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318 ROYAL PALM -FNCE20-0009 rs.�, ! City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) M.\ 800 Seminole Road C1 1", _• r) Atlantic Beach, Florida 32233-5445 V Iv a 20-- C1)07 t.---',:4' �' r Phone(904)247-5826 • Fax(904)247-5845 \4 01119:' v E-mail: building-dept@coab.us Date routed: "Z/(01 7 0 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM 1) Property Address: 'S I a OL �L d tel Lvi�l Department review required Yes No LC) ( uildiApplicant: (2‘... --c ( CSA ` _'tinning&Z��-onin: Tree Administrator Project: C, " --c.r 3(2 -ublic Wo k,) C---e c Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept.of Environmental Protection Florida Dept.of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: Approved. I 1Denied. Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING �1 Reviewed b • •�` " Date: 2- 7 -Zb TREE ADMIN. Second Review: Approved as revised. Denied. I INot 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 ( k,- .' Building Department jecEivE (To be assigned by the Building Department.) 800 Seminole Road />rl�� "`-'_'. Atlantic Beach, Florida 32233-5445 I— mez, C ) lett// Tj nn Phone(904)247-5826 • Fax(904) -5 � U 6 Z .Z/L2 L illi• E-mail: building-dept@coab.us Date routed: / Z 0 City web-site: http://www.coab.us BY• APPLICATION REVIEW AND TRACKING FORM Property Address: j t Uli A d A Wits Department review required Yes No _ `; r4Buildin Applicant: Co icA& -c ( v 0,c\ PI .,PtBnninq &Zo—nines Tree Administrator Project: C2 r cmc bl c Wo k6j C. E. u12.� l,�tilitie ' 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 v • PLANNING &ZONING Reviewed b Date: `_Z 2 2 TREE ADMIN. Second Review: Approved as revised. Denied. nNot 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 : _�,i,.,r City of Atlantic Beach APPLICATION NUMBER Cfs-.'' .. '1 Building Department (To be assigned by the Building Department.) 800 Seminole Road C 1 44"=._ ,. AtlanticBeach, Florida 32233-5445 (s. I\)a_ 2cw0 71'J ~ Phone(904)247-5826 • Fax(904)247-5845`' / / Lr�,j ' • E-mail: building-dept@coab.us Date routed: t;p ZO City web-site: http://www.coab.us - _ — APPLICATION REVIEW AND TRACKING FORM r) Property Address: 1j I 8 ` OVAL , A Wyk Department review required Yes No ` _ ) Linq . Applicant: L_,c) A.&'T ( c� GAS-� nnmq &Zonis Tree Administrator Project: ( I C 3Q public W 1is_Ltiliiies•-> 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: APPLICATIONffSTATUS Reviewing Department First Review: ✓►Approved. ❑Denied. ['Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date:s-/ 7 �GZU TREE ADMIN. Second Review: Approved as revised. tenied. nNot applicable PUBLIC WORKS Comments: Oeni 4264 VA ,i I QeV i S;bin t S S L korlAc ✓ P(PUBLIC UTILITIES Pe4 h. � R A, 62';'4./i p+...x PUBLIC SAFETY Reviewed by: Dater////ZV FIRE SERVICES Third Review: I 'Approved as revised. De led. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 „.0.A9=-,7-4,., City of Atlantic Beach APPLICATION NUMBER jS/+� .; Building Department (To be assigned by the Building Department.) 800 Seminole Road �Y� n 15 iv -. Atlantic Beach, Florida 32233-5445 ��. I\J�C 20-- W� 7 Phone(904)247-5826 • Fax(904)247-5845 P,olio- E-mail: building-dept@coab.us Date routed: *Z/6:2/ 7 0 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: .3 [ ' R C� F}L. PA. Ll/y� Department review required Yes No _ (�Buildin Applicant: Co iq& t 0 C>Pk� _'i nning &Zonin• Tree Administrator Project: CO I C---_O-- -' bic Wow [Public Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept.of Environmental Protection Florida Dept.of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: Approved. enied. Not applicable (Circle one.) Comments: / BUILDING e(^qA_ /— PLANNING PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: Approved as revised. Denied. I INot applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: Approved as revised. ❑Denied. I Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 seg'. , Building Permit Application Updated 10/9/18 ik _;) City of Atlantic Beach Building Department **ALL INFORMATION j+ V 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY t tw Phone: (904) 247-5826 Email: Building-Dept@coab.usO F— IS REQUIRED. Job Address: 31 bi�-L b L ns [� Permit Number: 1— I\iC,C- C_.:0 V 00 Legal Description i' i 33 dS — Z clC I f P QT- e1 Ck writ-M,/N4 RE# i 1 I1O(.0 - OOjO NIT4 4-07 14 btoc Z� Valuation of Work(Replacement Cost)$ /1Uc, 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 ❑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: fl' 1 O b 1^G 'CG/ )L4Cc--1.4'Tid/vChJ Florida Product Approval# for multiple products use product approval form Property Owner Information Name Ci 2v - C r IUg.Dey Address 3/a-ROYAL /Id/LrI3 _0Q. City /frTL • 4cf State re- Zip _7Z Z 3 3 Phone '(� 76` .f7/ — -73—z? E-Mail Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company Cv/457—"rdeeessr" ier-i'C Qualifying Agent •ZAI A72- 4,1 S'r Address /2e/(4! VZ 6-0_5 City/517t. gel". State 'r-l..— Zip 3'a Z3 3 Office Phone girt/ 70$ 7 75-5 Job Site Contact Number State Certification/Registration# E-Mail C TOC,e,„:- 6)Is'-,i/4/L• ce-n_, Architect Name& Phone# Engineer's Name&Phone# Workers Compensation Insurer OR Exempt Expiration Date IAA/ 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. RR OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all wcWill be5done0in�compliance with all applicable laws regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICtbF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO.VOUR PROPERTY. IF Ye U INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFOR' , RECORD G YOUR NOTICE OF COMMENCEMENT, r (Signature of Owner or Agent (Signat - of Contractor) Signed and sworn to(or affirmed)before me this3 day of Signed and sworn to(or affirmed)before me this,3C-Jday of FE& , otoa CA• •L. ISA¢.Jt: Fe:3. , •• ..y ; o - r4` ►; c• T_•� I Iii . u e .f .t. r- . r . . J•, ♦ Notary Public State of Florida A00%, Notary Public State of Florida � � Roberta D Carlisle ;r '; Roberta D Carlisle belyersonally Known 0 My Commission GG 251658 N.Personally Known 0' moo` My Commission GG 251658 o Expires 09/15/2022 �ad• Expires 09/15/2022 [ ]Produced Identifica..n or f• [ ]Produced Identificati,n Type of Identification: "'''''+ Type of Identification: . fr- PREPARED BY: • - 1 s r E4 ', r. "'IIIb... NLly i MIG -44 �71I bPIC�R t _� IF! iii a-lea`" $ LAND SURVEYORS Z. ..a as 7 Y T --Ser' Ing an- tiara f ECo -_._.-.. t P. ., igniecargocarlvs PROPERTY ADDRESS: 318 ROYAL PALM DRIVE ATLANTIC BEACH,FLORIDA 32233 FIELD WORK DATE:101281201a REVISION DATE(S):(REV.o 10/28/2014) NOTES: 4i R1410.2386 SETBACK INFORMATION SHOWN ON PLAT,NOT VERIFIED. LOT A'PEAPS TO BE SERVICED BY CITY WATER AND SEWER. BOUNDARY SURVEY FENCE OWNERSHIP NOT DETERMINED. • DUVAL COUNTY 24-6Or 15 f r 4 Y 50C.25 3017 err ) F 93.1 3' t N82°41223.E 93.00'(11 Zo- / 1 N 8Z°43'58 0o i a _ Oo Qo ON O 00 0- '"'^� Z� f -� 0_,-,3 Oz41-. T SII -f - �f wf l�P F . it !AV 1111 II- .. * \ It Off is T0.1 �*`nlif � 411 k.Pk-P � 6-% An- 1 rd � Z\'71 ur3:1 Il t. 23.1' 411,1 OZ. `'11 � � j�� • N— .\9 ,,4 3X 25 of " 4'" \_ oi , Clr?--1 t e.AtAleat . - - • FX--.. I 011 CARiT� O� 1 if i -11-S•11, • V.P4v4r#13kEil :' .7 Mt.��i*,,-- Z ZC A�� t of�' , /\ 582 t8. a�93.32'trfl Ztl a : 74 F.I il = oA 1 52.50It12031- 95 3 G _LE �a (GO .1-,erwy "1y d2m ea: . pec.`v.las pec my&- - an.t a bias af.A�''loin*an+*lei 4sa,< ;*' 11 are z#awe/11w- .s,24 -.;5z stir dots,1=dee ad/4141re Roma Brerz..-f, ►' '+ ir, tem r Qinnar 5- a 1Aet }� Building Permit Application Updated 10/9/18 - , City of Atlantic Beach Building Department **ALL INFORMATION s 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY ' IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: 3 l (Z-cx.-tc;..l (7C-& -N----,;)' Permit Number: Legal Description 31-6(®33.-...1s-.79c 00f Pro FKoyi4L-PAtAISU,air719Loii, '3LyI2 RE# 17/ 706 -OQ00 cu Valuation of Work(Replacement Cost) 700 Heated/Cooled SF Non-Heated/Cooled • Class of Work: ❑New EAddition ❑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 protect? ❑Yes(must submit separate Tree Removal Permit) ❑No Describe in detail the type of work to be performed: t , v`-f f,---,.--. ..—},- C. C-t --____ - - --.,(2.4_. rC..-\-V--A LY c-__, ,,,_4— Florida Product Approval# for multiple products use product approval form Property Owner Information , Name C=-G`uz� C ort,..-/-✓�/- - Address 3 \�i (2-c'-`ca 12c,...\---,.. -V✓ -v City t -�-_--- ..c-... "- State Zip 3 .-7.-33 Phone Cr-1.h—'41 L —-IS- E-Mail v._ `A_ c- ,L.,..‘.,-\ c.. -E2 yCc--(n,avto ` c=-0--- Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information ead5-7-0 cr FeeVe.e _ Name of Company 5 c_-- - Qualifying Agent 6,-----,-,7 Jc.) ,,,_� Address l? 6746 146z2S ,4V City 1o, ..1c.----t..it State (� Zip 322-33 Office Phone 90.1 11/9 a>z 36)1410V 71'Y 7 ?SSob Site ContacttNumber State Certification/Registration# tiC-pc_/4 E-Mail C.. j-c.,,-�c�� �---� �--' , \ ' .-.�._ : Architect Name&Phone# J Engineer's Name& Phone# Workers Compensation Insurer OR Exempt Expiration Date 7//)ice Z/ Application is hereby made to obtain a permit to do the work and installations as indicated, 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. i WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPER ' YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN AAl:� � •• :i RECORDING YOU NOTICE OF COMMENCEMENT. (i, 4Agent) // � (Signature of Owner .••-nature of Contractor Signed and sworn to(or affirmed)before a this 6 day of . e1d d sworn to(or a'9i)before m- this2 lay of Ocd-o 15. ,t--- , -C9?-0, by c'o I 6; ras � LIS.:' F►i-_—, . ✓' (Signature af_Notarv) 4Mliiiii • '••.JANMAURICIO WALKER ROBERTSON J IS� '� • MY COMMISSION 4 HH 009325 TONI GINDL R '�. 1_ 0naIl y Known OR �°`tPVUtiP: MYCOMMISSI053178 Personally Known OR . ���. EXPIRES:June11,2024 . ,.. •. •EPE;°: ] Produced Identification =*: ,T,: *: { ]Produced Identification l BondedThruNotaryPudicUneerwriters A', .:ot EXPIRES:October 6,2023 Type of Identification: /./ ,✓Q__r-,,-- �-,r-lac_. - ype of Identification: "•'.'F:• oQ; .- - �,i REVOCABLE ENCROACHMENT AGREEMENT /r f `�, **ALL INFORMATION I ••• ,;, City of Atlantic Beach �y HIGHLIGHTED IN GRAY �r'J 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 C'd ST TD Com-5T -. ,--)4'-zZ 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 Fo p'C.i 11.-) sr-At ( ,.(s'1` (U..) 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 -- 1 g . /3t -PALI+,9 r�+�• . • 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 fro' -any of the work herein under the terms of this permit and that all of said liabilities ar- .: - •• .s •• -• the USER. /' Date ld/26/2f7ZD Property Owner/Agent(signed in presence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument was acknowledged this Z(7 day of0 CI , 20 __ by Ct ' _Tl4-,4N. cJ ( c-- ,who personally appeared before me and Il.tinted •. e of Signer) ack l. ledge• tha 'e/she signed the instrument voluntarily for the purpose expressed in it. 11. orAw • Aid 0;q;,. TONI GINDLESPERGER ... MY COMMISSION#GG 353176 Department Approval: �• ,.. EXPIRES:October 6,2023 Signature of Notary Public,St. of Florid ":.'::,pFF,,o?=:Bonded ThruNotary Public Under iters Hrsonally Known [ j Produced Identification(Type) Scott Williams, Public Works Director H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18 .-c=1 -it RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION -*/ '4r City of Atlantic Beach HIGHLIGHTED IN GRAY IS •,,, A800 Seminole Road,Atlantic Beach, FL 32233 REQUIRED. PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job Address 31% Q4y,P1., f I,w1 S 'De__ Permit Number Contractor �Information �1 Company-.245r f UAcr f r k( (jv Qualifying Agent J/414"0 A.-q-r-Oz ()I L5 Address es/+iZ / ;F 14 VT' City 471 - 3C-� State FL Zip 3.7 Z'/ Phone 74� 2-7S5 Email C-7 _C -'���� ,''br(L - C'�7--+'1 % State Certification/Registration# Architect Phone Email Engineer Phone Email Workers Compensation Insurer OR Exempt/ Expiration Date-7 / • 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 JIk..) ct or.4(cJ r p&----- (Project Superintendent) with(Company Name)C:ujg" `ja 7‘,45'1.-- PE—Ile-6r GJ Phone Qp 7u$' 7 7 5 :- • 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 say- armless the City of Atlantic Beach from and against any and all loss,damage and cost of expenses arising in any mann: of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. • The Public Work i..-- or s'al..- • Tied 24 hours prior to starting work and again immediately upon omplletion /� /00Date /0 Z- G Z c P,yV gn-d in presen .-Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument was acknowledged this 2 j �-�. � -� day of 0- 0 e_e--- ,20___er / ,\ by N evuer T604 ��L‘LUrCr— ,who personally appeared before me and �I (printed name of Permittee) TONI GINDLESPERGER acknowl d th. he. •ned the instrument voluntarily for the purpose expressed in it. ••,01.6k"-:-; 1 : • ,., ,,: MY COMMISSION#GG 353178 *, :o, EXPIRES:October 6,2023 . ,- °1,,,FF%°P Bonded Thru Notary Public Undervrtiters � ' [ Personally K Signof Notary Public,St.te••rida [ ] Produced Identification (Type) H:\Applications&Forms\Word&Excel Document Originals\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18