601 Main St FNCE20-0019 t1A,�-,. City of Atlantic Beach APPLICATION NUMBER
�- Building Department (To be assigned by the Building Department.)
'�a 800 Seminole Road
_ _ '�� Atlantic Beach, Florida 32233-5445 FN� 2o-
Phone(904)247-5826 • Fax(904)247-5845 f t��eO
s 9 E-mail: building-dept@coab.us Date routed: l
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 60 ( MOLL‘N, �4 Department review required Yes No
auildiniiTh
Applicant: CAD r\ 'er-- 4nina Zoninq�
Tree Administrator .
Project: t P \0.-e_. - ' ,_A'��
C P-utdir.Utilities!,
Public Safety
Fire Services
Review fee $ Dept Signature -
Other Agency Review or Permit Required Review or Receipt Date 0 �
of Permit Verified By ,O Q
Florida Dept. of Environmental Protection
Florida Dept. of TransportationN.
0
St.Johns River Water Management District o
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: HApproved. I 'Denied. I Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING _ ' `'-----/4--- 3-/7 Z
Reviewed by: Date:
TREE ADMIN. Second Review: A roved as revised. ['Not applicable
❑ pp ❑Denied.
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
Building Permit Application Updated 10/9/18
J I yid
City of Atlantic Beach Building Department **ALL INFORMATION
�V 800 Seminole Road, Atlantic Beach, FL 32233
HIGHLIGHTED IN GRAY
b0 Phone: (904)1 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: J n1aiq J �`c• '1— Permit Number: FKQE Zv " 00 t
Legal Description 18 -34 l7 ZS-Z9E Sec_ k � (-041 131k 1 Z5 RE# 11 lOI —0000
Valuation of Work(Replacement Cost)$ [' Heated/Cooled SF Non-Heated/Cooled
• Class of Work: w 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
• 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:
-E - -rC4c-e
Florida Product Approval# _ for multiple products use product approval form
Property Owner Information `` L l
Name L- 1 f/IJdS C-C. Address 6b3 110\ �jl*"/`e _) I �l'l •< ijf-? ./1
City d I i �' Occ� ' State f Zip 3•ZZe53 Phone 9E>5 /yZ--9/-)5',..9
E-Mail Z.'f .7 rt,SCcI c 7 moi
Owner or Agent(If Agent, Power of Attornei or Agency Lett- 'equired)
Contractor Information
Name of Company Qualifying Agent
Address City State Zip
Office Phone Job Site Contact Number
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt❑ Expiration Date
Application is hereby made to stain a permit to do the work and installations as indicated.I certify that no work or installation has
commenced prior to the issu. ce 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
RECODING OTICE OF COMMENCEMENT. •
(Signature of ner or Agent) / (Signature of Contractor)
ned an sworn
affirr►i ,ef - -th. s( ( day of Signed and sworn to(or affirmed)before me • s day of
:•2QfpY�" ��; TONI GINDLESPtRt.,
\ / na rof ��� MYCOMMISSION#GG 178Sig;ature of Notary)
EXPIRES:October, 2023
,O;F;°Q Bonded Thru Notary Public Underwriters
[ ]Personally Known OR I I rfT'y lMlal' .. __
[ ]Produced Identification [ ]Produced Identification
F02-4 —S35-9z1-4(4—ape
Type of Identification: of Identification:
601 MAIN STREET, ATLANTIC BEACH, FL. 32233
A '}
11 ,
V LOT 4 ( LOT 4f.Txti, f .
m go j BLOCK 131 BLOCK 130 ::: ;
6 co - _LINE ---
D
THE N OF LOT 5,BLOCK 131-----N_ ( r
_ AERIAL PHOTOGRAPH
SCALE:P=30' mTHE N 35'OF (NOT-TO-SCALE)
i LOT 5 0
BLOCK 131 FENCE
(NOT INCLUDED) 5.5' FENCE N 5.6'N I LOT 5
N88° 56' 00"E < 0.4'E BLOCK 130
FOUND 112" 102.00'(P) N.,_„_____'-`
25.0' -• FOUND PIPE FOUND 112" 1
UTILITY �, AGE ,- IRON ROD
BOX y>ciPLATTED! - 1
r LOT LINE I
r.'- 30.6' /0 THE S15'OF
o35.2' f' o LOT 5
I Sr:COVERED LOT 6 /\ m BLOCK 131 0
��46' BLOCK 131 0 \.o (INCLUDED) cylo
D DRIVEWAY ' IDE o'•o -0 COVERED'F, #601 ► , o N LOT 6 I
Zz SCREENED / \"- 28.6' _ 36.1' -- U o BLOCK 130
0 0 o _ 37.3' �-r1 C I m BLOCK
o I I'll o N I o o I CORNER
D D RQ N.l N 73 < I AT LOT 6
0 N ``' mm FENCE BLOCK 130
D o ,. .1, I FOUND 1/2"
IRO PIPE
25.0' 2wr.1 S88° 56' 00"N/' 102.00'(P) o- -
BLOCK \ kY\
ICORNER 102.00'(P) '
FOUND 1/2" N 2'GUTTER Cri -
•
IRON PIPE o W 6th STREET - 7 _
ASPHALTct--ROADWAY
50'RIGHT-OF-WAY
-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 IS NOT COMPLETE WITHOUT ALL SHEETS
The survey map E. report or the copies thereof are not valid without the digital signature and seal of a
Florida licensed surveyor and mapper
Date of Field Work : 01-03-2020
Drawn By: Oleg
,,4
Order#: 76559 .`-
Last Revision Date: 01-03-2020 i xe
?.66cu.aPr,.L:o+-•` ..•x+�-
Boundary Survey prepared by: LB8111 , iTJ y EN =# nror�o.�o.... . -
NexGen Surveying. LLC �
5601 Corporate Way. Suite #103 _
West Palm Beach, FL 33407 SURVEYING, LLC.
561.-508-6272 - .
601 MAIN STREET, ATLANTIC BEACH. FL. 32233
0.z 1
4' III
1
I il. `LGa.i ,.t.,'' I LOT 4 I LOT 4 !'•„.;.',, ' .'
m m I;22 BLOCK 131 BLOCK 130 x ':-•,';
z Cl) THE N LINE OF LOT 5,BLOCK 131----"N I AERIAL PHOTOGRAPH
SCALE:1"=30' G-)
c) -n THEN 35'OF cn w -
(NOT-TO-SCALE)
LOT 5 0 l
BLOCK 131 FENCE FENCE
(NOT INCLUDED) 5.5'N I LOT 5
5.6'N BLOCK 130
N8 FOUND 1/2"
102.00'(P)1 E 0.4'E
25.0' IRON PIPE
- FOUND 1l2"
UTILITY N \ �v r
IRON ROD
BOX ....1 PLATTED 1 `n
r- cl - LOT LINE
N.? 30.6' '\ /n THE S 15 OF
c� _ 35.2' I. LOT 5
� c
COVERED LOT 6 /\ m BLOCK 131 O
73 6.6' BLOCK 131 0./ \a (INCLUDED) Sic) °
r DRIVEWAY RESIDENCE o+wc
o -0 — COVERED (, #601 ,.0 CD N LOT 6
z z SCREENED �'' 28 6' _ 36.1' C7 o BLOCK 130
_ --I (n i
0 0cri 37.3' -r i m BLOCK
o fTl o N I �'0 CORNER
D D l m I`-' ,;; G 1AT LOT 6
N w m m i
y o �_ I FOUND 112" BLOCK 130
25.0' 2WM r IRO PIPE_
Ns
BLOCK \, S88° 56' 00"W (- 102,00'(P)
CORNER 102.00(P) Usl
FOUND 112" , -2'GUTTER
IRON PIPE o W 6th STREET a t —
ASPHALT ROADWAY
50'RIGHT-OF-WAY I
r ,
-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 IS NOT COMPLETE WITHOUT ALL SHEETS
The survey map 6. report or the copies thereof are not valid without the digital signature and seal of a
Florida licensed surveyor and mapper
Date of Field Work : 01-03-2020 ,.,,.- -•, .,
Drawn By: Oleg •
. A $
Order #: 76559 �.
Last Revision Date:prepared
y0 1 T +�'P'M'r w9
III//// IIl`V' -.,
Boundary Survey prepared by: LB8111 `* mono..crcu *
nz u
NexGen Surveying, LLC
5601 Corporate Way. Suite #103
West Palm Beach. FL 33407 SURVEYING, LLC.
561-508-6272
ow-w;. City of Atlantic Beach APPLICATION NUMBER
41' a{ o Building Department (To be assigned by the Building Department)
,1s.) 800 Seminole Road
FNQ_E Z O cXo1
Atlantic Beach, Florida 32233-5445
Phone� v E-mail:(b Odi) n-de t6 coab.u904)247-5845 Date routed: 3 13 CO
,p � 9 P@ 1
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Vim'O ( Meiir` Department review required Yes No
uildingT
Applicant: LAD(\ E -- �P nina &Zoning
•
Tree Administrator
Project: L7
ihlir. Utilities�
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date c7 ��
of Permit Verified By CO
Florida Dept. of Environmental Protection
Florida Dept. of Transportation 0
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. fNot applicable
(Circle one.) Comments r
BUILDING L4,1- Le 10' G7 5 f-L I v-/- ive
PLANNING &ZONING Reviewed by:� Date: ��I 3_'�G
TREE ADMIN. Second Review: A roved as revised.
n pp ❑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
Building Permit Application Updated 10/9/18
S'Ag„
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
4 si v� IS REQUIRED.
4pQ` Phone: (904) 247-5826 Email: Building-Dept@coab.usz.
Job Address: ���� J ^�� Permit Number: FKQE ZO OO`
Legal Description 1.8 -4• V7 ZS-Z9E Sec. N � L-OT1 IJ l k l 75 RE# 11 () )d I -0000
Valuation of Work(Replacement Cost)$ (.5 �� Heated/Cooled SF Non-Heated/Cooled
• Class of Work: w ❑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
• 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:
Florida Product Approval# _ for multiple products use product approval form
Property Owner Information `` L � /
Name L '� /(/dSCf Address 6b3 /f1.o�r44 S/".�ec f I/�/ < 44-2I
City , D
/ '1 t' eco ' State Zip 3-Z2:53 Phone 9r35 /vZ-96"'52
j2
E-Mail Gcf •7 /`ySCe / vc 7 hit
Owner or Agent(If Agent, Power of Attorne� Uor Agency Lett- 'equired)
Contractor Information
Name of Company Qualifying Agent
Address - City State Zip
Office Phone Job Site Contact Number
State Certification/Registration# E-Mail
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt 0 Expiration Date
Application is hereby made to a.stain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issu. ce 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
RECODING - OTICE OF COMMENCEMENT. •
(Signature of• ner or Agent) (Signature of Contractor)
ned an sworn too affir •. bef r thI. // day of Signed and sworn to(or affirmed)before me • s dayof
2026 s c d 4 Lit ��"� g _ _ by
TONI GINDLESPtli
R:na �r1�"� Ff,, •*� #' MY COMMISSION#GG 17�5i¢
t .. ature of Notary)
c•,f. <.P<r EXPIRES:October 2023
-/,FOf F60d� Bonded Thru Notary Public Underwriters
[ ]Personally Known OR =
[ ]Produced Identification [ ]Produced Identification
Type of Identification: I v Z4 s d1q (4-0,Ipe of Identification:
601 MAIN STREET, ATLANTIC BEACH, FL. 32233 NII LOT 4 1116_
LOT 4 ; .'! .lif., oiri
4;� f
w BLOCK 131 BLOCK 130 •"s:.---i
t
> 0),
z o THE N LINE OF LOT 5,BLOCK 131-----\,1/4L _._ AERIAL PHOTOGRAPH
SCALE:1"=30' ci) TI THE N 35'OF i./4 (NOT-TO-SCALE)
LOT 5 0
BLOCK 131 FENCE FENCE
I (NOT INCLUDED) 5.5'N 5.6'N LOT 5
I
N88° 56''(P)
< 0.4'E) BLOCK 130
E
FOUND 1/2" 102.00'(P) �.x—x—x
25.0 __AI
IRON PIPE
` Li FOUND 112"
UTILITY �, \ �, o IRON ROD
cR
BOX Ni J PLATTED \ -
LOT LINE
30.6' /n THE S 15'OF
35.2' 'v7 LOT 5 ,
rn COVERED LOT 6 /\ m BLOCK 131 o
r DRIVEWAY / 6:6' BLOCK 131 8( \o (INCLUDED) °
v I 'RESIDENCE o o N)
o v D COVERED („ #601 AIC o N LOT 6
0 D Z T SCREENED 4' o BLOCK 130
riD
_ -i z l �. 28.6' 36.1' 1
0 0 37.3' I l 1 i m BLOCK
71 o I In o No o CORNER
N
D D RI N 70 r<n 1 AT LOT 6
N " * o FENCE BLOCK 130
D FOUND 112"
-< 1 IRO PIPE
2WM
25.0' . q --�r—._ O
I 41 i S88° 56' 00"W V 102.00'(P)
BLOCKUsl
102.001(P) ',
I CORNER
FOUND 1/2" N C 2'GUTTER
IRON PIPE o W 6th STREET — —
ASPHALT�ROADWAY
r ,
50'RIGHT-OM/1u/
,,,Dev
OFn// op4ENT
EO
-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 IS NOT COMPLETE WITHOUT ALL SHEETS
The survey map 6c report or the copies thereof are not valid without the digital signature and seal of a
Florida licensed surveyor and mapper
Date of Field Work : 01-03-2020
Drawn By: Oleg
Order #: 76559s!
Last Revision Date: 01-03-2020 ! Swssza.motr.rcwn.sop(..ry*
Boundary Survey prepared by: LB8111 r # U wON IM. *-
PM Ma
NexGen Surveying, LLC AiEXGEN
_ ar Iwo
5601 Corporate Way, Suite -#103 West Palm Beach, FL 33407 SURVEYING, LLC. -
561-508-6272 •,
0.,Anr City of Atlantic Beach APPLICATION NUMBER
;j r ,o4 Building Department ^.., _._-. (To be assigned by the Building Department.)
800 Seminole Road Ct,a I,I V � +
a ''�: Atlantic Beach, Florida 32233-5445 1 N� c)" po` 9
Phone(904)247-5826 •• Fax(904)247 5 MAR 13 20211 3` l 3� o
~,j q V E-mail: building-dept@coab.us Date routed: 6�
City web-site: http://www.coab.us
BY:_____________________
APPLICATION
3X:------___-----
APPLICATION REVIEW AND TRACKING FORM
Property Address: Vim'0 ( ,C ,C\ �4 Department review required Yes , No
tuildin T
Applicant: C3(,3(\ gr-- finir .,Zonin
Tree Administrator '
Project: (p f P�oe. • _ „,,,,,,r,..,.
tilities .
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date 0 ��
of Permit Verified By CO Q,
Florida Dept. of Environmental Protection
Florida Dept. of Transportation c O
St.Johns River Water Management District O
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 b : ,/%/_ . .. Date' ✓ i
TREE ADMIN. Second Review: ['Approved as revised. Denied.
❑ pp ❑ ❑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
601 MAIN STREET, ATLANTIC BEACH, FL. 32233
i LOT 4 i LOT 4
II
m W, BLOCK 131 BLOCK 130 -
D D
THEN LINE OF LOT 5,BLOCK 131��_
Z --- AERIAL PHOTOGRAPH
THE N 35'OF u, (NOT-TO-SCALE)
LOT 5 0
•
BLOCK 131 FENCE
(NOT INCLUDED) 5.5'N FENCE LOT 5
5.6'N
N88° 56' 00"E 0.4'E BLOCK 130
FOUND 1/2" 102.00'(P) �'- -`
'
25,0' IRON PIPE I FOUND 112"
UTILITY rSTORAGE N o IRON ROD
BOX N PLATTED_
r' N\4 LOT LINE —
^' 1.. /0 THE S 15'OF
35.2' r LOT 5 cn
1 71
m COVERED LOT 6 , /\ m BLOCK 131 O
DRIVEWAY 6.6' BLOCK 131 wo/ \o (INCLUDED) oho
D RESIDENCE O.NC
o D 73
COVERED v, #601 ati_ O N LOT 6
n Z SCREENED w
rl,
_ r Z 28.6' 36.1' (2_,
BLOCK 130
oD co P-• 37.3' C� I� m
BLOCK
D �I m o N 0 - CORNER
-< > --1 0 coN c m N r H AT LOT 6
E. G' o FENCE R.
BLOCK 130
> 1.0'E � FOUND 112"
2WM IRON PIPE
25.0' 41)
�— S88° 56' 00"W 102.00'(P)
BLOCK 102.00'(P)
I CORNER
FOUND 1/2" 2'GUTTER cNn
IRON PIPE o W 6th STREET o
—
ASPHALTTROADWAY
50'RIGHT-OF-WAY
(----- 7,711.64 Square Feet
856.85 Square Yards
-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 IS NOT COMPLETE WITHOUT ALL SHEETS
The survey map S, report or the copies thereof are not valid without the digital signature and seal of a
Florida licensed surveyor and mapper
Date of Field Work : 01-03-2020
Drawn By: Oleg
Order #: 76559
Last Revision Date: 01-03-2020
Boundary Survey prepared by: LB8111 X E c.oe. _o
il.. ,SY86 i
NexGen Surveying, LLC E - -
5601 Corporate Way, Suite #103
West Palm Beach, FL 33407 SURVEYING, LLC.
561-508-6272
1-A'hrfi-A\ REVOCABLE ENCROACHMENT AGREEMENT **ALL INFORMATION
�J_.411/ 1 City of Atlantic Beach 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
exiing and r the laws of the State of Florida, hereinafter referred to as "CITY" and
I d 0 n Frr se_ e I (G OC,. \E r-- 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 6 v i id cc.,-) Brie Z .
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 sh II be giv n by certifi d mail,return
receipt requested,to the following address 440 3 /no.i'/1 5 �i`-C C l� 4 4. k.-,4 ,L 1,r'C-6k
• 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
liabilitire hereby assumed by the USER.
--\_ �Z Date // 2c7
Property Owner/Agent (signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL g ( ; �Q-
The for oinginstrument was acknowledged this day '"\U of /gyp'/'\ , 201 0,
"1/`v
b ..,25Kc`Xt Sc_c ,who personally appeared before me and
(printed re o Signer)
a k'owledged 63- e/ he signed th nstrume - =--- ."-- 71—Ypres:-d in it.
1,:,pV PU'. I 1
` '. MY N#GG 353178
r .n
—Ci a: :o
EXPIRES:
COMMISSIOOctober 6,2023
'''fFOFF-c! Bonded Thru Notary Public Undetwdters Department Approval:
Signature of Notary Public,State of Florida `
[ ] Personally Known >4/17Z��� .���
[ ] Produced Identification(Type) �� Scott Williams, ublic Works Director
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18 " '7��(0
".''`'''` Building Permit Application Updated 10/9/18
� 1', City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
< nWe IS REQUIRED.
Phone: (904) 2477-J5826 Email: Building-Dept@coab.us
bO` i
Job Address: Me),-/q J cPermit Number: F-NzE ZO - OO`
Legal Description 18 -3' l7 ZS-Z 1E Sec. k / LOT Q l k I 75 RE# 11 0'101 -0000
1
Valuation of Work(Replacement Cost)$ l' X Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ew ❑Addition DAlteration ❑Repair ❑lMMove ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): DCommercial residential
• If an 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:
K - f(7/c-e_
Florida Product Approval# for multiple products use product approval form
Property Owner Information // L
Name Lc2'1 F/(JdS C-C. Address 6b3 �1aj1 •" ' /-�e992.-
7 1 c1�J •‹ 4erjlrj
City : / .. t' State Zip 3223 Phone 9r35 /yZ-`JK 1,$)
E-Mail /.L., .1 rote I o. 7li.)- 10-16%ft - .
Owner or Al/gent(If Agent, Power of Attorne or Agency Lett- 'equired)
Contractor Information
Name of Company Qualifying Agent
Address City State Zip
Office Phone Job Site Contact Number
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt❑ Expiration Date
Application is hereby made to stain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issu. ce 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
RECOEING OTICE OF COMMENCEMENT. •
(Signature of I,ner or Agent) (Signature of Contractor)
frnl , fir
j-s bef r - th' f daf Signed and sworn to(or affirmed)before me • s day of
�, OM �--�its ' by
111111WI-�, ��p yp...., TONI GINDLESPfRGER (
R _•na trof, 1�r� • • .,1 - MY COMMISSION#GG . 17✓35i' ature of Notary)
=;' iy,c° EXPIRES:October, 2023
, '�O ?„. Bonded Thru Notary Public Underwriters
[ ]Personally Known OR
[ ]Produced Identification [ ]Produced Identification
Type of Identification: F ?Z `S 35- 7p z1`4(4`ape of Identification:
-wad.r City of Atlantic Beach APPLICATION NUMBER
Afr Building Department (To be assigned by the Building Department.)
jr-) Atlantic
SeminoleRoad �NC. o oot
AtlanticticBeach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: 3! I.
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: (.0O ( V\'\c r\ �-4 De artment review required Yes No
uildinq
Applicant: Lin r- �P nina &Zoni
Tree Administrator
Project: (,;
re,0—E.
ilities �
Public Safety _
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By C 0
Florida Dept. of Environmental Protection
Florida Dept. of Transportation O
St. Johns River Water Management District O
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: roved. ['Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: /6/1).-- Date: V30/20
TREE ADMIN. 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. ['Denied. ['Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
, c,''''.4. Building Permit Application Updated 10/9/18
f'
or
:• City of Atlantic Beach Building Department FFICE COPY **ALL INFORMATION
�+ v 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
ar ,n 9r IS REQUIRED.
O` Phone: (904) 247-5826 Email: Building-Dept@coab.us _
Job Address: .....6465.--
.. iG/1 S/L/`c--ch Permit Number: Nti ZO ~ 0 t
Legal Description 18 -:Y1* 1,7 ZS-i' E Se<1. 1-4 L-oTI 131k 4 Z 5 RE# 11 (, )01 ---0000
Valuation of Work(Replacement Cost)$ L
X Heated/Cooled SF Non-Heated/Cooled
• Class of Work: 04w ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Ld Kesidential
• If an 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:
Florida Product Approval# for multiple products use product approval form
Property Owner Information �] �
G�
Name L � 1 /l/SC-r' L-"- Address 6b3 5h ! I/7t?�< E-'rLl? {
City d / z1 t' becA ' StatetAzZip 3Z2:53 Phone 9C>5 !/�9Z-`I b j�
E-Mail Z..,4 •1 rv5CC / v. 17‘1)- TU iL ..6t7,)-1.
Owner or A/gent(If Agent, Power of Attorne i or Agency Lett- 'equired)
Contractor Information
Name of Company Qualifying Agent to N
Address City State Zip 0
Office Phone Job Site Contact Number v J cn
State Certification/Registration# E-Mail ...1 _ ci 0
Architect Name&Phone# CL • ' F- M
Engineer's Name&Phone# �' OA 0 Ili
Z
Workers Compensation Insurer OR Exempt❑ Expiration Date U W p Fr
Application is hereby made to •tain a permit to do the work and installations as indicated. I certify that no work or installutjo��,,rC3hax 0
commenced prior to the issu. ce of a permit and that all work will be performed to meet the standards of all the laws reg ( g z
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,Sm .. u.
gi
O <
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS, etc. NOTICE: In addition to the requireerJs 0-t
permit,there may be additional restrictions applicable to this property that may be found in the public records of this courtly,5�13 ;l
there may be additional permits required from other governmental entities such as water management districts,state age4#ei ctir; s
U J II >-
federal agencies. ® } o. r CP
u� F-{-- u o
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance w U W p Lst
UJ
applicable laws regulating construction and zoning. Wv COcc La
5 >
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MY
CC
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECOZING OTICE OF COMMENCEMENT.
(Signature ofpwner or Agent) (Signature of Contractor)
i ned an ti orOt (x ffirrh )befgr : th. // day of Signed and sworn to(or affirmed)before me •'s day of
[,ya .t ,---c.ll Y
M`ai TONT GINDLESPE--
�CLna rof - = , f?,(Si: ature of Notary)
+; "� ;,: MY COMMISSION#GG
�r:1EXPIRES:October, 2023
F.......... Bonded Tbru Notary Public Underwriters
[ ]Personally Known OR - • . -
[ ]Produced Identification p�1 I _/�[ ]]Produced Identification
Z-4Type of Identification: � `S 3.5-- 7—t ."l( `J1pe of Identification:
f • **ALL INFORMATION
ry;;s=j---- Owner Builder Affidavit `JOB COPY HIGHLIGHTED IN
4 ° City of Atlantic Beach Building Department GRAY IS REQUIRED.
},. 800 Seminole Rd, Atlantic Beach, FL 32233 /y Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: ritZ6070—Oci9'
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$5,000 PENALTY UNDER FLORIDA STATUTE NO.455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY" OR THE FLORIDA"CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US ) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: 6O3 T� 1
1r -2,--t 6C Ai .i7Lic
loc,(1,1
Owner Name: L /it-LA .(rte$( e/b (4(51\ Phone Number: � - / ''? - 26 35)
Mailing Address: w-g /'t r!I $ /'-er T City: X101 LC, beAR State: ( Zip: 522.`i j
Notarized Signature of Owner _/
Thfar.egoing,instrtlment was acknowledged before me this ( ( day o' ,,c4s ) ,20Z-On the State of Florida, County
of t/C--
IP I
C
Signature of Notary Publi. (:)._ g._
iii ._..3________,
„,
[ ] Personally Known OR [ ] Produced Identification
REVIEWED FOR CODE COMPLIANCE
CITY OF ATLANTIC BEAC!4Pe of Identification: -I , l._.
SEE PERMITS FOR ADDITIONAL
REQUIREMENTS AND CONDITIONSUpdated10/24/18
'v !?9q, TONI GINDLESPERGER
(1�� --'. c,` MY COMMISSION#GG 353178
j :;;,`', o`� EXPIRES:October 6,2023
F`p' Bonded Thru Notary Pubiic Underwrtters
601 MAIN STREET, ATLANTIC BEACH, FL. 32233
JOB COPY
N ,,
LOT 4
co co
BLOCK 131 .
l'ILOT 4 t '
BLOCK 130
Du) ( n sr .
z �' THEOF N LINE LOT 5,BLOCK 131��_ L_
z o -.- AERIAL PHOTOGRAPH
SCALE:1"=30' cn -n THE 35'OF v", (NOT-TO-SCALE)
LOT 5 0
BLOCK 131 FENCE FENCE
(NOT INCLUDED) 5.5'N LOT 5
5.6 N
N88° 56' 00"E < 0.4'E ` BLOCK 130
FOUND 1/2" 102.00'(P) �'—"—
_25.0' IRON PIPE ` FOUND 1/2"
UUTILITY N STORAGE N "_' . IRON ROD
BOX �' `n
D4 \
N _ 30.6' /0 THE S15'OFi
o
35.2' _ � LOT 5
I LOT 6 r BLOCK 131
A
COVERED ' /\ m I o
DRIVEWAY /\6.6% BLOCK 131 0/ \a (INCLUDED) i 6.1 °
› RESIDENCE o NC
COo D COVERED �, #601 ac i o N LOT 6
22 r- z SCREENED UG' 28 6, 36 1' p o BLOCK 130
0
0 oo x 37.3' �� frt BLOCK
o I fT1 o N o o CORNER
D m o N N x < I AT LOT 6
< m
N " m
m - FENCE BLOCK 130
FOUND 1/2"
IRO PIPE
25.0' 2WM ---T) t _. ., r`V o
BLOCK ` S88° 56' 00"W 102.00'(P)
kP
I CORNER 102.00'(P) 'U d
n
FOUND 1/2" r C 2'GUTTER
IRON PIPE o W 6th STREET _ i:=2, _
— ASPHALT-cr-ROADWAY
50'RIGHT-OF-WAY
-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 IS NOT COMPLETE WITHOUT ALL SHEETS
The survey map & report or the copies thereof are not valid without the digital signature and seal of a
Florida licensed surveyor and mapper
Date of Field Work : 01-03-2020
Drawn By: Oleg
Order #: 76559
Last Revision Date:01-03-2020 (17k EXGENq`
Boundary Survey prepared by: LB8111 ,� civo.o
1.514 2.3
NexGen Surveying, LLC
5601 Corporate Way, Suite *103
West Palm Beach, FL 33407 SURVEYING, LLC.
561-508-6272