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1528 W PARK TER FNCE19-0124 6' ,;51.-4V1 FENCE WALL OR BARRIER PERMIT PERMIT NUMBER ) f p1 oar CITY OF ATLANTIC BEACH FNCE19-0124 .,.-_,,v- w �� ISSUED: 10/29/2019 '- y; , 800 SEMINOLE ROAD °';'�~ ATLANTIC BEACH. FL 32233 EXPIRES:4/26/2020 , " MUST CALL INSPECTION PHONE LINE(904) 247-5814 BY 4::PM FOR NEXT DAY INSPECTION.. BALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF:THE'FLORIDA BUILDING CODE,INEC, IPMC, AND CITY.OF ATLANTIC BEACH CODE OF ORDINANCES ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY. . a , 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:. 1528 W PARK TER FENCE WALL OR BARRIER FENCE; FENCE $2500.00 TYPE OF ' e REAL ESTATE BUILDING USE. " .,. ; ZONING: SUBDIVISION: `CONSTRUCTION ' NUMBER: GROUP: . 171939 0000 SELVA MARINA UNIT 02 COMPANY:, ADDRESS:' CITY `° STATE:. ZIP: r OWNER: ' , ' , ADDRESS: , . CITY STATE: ZIP.,' GHIOTTO PHILIP M 1528 PARK TER W ATLANTIC BEACHFL ;32233-5535 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. ,LIST OF CONDITIONS , Roll off container company must be on City approved list. Container cannot be placed on City right-of-way. 1 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL Notes: All runoff must remain on-site during construction. , 2 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL Notes: Roll off container companymust 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. 3 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL Notes: _ Full right-of-way restoration,including sod,is required. • Issued Date: 10/29/2019 1 of 2 -51.m:,..Jr, FENCE WALL OR BARRIER PERMIT PERMIT NUMBER j � FNCE19-0124 ;: 0 CITY OF ATLANTIC BEACH, ISSUED: 10/29/2019 800 SEMINOLE ROADEXPIRES:4/26/2020 �rrt5r) ATLANTIC BEACH. FL 32233 4 PUBLIC WORKS RUNOFF INFORMATIONAL Notes: All runoff must remain on-site. Cannot raise lot elevation. 5 PUBLIC WORKS FENCING REMOVED INFORMATIONAL Notes:° All old fencing and debris must be removed from job site by Contractor. 6 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL Notes: Any damage done to infrastructure must be,repaired by Contractor. . DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT BUILDING PLAN CHECK 455-0000-322-1001 0 $17.50 FENCE 455-0000-322-1000 0 $35.00 PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 TOTAL:$81.50 Issued Date: 10/29/2019 2 of 2 rry�Tf . City of Atlantic Beach APPLICATION NUMBER ys Building Department (To be assigned by the Building Department.) • 800 Seminole Road �'v Q , -0 Atlantic Beach, Florida 32233-5445 j Phone(904)247-5826 • Fax(904)247-5845 ' 0109: E-mail: building-dept@coab.us Date routed: t Cilt,/t, 7 ( 1.9 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: i S Zj RR,_ ( ek ) De artment review required Ye No uildin V Applicant: rAD N GQ__ Wining &Zoning) Tree Administrator Project: r-Gtic..e, ' • is ryor� : . . Util"r 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. ['Denied. ['Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: /0-2.2•"147 TREE ADMIN. Second Review: !Approved as revised. ❑De d. ['Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. Denied. ['Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 r1�Li City of Atlantic Beach APPLICATION NUMBER JS \ Building Department (To be assigned by the Building Department.) �q 800 Seminole Road ( � , !, z c' Atlantic Beach, Florida 32233-5445 I-- w V Phone(904)247-5826 • Fax(904)247-5845 la -, ;t �� v E-mail: building-dept@coab.us Date routed: r I City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 1 J Z. ', (AR K_ ( Department review required Yes No l`�ildin �--.. Applicant: Dbo N E-{? _ nning &Zoning Tree Administrator Project: �tiC_,F ,,PU i ai is Utili • _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. (Denied. I INot applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by:4XDate: (a- ( (et TREE ADMIN. Second Review: A roved as revised. Denied. ❑ pp ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. I (Denied. 1 (Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 r !rLir S ,�, City of Atlantic Beach \ ,► APPLICATION NUMBER s � Building Department , (To be assigned by the Building Department.) -- _ ; Ixt 800 Seminole Road OCT _ w I Atlantic Beach, Florida 32233-5445 l• f ` v Z j� I Phone(904)247-5826 - Fax(904)247-564 / E-mail: building-dept@coab.us _� `� _ Date routed: t�l 1 7 l t c) City web-site: http://www.coab.us 111 APPLICATION REVIEW AND TRACKING FORM Property Address: 1 J Z. P A-kK._ ( ele Department review required Yes No (<11—uildin _ � e-0Applicant: Dbo k) � ,p nth g&Zonis �-` Tree Administrator Project: 1� �l�Ca (Pu '6TcW°rk�___, . . iblic Utilitie L> 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: IV]Approved. ['Denied. ❑Not applicable (Circle one.) Comments: BUILDING Plw\5 -foo lae5e4a LaseAcht✓ PLANNING &ZONING Reviewed by 4,X .CLLBo,""'2 Date:4,.--/7-// TREE ADMIN. Second Review: ['Approved as revised. ['Denied. Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ['Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 ( Lj7 City of Atlantic BeachAPPLICATION NUMBER ,` �� Building Department (To be assigned by the Building Department.) s 800 Seminole Road 1..., m L C� -o .z 4-0.� Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 11 ar v E-mail: building-dept@coab.us Date routed: r City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 1 J Z. - RR,K . t ) Department review required Yes No - uildin Applicant: a/6k) G-(_ _,P not &Zon Tree Administrator Project: PEtiC-E ,ice i6Tc Wo`rRcsc ._blic 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. Denied. I Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: • ate: /U - 2/-i� TREE ADMIN. Second Review: ❑Approved as revised. ['Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: nApproved as revised. I 'Denied. ['Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 C pp BuildingPermit Application OFFICE COPY updated 10/9/18 City of Atlantic Beach Building Department **ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY Jj;�r IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us f Job Address: A- G e PoriL / CT/Q�L(/ , Permit Number: �� CC 1 G, - b i �4 Legal Description RE# Valuation of Work(Replacement Cost)$ OP 2Z Heated/Cooled SF Non-Heated/Cooled • Class of Work: Diew ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial GlR'esidential • If an existing structure,is a fire sprinkler system installed?: ❑Yes C3•fGo • Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) o Describe in detail the type of work to be performed: �Remut'e-&I 7 hca frcpkce.G-))/ii fir.,,) 4 j 'kat- fe_itt:a-iiu kt Florida Product Approval# for multiple products use product approval form Property Owner Inf.rmation Name / ✓ I D .r, Address f 6- M✓�ierie , ` ' / city IaL •c C/ - State �L- Zip 322-33 Phone /U`f� is --(i > E-Mail 'DM i - , Owner or A:ent(If .:ent, Power of Attorney or Agency Letter Required) Contractor Informat oon/...)>4"2/D /� '"�"' Igo" �L . Name of Company /...)>4"2/DF:C/7C/ Quali ing Agent Le L,. iV L.1 Address City kVC.. /7/ State Zip Office Phone Job Site Contact Number State Certification/Registration# E-Mail OCT 1 7 2019 Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Insurer OR Exempt❑ Expiration Date i2,,;1,.1;.,,,, ______irtmen, Application is hereby made to obtain a permit to do the wor nd installations as indicated. I certify that nopi stA itio h commenced prior to the issuance of a permit and that work will be performed to meet the standards of afl"tH•d lai"i✓s rh/u`1 i ' k'-E'ach, construction in this jurisdiction. I understand that a parate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS,TA KS,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. O'- ti OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all Q applicable laws regulating construction and zoning. W N WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT Mh)Y `. 4<n RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU IN o , >' TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE - w p w RECORDING YOU . OTI OF COMMENCEMENT. •• m Q z ct� • � �'� •, Gtr t� o o (Signature of Owner or Agent) (Signature of Contractor) ea CI z 0 S ' ne and sworn to( d be • e this/1day of Signed and sworn to(or affirmed)bef. • me this ti fcit 02 U) 9� , c�/ y3 Ua vD7"/;J by 1— ►– Z 6.1" s��g >) , a� _ ture of Notary) ILL. a ...,?4,&...:,:,:i.,„..,: TONT GINDLESPERGER W '.; '!! :. MY COMMISSION#GG 353178• - w 3 W 11 �RF�� j w Q W .�'•o, . nQS Pber 6,2023 W O U) W [ ]Personally Known OR F''' om-y ru .a kr..k UnderMTtters ; CC W [ ]Produced Identification 2 -- 5 Type of Identification: G-) (DIC)-2-2-0-54.— 5 1 3- type/of Identification: _ Ui al; REVOCABLE ENCROACHMENT AGREEMENT **ALL INFORMATION `' 1� w.\ City of Atlantic Beach 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY ' '�' / IS REQUIRED. REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the ate of Florida, hereinafter referred to as"CITY" and a �Al..i.A -i _ . 'wok 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 re/1Ct- rt VC l/4t eut . 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 /6-2 Park /Ccr ce-ILL >le . • 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. &I-/ ZeR L- ed . C .D7 Date /0//‘///q Property Owner/Agent(signed in presence of Notary Public) STATE OF FLORIDA, COUNTY OF DUVAL The foregoing instrument was acknowledged this day of Q�� I, 20 ` by L—// 7 .bel 3- 62.04-- , who personally appeared before me and 5inted name of Signer) ack -dged iiii - she Signe• the instrument voluntarily for the purpose expressed in it. C/ r Al Department Approval: Signature of Notary Public,Stet Florida Oft,-: TON GINDLESPERGER i :•• :. MY COMMISSION#GG 353178 [ ] Personally Known ' ) ode`,.= EXPIRES:.':.•:•'. :,2623 _ _ i ''d [,j-Protruced Identification (Type) c l__. '•.3%,,,.•••' Bonded'Nu t, _ _Ada1 ; Scott Williams, Public Works Director H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18 1 Owner Builder Affidavit **ALL INFORMATION c,�'�`�;. HIGHLIGHTED IN ) City of Atlantic Beach Building Department GRAY IS REQUIRED. J fi 800 Seminole Rd, Atlantic Beach, FL 32233 ` .-.-,J;119).-7 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 REQUIREMENTSREFOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. Job Address: /6 Z8 1 G/✓k_/erre ��^ Owner Name:<BetL01.1/97 � ) Phone Number: % '33(0'4 7/' Mailing Address: 15 2 "7 ,"�-j efface_ Id . City: 46 Stater Zip: 3123-3 Notarized Signature of Owner /5-e2egbe-y -'- (Gc/,`7 , The oing instr ent was acknowledged before me this l Cr pay of 61. I. ,20 9n t e State of Florida, County of Q VQ-- Signature of Notary Public ' 'L' ‘,.. ) [ ] Personally Known OR [(] Produced/ Identification Type of Identification: `� (--` v"".• TONI GINDLESPERGER Updated 10/24/18 • " MY COMMISSION#GG 353178 :,-'1.z.- .= EXPIRES:October 6,2023 FOR it•' Bonded Thru Notary Public Underwrites �� AIR O Z W J_