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1939 MAYPORT RD DWAY20-0051 Building Permit Application Updated 10/9/18 City of Atlantic Beach Building Department **ALL INFORMATION �' La. / HIGHLIGHTED IN GRAY , 800 Seminole Road, Atlantic Beach, FL 32233 IS REQUIRED. Phone:} / (904) 247-5826 Email:� Building-Dept@coab.us Job Address: /9 3 q / 4/ y pole , AD Permit Number: i � AL/ ZO` CO J 1 Legal Description 19-16 / 7 /- ;Ls - a 9 g DoAN1k Alp LOT 3 iBLK 11.RE# ,7z 190 -oo oa Valuation of Work (Replacement Cost)$ 6; 7401 et, Heated/Cooled SF /V/Ai Non- Heated/Cooled N1/41 • Class of Work: ❑New 15QAddition DAlteration DRepair DMove ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ACommercial ❑Residential • If an existing structure, is a fire sprinkler system installed?: DYes 1 'No • Will tree(s) be removed in association with proposed project? ❑Yes (must submit separate Tree Removal Permit) )!if)No Describe in detail the type of work to be performed: - C=' «VQ CA i—I, vetA.20-Lt •-poi--k(A 9 Florida Product Approval# for multiple products use product approval form Property Owner Info wnerInformation Name Aj1L/ 7), rm2-EA C44( ,L Address ST 3.2./44T,a NzA S W/9 y City 379eeS0 J J/ LL 8. State ICL Zip 3 ,2)] Phone 904/ 73 S 9600 E-Mail p etr'QIZ 2 C w0 r1 s g1,c0)404..nON! Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) /UM Contractor Information Name of Company()1 a y f rt iRtw t CALA W LL, Qualifying Agent 0 WA T/) Address S Y36t, Pl it 1✓z.H s way City TRCKgaIJvi/IA State ISL Zip 3X-2/1 Office Phone /4/79Job Site Contact Number 9O'/-S"6k'q/2L0 State Certification/Registration# AI/19 E-Mail Architect Name& Phone# AIM Engineer's Name& Phone# /L///r' Workers Compensation Insurer A)/X1 OR Exempt 0 Expiration Date N/i9 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 REC �Y)�T.P iLc-c'ICE QF COMMENCEMENT. OVii . (Signature of Owner or Agent) (Signature of Contractor) Signed and sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed) before me this day of by 1 , by i. (Signa e of Notary) (Signature of Notary) .�*►ci, Notary Public State of Florida >° `* Jann J Clark Personally Known OR : .Ay Commission GG 299392 ) Personally Known OR I 1 PrnriurPri Iriantifiratinn '..<Nres 02/07/2023 g,p-Ne,",/ - _ _ _ , 1 Produced Identification .*- f \� CITY OF ATLANTIC BEACH ° ) 800 SEMINOLE ROAD r) �r ATLANTIC BEACH,FL 32233 (904)247-5800 SURVEY AGREEMENT NOTICE All new projects creating more than 250 Square Feet of impervious surface or requiring on-site storm water retention, including swimming pools, will require pre-construction and post-construction topographic surveys, as required by COAB, Section 24-66 and described in Bulletin 2-18, Surveys. The surveys must be new original documents, from a licensed surveyor, signed, sealed, and dated. Other small projects, such as fences and construction less than 250 SF, will not require a new topographical survey, but a current original-size survey with all relevant details is still needed. These surveys, when included as part of a building permit application, must be complete, up-to-date, and original size and scale, as produced by the surveyor. Copies of old surveys lacking details or copies not of original size cannot be accepted. Building permit applications with unacceptable surveys cannot be reviewed and the application will be returned to the applicant. Thank you for your cooperation in this matter. AGREEMENT I have read and understand the Notice above and affirm that the outdated survey I am submitting is still accurate and complete, and all structures and impervious surfaces on the property are shown on the survey. I further understand that, if the survey is found to be inaccurate or incomplete, a $50.00 Plan Resubmittal Fee will be charged; or if the permit has been issued, a Stop Work Order will be posted with the associated $110.00 Fee. JOB ADDRESS 19:0 9 m R D A n c sefi c+; F1- 3,2_,2.33 OWNER or CONTRACTOR (Print) P��leCw� L I- Signature ,,e74/44,(- (ft,t,/(41 Date 0 g//2 7,1-°A'd 1 NOTICE OF COMMENCEMENT State of cLOX 1 p 7 Tax Folio No. / 2- /?O —0040 County of D1A,V L. 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. Legal Description of property being improved: f9�llo /7- zS -62,q 6o1v J . R/p i oT3 'LK- Z1 Address of property being improved: /939 /V1/ �f PZ'RT RO 2.b General description of improvements: REL y CLc/ A1C J L A 3PiyA LT Peg I Lo s It1 i((,LfA/G Pi9a/n/6 LoT-4,95e _ Owner: 0e4/LG y PE Ti€ rie GR LLwe e,c Address: S'9i t /114M/t).AS Wig y Owner's interest in site of the improvement: Fee Simple Titleholder f f� //(if other than owner): N Name: N Contractor: Address: /1///q Telephone No.: P1//6 Fax No: N6 Surety(if any) Address: AA Amount of Bond $ Telephone No: A..)/f) Fax No: /ti/A Name and address of any person making a loan for the construction of the improvements Name: N/a Address: W/i Phone No: /U/15 Fax No: N/4 Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may be served: Name: N/R Address: A// + Telephone No: Ai/A Fax No: NJia 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. ( ill in at Owner's option) Name: /v�j� _ Address: A//j-i Telephone No: Ai j4 Fax No: NA Expiration date of Notice of Commencement(the expiration date is one (1)year from the date of recording unless a different date is specified): ? THIS SPACE FOR RECORDER'S USE ONLY OWNER Signed: 1 , / Date# /90/2-�447 Before me this G' ' day of 4...Ep/t,01' R..in the Count of Duval,State Of Florida,has personally appeared 5 Notary Puonc State of Flon Notary Public at Large,State of lorida, Rsu^nt)!o Duval. ,iann J Clark My commission expires: 002 f Q 1 f c>,(Jr My Commission GG 29935 \( F xp es Q2107'2023 Personally Known: 1 P �''a�` �'� or --'"'%/,. TREE & VEGETATION AFFIDAVIT FOR INTERNAL OFFICE USE ONLY (-: r `f City of Atlantic Beach PERMIT # , '`` CommunityDevelopment Department 800 Seminole Road Atlantic Beach, FL 32233 ' ,:_ (P) 904-247-5800 SITE INFORMATION ADDRESS / 939 Mll t/po jPi7 4,4", SUBDIVISION Do '/1 t m BLOCK / LOT ,3 RE# / 7),, /go -6000 J RESIDENTIAL X,COMMERCIAL ❑ OTHER APPLICANT INFORMATION J NAME % Z,6,r jPci ala tMWe2,/, PHONE# goy-93g-%x ADDRESS svga3.., 1T-rA/0%,, (/Q(7/ CELL# 90v_s-62, fp-2 pp CITY �l e N..S' V/CL's STATE JCL, ZIP CODE 3. ... .../l EMAIL Peir04 &Ct00 r/G S q bt 0AOL i COM- 0,OWNER ❑ 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 HEREB CERT Y THAT ALL INFORMATION PROVIDED IS CORRECT:Signature of Property Owner(s)or Authorized Agent 7 �44 4 L, — ,B/c 6 X11 we-&e. 094.00V IGNATU'<�• •APPLI N PRINT OR TJYPE NAME DATE 1 u-eZt P6TRxJ6d 696o WeL& o9 �� ; o SIGNATURE OF APPLICANT(2) PRINT OR TYPE NAME TATE Signed and sworn before me on this 0 ' day of iS AZT Btn , aQ-0 ,O by State of /-Lo1+e-in7 gg-ty f i)6-Tieks.ti �,Tt"cP(Ale County of ,DIAVfr1'l, Identification verified: \I(_5 Oath Sworn: E Yes rr --o j 3 iN Notary Public State of Florida Q144-512.— t'; ,ry Signature a Jann J Clark y • My COf11TI .(,)1 GG 2N.ig4 R / Fxr res 02107,2023 c of o-1 11.n a 3 �,a Commission expires e.i..... ,),,,?? i '1I REVOCABLE ENCROACHMENT AGREEMENT r I /; �� 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 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. 4._C(,c 6,6 4A114gsp/4AT P t f e•JS This work is generally described as /14i L L�.I)0e PR ye,g 0✓6 1,or-- efrq _' 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 /q 3 9 /�o y pv ocT lem b, /Q1-14911/-06?J BoicAl� a3 z,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 labilities are hereby assumed by the USER. /?, ,?,,.e 2,, , z ll Date 09 ag /' Property Owner/Agent (signed in presence of Notary Public) STATE OF FLORIDA, COUNTY OF DUVAL The foregoing instrument was acknowledged this 0 3 day of J eP7e/r)Bzg-- , 20 , by ft—rg eIV iO1_.0 Gv 6 Z,L , who personally appeared before me and (printed name of Signer) acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. ),l-4A(1S / p Notary Pub c state of Fro„da Department Approval: Jann J Clark g ture of Notary Public, State of Florida: t My Commismon GG 2953c2 Personally Known ,, aw Expires 02,07,2023 [ ] Produced Identification (Type) ' Scott Williams, Public Works Director x RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION J.‘ City of Atlantic Beach HIGHLIGHTED IN GRAY IS 800 Seminole Road, Atlantic Beach, FL 32233 REQUIRED. PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job Address /989 mrr/OR1T /east Permit Number Contractor Information /1 ', I Company/G�y //Q ,EA✓� CJA�•/.) WEtZ, Qualifying Agent 0V✓/Ueje Address S'9301 /14A-09/2%►9 S V/Ay City 3/1 edeso iv ✓//-t State 1., Zip ,.9 2J Phone 9i9(/- 13g-7 boo Ok• G6?-11 o d Email Pe,i7'e4 e c WOrkS y U @ A dG . &m State Certification/Registration# fJ fil Architect A//11 Phone A1/,1 Email AY-- r1 Engineer A A Phone /vbq Email A//A Workers Compensation Insurer N/A OR Exempt ❑ Expiration Date Al/A • 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 (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. • T„:.Public Works Director shall •e notif 24 hours prior to starting work and again immediately uponf o�mjpletion. , /,� Date O gl op /Zoo7/0 Permittee(signed in presence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL ,! The foregoing instrument wasacknowledgedthis 0!3 C/ day of � _PTG, !� ,20 V-0 , �-T/ by ' e Ex / i e CA G DLit 0"L t✓ ,who personally appeared before me and (printed name of Permittee) acknowledged that he/she signed the instrument voluntaril fo he purpose expressed in it. Notary Public State of Florida Jany J Clark O ._ i M 4-.1. Ja n J Clark r��299392 v�liU+� cXv�•eso2n ?' Personally Known ignature of Notary Public, ••t.t-.s I. •'.•• [ ) Produced Identification (Type) ,-s�=\Tri,,, EXHIBIT A: LETTER OF AUTHORIZATION City of Atlantic Beach ``y Community Development Department 800 Seminole Road Atlantic Beach, FL 32233 FOR INTERNAL OFFICE USE ONLY "%,-_,;.»% (P) 904-247-5800 PERMIT# OWNER INFORMATION I,, /NAME ltt,(,./ PCT )J 6 �4LII ie 26 PHONE# 90 q- 93g-g6cv ADDRESS S;T f22., 0"c 4Ti J ).i.-/9S KW,/' CELL# 90V,56�- /,9 0o CITY ,111 ,szvn.JVa,L G STATE FCS ZIP CODE 3 a,,,, AGENT INFORMATION NAME Jura PHONE# /4 ADDRESS /1//4 CELL# /V/4 CITY n//A STATE /0 ZIP CODE A/4 X/A is hereby authorized to act on behalf of /J� the owner(s)of those lands described in the attached application and as described in the attached deed or other such proof of ownership as may be required in applying to the City of Atlantic Beach, Florida,for an application related to a Tree and Vegetation Removal Permit. I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT:Signature of Property Owner(s)or Authorized Agent / 1 E/Z,G67460 iVEUi e99740W S tATV'E •F 0 E PRINT ORiFYPE NAME DATE i.„q/ -el"-e—) / / ' frrie-a/ (j/4 a vuelb 09640,0o SIGNATURE OF OWNER#2 PRINT OR TYPE NAME DA E Signed and sworn before me on this 0.? day of S g f TE'-)8ER ,0wa-0 by State of /C4(:),�� &&GLr 1 PPT,Eitig ( CSOW6L�- County of 2) Identification verified: yes Oath Sworn: ❑ Yes �o s # A (. /z-- ,,,Nr' Votary Public State of Florida Jann J Clark N ary Signature My Commission GG 299392 �, r ExD res 02/07/2023 ^ ) 1/4/ Commission expires 0 b( ' ©7 1 of O a3 MAP SHOWING SURVEY OF LOT 3, BLOCK 21 , DONNER'S REPLAT. ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 19, PAGES 16 AND 16A OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. CERTIFIED TO: BILLY H. CALDWELL AND PETRENE A. CALDWELL ilt li SIMMONS ROAD ( 30' RIGHT OF WAY ) 1 AS PER PLAT \I r 120.50' PLAT N89'34'34"E 120.61 ' F.M. ' EDGE OF ASPHALT MSP CURB Q ,I.- a MB0 20 MPH-SLS L "Zr WPP • N89'34'34"E O ° 214.58' F.M. r r 215.00' PLAT o 0 3 3 ° •aa CONCRETE DRIVE ' • W N AND PARKING Qn .L ill • .d'..• d: p W m O ^ . .. GRAVEL x x N L G ' 1 AREA 000 o CAif) n u 8 t SHH POLE ,10/ 48.1' ''.. O o 0 0 re_, III �' °MSP A IV 1939 MUVB o1'0 o ONE STORY c ; STORAGE D 12.0 ,7'5. n Z i MASONRY 20, z\ BUILDING' '._BUILDING -_0 12. a6.1' 7s'. LOT 4, CUR: BLOCK 21 gi 'P W/SL .cI A/C❑ 9' 4 C. L. FENCE Is oURB o x 6' WOOD FENCE ) S89'01 '22' W 130.90' 6' WOOD FENCE LOT 2, BLOCK 21 UTLITY SYMaL' S WGGD POWER O WPP PCLE FT FGTRIG ESM 6 RVIGE METER 510NALIG E1TSRH HADD HOLE MIxELLMFLtn MUnVB UTILITY VALLF Pa UTLITY 0 RI ER PDX LRD WATER METER MAIM NOTE: NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA UCENSED SURVEYOR AND MAPPER. ADDITIONS OR DELETIONS TO SURVEY MAPS OR REPORTS BY OTHER THAN THE SIGNING PARTY OR PARTIES IS PROHIBITED WITHOUT WRITTEN CONSENT OF THE SIGNING PARTY OR PARTIES. NOTES: LEGEND DATE OCTOBER 5, 2020 1. BEARINGS ARE BASED ON THE SOUTH R\W UNE OF SIMMONS ROAD AS BEING N 89'34'34" E, ASSUMED. DENOTES CONCRETE MONUMENT 1" = 30' 2. THIS IS A BOUNDARY SURVEY OF THE LANDS DESCRIBED HEREON. SCALE 3. ELEVATIONS SHOWN THUS (15.0) REFER TO THE US DEPARTMENT OF COMMERCE, NATIONAL OCEANIC & x-x DENOTES FENCE ,106 NO 50793 ATMOSPHERIC ADMINISTRATION (NOAA), NATIONAL GEODETIC SURVEY (NGS) DATUM, NORTH AMERICAN VERTICAL O DENOTES 1/2 'IRON PIPE SET 579 DATUM OF 1986, (NAVD OF 1988). A &J LB 6661 F. BOOK(S) 4. BY GRAPHIC PLOTTING ONLY, THE PROPERTY SHOWN HEREON APPEARS TO LIES WITHIN ZONES:"X" (UNSHADED) 27 DENOTES 1/2 'IRON PIPE PAGE(S) 27 AS SHOWN ON THE FEDERAL EMERGENCY MANAGEMENT AGENCY (F.E.M.A.), NATIONAL FLOOD FOUND LB 3672INSU 120075 NCE 040gROGRAMAP R�VIDSEDSDATE:CE RATE 11/02/20 8P MAP NUMBER�203NC04ITY08JNEL NUMBER: 3 QQ DENOTES TEJ LBN6661&DISC SET FILE COMPUTER 507(EFF ON SERVER) 5. UNLESS OTHERWISE NOTED, ANY PORTION OF THE PARCEL THAT MAY BE DEEMED AS WETLANDS & INC.BY STATE OR GOVERNMENTAL AGENCIES, HAS BEEN DETERMINED AND ANY LIABIUTY RESULTING A J LAND SURVEYORS THEREFROM IS NOT THE RESPONSIBILITY OF THE UNDERSIGNED. 6. THERE MAY BE RESTRICTIONS OR EASEMENTS OF RECORD EVIDENCED BY TITLE EXAMINATION CERTIFICATE OF AUTHORIZATION NO. LB 6661 THAT HAVE NOT BEEN SHOWN HEREON, ABBREVIATIONS THAT MAY BE USED IN THIS SURVEY PROFESSIONAL LAND SURVEYORS P.C.P. PERMANENT CONTROL PONT MSP METAL SIGN POST 5847 LUELLA STREET P.R.M. PERMANENT REFERENCE MONUMENT LB. UCENSED BUSINESS JACKSONVILLE, FLORIDA 32207 P.O.C. POINT ON CURVE W/SL WITH STREET UGHT P.O.B. POINT OF BEGINNING C.L CHAIN UNK OFFICE: (904) 346-1733 P.O.R. POINT OF REFERENCE MPH MILES PER HOUR FAX: (904)'346-1736 P.C. POINT OF CURVATURESPEED UNIT SIGN P.T. POINT OF TANGENCY ASL/SC AIR CONDITIONER P.C.C. POINT OF COMPOUND CURVE OHL OVERHEAD LINES P.R.C. POINT OF REVERSE CURVATURE F.M. FIELD MEASURED / �1A. GA GUY ANCHOR R= RADIUS EQUALS , // /r✓9✓l..4 R/W RIGHT OF WAY L= ARC LENGTH EQUALS /(�•(� 4(11 O.R.B. OFFICIAL RECORDS BOOK CH.= CHORD BEARING & DISTANCE EQUALS F.B. FIELD BOOK p= DELTA OR CENTRAL ANGLE EQUALS G J. WARD, STATE OF FLORIDA NO. NUMBER I.P. IRON PIPE MB MAIL BOX CONC. CONCRETE REGISTERE LAND SURVEYOR, CERTIFICATE NUMBER 5155