 9 in the County if i•val,State Recorded 10/09/2019 11:21 AM, L Io RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Of Florida,has personally ap .. L,4�J /{ / ¢.aJC(4- Notary Public at Large,St t of lori llkir V of Du al. COUNTY My commission expires: / RECORDING $10.00 Personally Known: 9-- ' or Produced Identification: 4 S 2.. -CD Cot 4 S &33 Z -C] • Yj 7 eteue tv, tr#0e2 //-37rf/1j(5( /7:274412 az7-tx e j,LfI/ /4<)( k,yeutpX27 _if � � = X23 r i j REVOCABLE ENCROACHMENT AGREEMENT + City of Atlantic Beach **ALL INFORMATION HIGHLIGHTED IN GRAY �' 800 Seminole Road,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 /cob1,tl6,ti8,i-,,/0e- 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 /NST�pAide-e 2Gf/ .e_ !ll----16/14.1 d*' 5 .dl r 4,7"--4-7/-77.04/ 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 , ,�_ ; ,,,,A— a 'l!/G--:L_at 'L;,.,, '_ 3 • 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 10f� �, Property Owner/Agent (signed in presence of Notary Public) / / STATE OF FLORIDA, COUNTY OF DUVAL The foregoing instrument was acknowledged this 9 day of °O_-4--- , 20 1 9, by_yie(4-#) 4 61--4010-4- , who personally appeared before me and •rinted name of Signer) ack ,• ledge that tie/she si ed the instrument voluntarily for the purpose expressed in it. r !-- -LA ilii` TONIGINDLESPERGER Department Approval: Signature of Notary Public,Stat of lorida ;; ;. MY COMMISSION#GG 353178 ' '"���` EXPIRES:October 6.2023 �) [ ] Personally Known `•?pFWq?"'eond� , `/ �` L/, l CI) Notary Pubic thdennllets [ ] Produced Identification (Type) t--• Scott Williams, Pu lic Works Director /8'/" ,y H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18 s= ir, s RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION 't rAhm City of Atlantic Beach HIGHLIGHTED IN GRAY IS ��✓+` 800 Seminole Road,Atlantic Beach, FL 32233 REQUIRED. 1,11 PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job Address/r3/ 5611/4 /�fr¢�eto; d / /172-4-4,7e,- 5t---,4i Permit Number DWAY ICI-60145 Contractor Information Company ge,4-c/C5 ,0,4_56,147 -evA)O/F f= Qualifying Agent Address /7, 4' O/1MJ/�'� City 131e/i�ShcVf/L(L= &-State1t L Zip 32Z51/ Phone CV 4'26.;772 Email BECff&S"4<Svc►/2A9�.D(co C'ieen7044M14,, ..syn State Certification/Registration ttG /r00g9//J"02.-- Architect Phone Email Engineer Phone Email Workers Compensation Insurer OR Exempt,' Expiration Date • Permittee declares that prior to filing 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 /444/ , Z,¢;ffG3.Le (Project Superintendent) with (Company Name) Phone • 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 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. • he Publi or Director shall be notified 24 hours prior to starting work and again immediately upon completion. / Date #9//y.Per ittee(signed in presence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument was acknowledged this day of n4 ,20 I , by R(A-6) ,who personally appeared before u- a _ (printed name of Permittee) --- ` Jnr + " ackno ted th.- - he igned the instrument voluntarily for the purpose expressed in it. :� ,., . "' EXPIRES:Odder di ... ggdedThruNclsflP+bie Undoevallem 414 [ ] Personally Known '\ Signature of Notary Public,State of Flori." [ ] Produced Identification(Type) v H:\Applications&Forms\Word&Excel Document Originals\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18 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: / '3/ SE-4V,. - df,6 '/4/4- OX/ iL. '/,?7c? ./3r% �'r.5f /=% ?2223 Owner Name: i(7,-D4 se/I 1 J Ll47t/C/ i Phone Number: 2/ 124-0 74/13 Mailing Address: 71,5/..51---1/1/ 4/1 I/i//i M City:,4YZ.4i77-e .64j /'State:f L. Zip: 3253 Notarized Signature of Owner (�fj�� �l` � 9i`1('f`—'_ Th r�going instr ment was acknowledged before me this �J day o '?-i , 2W in t e State of Florida, County of I-� VVCA--C t Signature of Notary Public ,_� [ ] Personally Known OR ] Produced Identification Type of Identification: L.._____ (—,- Updated 10/24/18 ` , .; MY COMMISSION#GG 353178 ''-:i% :tee EXPIRES:October 6 2023 '••1';:,r�oP' onded B11YV Notary PutCC Uoda rs . .. MAP SHOWING BOUNDARY SURVEY OF The North 1/2 of Lot 2, all of Lot 3, SELVA MARINA, UNIT NO. 10—B, according to the plat thereof as recorded in Plat Book 36 page 61 of the current Public Records of Duval County, Florida. Lot 4 Lot 5 SELVA MARINA UNIT SELVA MARINA UNIT NO. 10-B NO. 10-B CERTIFIED TO: PB 36, Pg. 61 PB 36, Pg. 61 NNW Corner of Lot 4 Plat) Brian A.Blanche and Karen A.Blanche Et.." — '% Fd.No/Id. IP, 81.3315 e Tiatl 1��5..13• (FM) o.i'(Fi) o N E(FM) 10' Easement First American Title Insurance Company in• ;.,ie 81°27'41'° , — Ponte Vedra Title,LLC n N m N X X X 6, W,od Fence o'(F) Fd. 1/2" IP, 0.2'(FI) I No Id. eoo a) p 5.8'(FO)X 2 = I Fd. 1/2" IP, I No Id. i". et la. 0' 30' 60' Backflow X ,4 e -Preventor I LI 9 23.6' I 0 ti 14.4' • c z 4.C in i0 Screened 30.0' N r Q m a ko 1111 Patio M N �? loo tiS m terd� 46.4' s - ��Cc�M O iV 4. i� m I o 7 O © w $ c . rt y ,Zm 1.. c N M �d ta a 4 2 nn D o One Story Brick ih el °' o I tM W co .— m N Residence N o . • 3 C n. d #1831 13.1' 6.7' 31.3' Q � 3 d .. 19.4' 7.1' .8.1'rr A/C ,- LIMA.• d. IP size noted - No Id. U.O.N. ` o in illI p 'n O Set 1/2" IP Cannady LB # 7080 o v d' IIKy O Fd. IR size noted - No Id. U.O.N. N iG 0.9'(n) • Nail and Disk as noted Z m ' '='—` • 11,-; o ( ) -ae- Denotes Overhead Electric VJ 2 CO c ; o.e'Fo Denotes Easement Line ZLot 3 _ I- -x—x- Denotes Fence line transformer N Lot 2 w —1,— Denotes Line not to scale pad in TO 1..:..-1. 1 Denotes Concrete Area .4201 ^Zml 0 0. oQ^ Concrete Abbreviations o n �>on Drive a )Zto / A C - Denotes Air Conditioner I hB.R.L. - Denotea Building Restriction Line p (c) - Denotes calculated per Plat Conc. - Denotes Concrete r a 20.5• 25.9' 0.9'(FI) 0.2'(FQ Fd. - Denotes Found (Fl) - Denotes Fence Line Inside of subject property line t. . (F0) - Denotes Fence Line outside of subject property line In. s Mood Fence Fd. 1/2" IP, (FOL) - Denotes Fence Line on subject property line 1.3V-1)--..„\X ' No Id. (FM) - Denotes Measured Dimension made in field66' (FM) or substantiated by Field Traverse measurements (FM) 107' GP - Denotes Generator Pad Fd. 1/2" IP, S$'1°2859•,W ( 107.61'(Plat) Id - Denotes Identificationyy(Plat) IP - Denotes Iron Pipe Na Id. 5 B1'33'15" ii IR - Denotes Iron Pin or Rebor LB - Denotes Licensed Business ^ Lot 2 I.- (P) - Denotes Plat Dimension shown on recorded Plat U B L I C O R KS South 1�2 PPBI. -Denotes e tee Poi BookIntersection LLLJJJJ SEL VA MARINA UNIT e 10—B 61 P.C. - Denotes Point of Curve p NO• P9 P.R.C. - Denotes Point of Reverse Curve PB 36, \ Pg. - Denotes Page {V_ APPROVED o Pus. - Denotes Paaes x MAP SHOWING BOUNDARY SURVEY OF The North 1/2 of Lot 2, all of Lot 3, SELVA MARINA, UNIT NO. 10—B, according to the plat thereof as recorded in Plat Book 36 page 61 of the current Public Records of Duval County, Florida. Lot 4 Lot 5 SELVA MARINA UNIT SELVA MARINA UNIT NO. 10-B NO. 10-8 CERTIFIED TO: '� PB 36, Pg. 61 PB 36, Pg. 61 NW Corner of Lot 4 Brian A.Blanche and Karen A.Blanche o«-'^ Fd. 1/2" IP, E(plat) 115.21'1p►at)FM) 0.1'(n) a;LL No Id. N g1.33.15" l FM) 115"13' • First American Title Insurance Company 4_ E 10' Easement Ponte Vedra Title,LLC P y N N • N 5127/ X X X 6 W.od• Fence 1.0•(FI) 1 Ed. 1/2" IP, as et 0.2'(n) I No Id. 0 O 5.8'(FO)X z I Fd. 1/2" IP, i No Id. i' N X 0' 30' 60' rs BackflI e ow _ IIIIIPreventor 8' X U a 23. 14.4' • G Z ill •O P U B L I WORKS ScreenedIII 30, N ii u• water Patio 0' . M Ti u3 FE 10 a N eters v" : a 7 A ^' 46.4' o o N •« in d. -i z o� (VfAPPRO o •�, © M . d §Za { } DENIED p o N"' ° o - o W al V. o One Story Brick in " m o I Ui W y { } NOT APPL ABLE TO DEI % O Residence N s' #1831 a m a a 7.1• 13.1' 6.7' 31.3' lo •• in . 3 a' 19.4' i. "Aril A/C r e- Legend C 7 N e • Fd. IP size noted - No Id. U.O.N. G ,.. „ ,� O m O Set 1/2" IP Cannady LB # 708001 ' a d N © Fd. IR size noted - No Id. U.O.N. N \i0 \ 0.9'(FI) ® Nail and Disk as noted .o N 1° o —oe— Denotes Overhead Electric 4) =O a 3 0.6'(Fo) Denotes Easement Line Z roi v1 iv Lot - Pool 1-- ---x—x— Denotes Fence line transformer i H Lot 2 in Z - Denotes Line not to scale pad I N an I..S•'.• 1:.-';1 ".I Denotes Concrete Area , 1 0 ^lz o ft ,�•�/�0 o ^n._/Concrete 0 1Abbreviationsl Vf o Drive aA/C — Denotes'Air Conditioner t,�B.R.L. — Denotes Building Restriction Line `,1`�v p (C) — Denotes Calculated per Plot tjv Conc. — Denotes Concrete st 20.5' 25.9' Fd. — Denotes Found 0.IPS" 9'(Fl) 0.2'(FI) • (FI) — Denotes Fence Line inside of subject property line t': • (F0) — Denotes Fence Line outside of subject property line IIII. et Wood Fence Fd. 1/2" IP, (FOL) — Denotes Fence Line on subject property line 1.3.(FI) X . •--• No Id. (FM) — Denotes Measured Dimension mode in field 107 66' (FNt) or substantiated by Field Traverse measurements a.59.,W (FM) 61,(plat) GP — Denotes Generator Pad Id— Denotes Identification Fd. 1/2" IP, 81"2 t 'IV' IP — Denotes Iron Pipe No Id. S s B1'33'15"W(plat) O IR — Denotes Iron Pin or Rebar LB — Denotes Licensed Business • LOt 2 0 (P) — Denotes Plat Dimension shown on recorded Plat SOU th 1. 2 PPBI. — Denotes Point ofDenotes Plat kIntersection ,.. MARINA UNIT v $EL VA DE 10-e 61 P.C. — Denotes Point of Curve + NO. pg 36, P9' \ P.R.C. — Denotes Point of Reverse Curve Pg. — Denotes Page Pgs. — Denotes Pages ill