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436 Beach Ave FNCE19-0145 6' rt p,-% FENCE WALL OR BARRIER PERMIT PERMIT NUMBER J.'t' FNCE19-0145 ?, CITY OF ATLANTIC BEACH ISSUED: 1/2/2020 800 SEMINOLE ROAD l '___} x,u:;iEXPIRES: 6/30/2020 ATLANTIC BEACH. FL 32233 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: 436 BEACH AVE FENCE WALL OR BARRIER FENCE 6' FENCE $10000.00 TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION: CONSTRUCTION: NUMBER: GROUP: 170164 0000 ATLANTIC BEACH COMPANY: ADDRESS: CITY: STATE: ZIP: OWNER: ADDRESS: CITY: STATE: ZIP: POLISTINA TERRY LEE 436 BEACH AVE ATLANTIC BEACH FL 32233 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 company must be on City approved list. Approved list can be obtained at the Building Department at City Hall. Roll off 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: 1/2/2020 1 of 2 o'-A.1 FENCE WALL OR BARRIER PERMIT PERMIT NUMBER io 4s •`� FNCE19-0145 CITY OF ATLANTIC BEACH �� ISSUED: 1/2/2020 800 SEMINOLE ROAD X013 91.. ATLANTIC BEACH. FL 32233 EXPIRES: 6/30/2020 4 PUBLIC WORKSr- FENCING REMOVED INFORMATIONAL Notes: All old fencing and debris must be removed from job site by Contractor. FEES 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: 1/2/2020 2 of 2 rc jr, City of Atlantic Beach APPLICATION NUMBER 4s " • „� Building Department (To be assigned by the Building Department.) 800 Seminole Road !_ a « rj Atlantic Beach, Florida 32233-5445 ` (v C.E-- J��( C�J Phone(904)247-5826 • Fax(904)247-5845 1 Z Z 3l t 9 \rja u%' E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: •31,' L4eCJa.Jm jç(J , Department review required Yes No Buildin ______ Applicant: O GO(\ Q_ /--- Pfanning &Zoning Tree Administrator (: Project: Leov i`eiN C e , Public Works-a ,- 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: I 'Approved. ['Denied. Io►oN t applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: ate: /2-Z6 -17 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 rj'a,�';% City of Atlantic Beach APPLICATION NUMBER s i� • , , Building Department (To be assigned by the Building Department.) 800 Seminole Road '~_N CE_ '9 -0145 1.5in z Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 Fax(904)247-5845 j Z/Z %I c T�? E-mail: building-dept@coab.us Date routed: ( 1 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 436, De0.C/1 Rue, Department review required Yes No B"uild i n Applicant: O GO(\ Q. r- Funning &Zoning ) Tree Administrator C Project: L Fe,C.e C ublic Works iP lic Utiiities`1' 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: < a:CC BUILDING Re(YDUt d Pr PLANNING &ZONING Reviewed by: Ja Date: 12 -5oI 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 City of Atlantic Beach APPLICATION NUMBER s ,c4 Building Department (To be assigned by the Building Department.) • 800 Seminole Road `i_N CE- t —CD( 45 Atlantic Beach, Florida 32233-5445 v Phone(904)247-5826 Fax(904)247-5845 x�;; qr E-mail: building-dept@coab.us Date routed: Z Z 3/19 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 43(c, exocl_cy, to Department review required Yes No uildinq _ Applicant: 0 GO(\ Q 11(anning &Zoning Tree Administrator (— Project: ( 1`e-11 C e C r �P_ublic 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: rqApproved. ❑Denied. ❑Not applicable (Circle one.) Comments:po,.o,bir,. a It otepo r„`,"-' d fp ILDI /• r PLANNING &ZONING v7., Reviewed by: Date: 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 C s4'' Building Permit Application Updated 10/9/18 ;2'', City of Atlantic Beach Building Department OFFICE COPY **ALL INFORMATION V., 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: Li3(0 (3 -QCL A vt [S 4. • Permit Number: I ((\C.& 9 -O 1.45 Legal Description Lo+ 3, P> I k Z 5--69 ! i-_ 75- AlttiLl7 01 C04 0°00 Valuation of Work(Replacement Cost)$ 1 0 0 c; 0 Heated/Cooled SF Non-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 (Jo • Will tree(s) be removed in association with proposed project? DYes(must submit separate Tree Removal Permit) IVo Describe in detail the type of work to be performed: \U(t 7 y, ..u ( y �c"(Q, /2c. ,i c-)7 d.o.,,�•c� 10 ti lnv,�.r % Co." e— 6 F4 ke', �[�4 GtLu e,NA =(.e ya✓� c) Florida Product Approval# for multiple products use product app val form 2 Property Owner Information 0 M Name rr ki 1-- (-) Ir s { , Address Y 36 ej faCk Ai Q Q _1t�2 City A t (..1. f l c lJ r-.-C State r' Zip 3 « 3 3 Phone C r —Z i , a 0 CI . E-Mail Po I r s4- i ,--4,-F- Ca ,--so.r (• C-. ' < g H Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) o m i= ce F Contractor Information cC-) 0 Q t; c Name of Company reAce_Sc c„'?e.s Qualifying Agent TO,Sor, S-`� ),e►-i P1 rc 0 Address 41330 —(O (0 )N i c., , - ' 'u 2 City 5 3-6A^P State Fi Zip 3i aals 0a' c u. Office Phone 9 U , - y(- f-- C y L 3 ob Site Contact Number ( t . z State Certification/Regis . E-Mail tJ-Jc, (1 t t,' Q.v co I1 @- c.�✓r,0 l o C-e.,� Q Architect Name& Phone# (( J J ▪ ,L1�-_t`":.- —; Engineer's Name&Phone# '---Cs-C,r- P . CtG l__) 114/16 nl la Workers Compensation Insurer ` OR Exerihpt 0 Expiration Date > I— 'd E. Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or insta▪Iti&i haste u commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws reating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, NS, u a 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 ITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDIN CE OF MMENCEMENT. / (Signature of Owner or Agent) (Signature of Contractor) • ned and sworn to( a •-• befor: ' :t a'12 .ay of Signed and sworn to(or affirmed) before me this day of ( by / id• ; . - , by Y _ "11 :I.ture irf�j�. it�� (Signature of Notary) j:;.:: „ TONI GINDLESPERGER . ,., Y COMMISSION#GG 353178 [ ] Personally Known OR .. ��..:4 EXPIRE$: �aten3 3Cno ( OR "�'•'FOe,f f" Bonded Thru N, y; [ ] Produced Identification ( Z:iu....+i4:J•4h:, ' ati n Type of Identification: _ l_.- ype o Identification: S�A,y; City of Atlantic Beach APPLICATION NUMBER �S r,# Building Department (To be assigned by the Building Department.) " ' Seminole Road j_i CCI _�I "i CC r Atlantic Beach, Florida 32233-5445 1 J Phone(904)247-5826 • Fax(904)247-5845 ' z/z 3�► _�� ; E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 4 32 e)e Hu . =partm•nt review required Yes No ilifi di .•I I•_. Applicant: O(A)(-\ Q / -- ' anning&Zoning , Tree Administrator C F ( Public WQr_cTs Project: � �`�,�1 C e � �_ C-- 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. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed byleyeiafFhedip Date:fhi ix-J'l'✓q 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: DEC 2 3 2010 Reviewed by: Date: Revised 05/19/2017 —_ z?,� 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 s of the State of Florida, hereinafter referred to as "CITY" and l e rr L 0 t( S17n :p - 0c-one t- 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 antic Beach. n This work is generally described as 4 3 6, Q.Q_o--k y -\--`Q ra ,• 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 C TY to USER,saiotice to USER shall given by certified mail,return receipt requested,to the following address S (D t:Dt" CL L- . • 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 • - _ ER fro any of the work herein under the terms of this permit and that all of said Iia•• ' - - - eb assu •d e USER. 7 Date l Z 7 ( 9Proper O/er •• :- it si:n-•• 'n presence of Notary Public) STATE OF FLORIDA, COUNTY OF DUVAL The foregoing instrument was acknowl ed this Z 5 day of E_e_ , 20 19, by - IP +r'r 0 ((' A; who personally appeared before me and • ted •: e of igner) ackn• dg-. he he signed the instrument voluntarily for the purpose expressed in it. . ir 'AR 0 -• � Department Approval: Signature of Notary Public, State •�toric TOHIGINDLESPERGER ��C�e�L � [ ] Personally Known (L: .• -=_ MY COMMISSION#GG 353178 �/' [ ] Produced Identification (Type) +—�` '-�*''�dr41 EXPIRES:October6'2°23 Scott Williams, Public Works Director `t;;P;4.•• Bonded TNu Notary Public UnderrrrNers Amok . - X,21 -'70 if H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18 70 7 N 0 w w 0 w i m 0 w 0 J rn -Tl0c� �? 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