31 N SARATOGA CIR - FNCE20-0138 Building Permit Application Updated 10/9/18
t} ; City of Atlantic Beach Building Department **ALL INFORMATION
t r HIGHLIGHTED IN GRAY
V 800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: �.3/ S,leA 7V6A 7 e A)• Permit Number: 1_ cr- Z C) 38
Legal Description 31"13 3g`2 -reATLANTI� ;Pc Viva v.vty•Z1.oi L31)144RE# ( 7 71K—Qc.t'O
Valuation of Work(Replacement Cost)$ /9/} Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ?New ❑Addition ❑Alteration ❑Repair ❑Move,.2 emo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial jd'Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes f filo
• 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: eGMinde d'i4"V Ie" I ' 57' L✓(o C./C1vfl FL'yV
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name .6etice c1 e- Address 3/ 5-4 63 1V6-/4
City ,9T(. (j 6 State 1'^(_ Zip 2 z 2 3's Phone
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information 1
Name of Company(�),a5r?)CO)457 Fe; J POZ-6t /5
��,,qo � Qualifying Agent �'^� (J
Address /ZZt €fiPit6j-D j/WC .5 City /tn - QGM State lc_ Zip
Office Phone g 71g' 7 75-", Job Site Contact Number
State Certification/Registration# E-Mail !' 1.G FE^/ 6- 1-7,oI4 W-•.s.
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Expiration Date ///Z 1
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 OBT IN F. .'ANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
REC• :!11 O OTICE OF COMMENCEMENT. y i
/ (Sig t f w / r2nil (S gnature of Contractor)
40- 4,4-/q s
Si;ned and,.4n[.t.. .ff e_ •) .,-fore me this 2 day of Signed and sworn to(or affirmed)before me this .2 day of
•7��� C ZoZf by «tib -6ocA�t
.s e O �:t i�r1 '• V C w-a-.TS iZ E � ..�o n.Th�4
� �-• ia1arMVP e,
`�;�� Ex r '-�' �tg.r Carlisle �I _ /
P
/ y Com, is 1,° jf :tureof Notary) o (Si nature of Notary)
,,ox'Nii, Notary Puolic State of Ronda
1: Roberta D Carlisle
[ Personally Known OR [015-ersonally Knowrt'Q c My Commission GG 251658
[ ]Produced Identification [ )Produced Identifjtatiaraine Expires 09/15/2022
Type of Identification: Type of Identificatio
=7,� REVOCABLE ENCROACHMENT AGREEMENT
r ." **ALL INFORMATION
,, \,,,,.,;1City of Atlantic Beach
HIGHLIGHTED IN GRAY
i-')
' + 800 Seminole Road,Atlantic Beach, FL 32233 IS REQUIRED.
J,Ji %
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!// $7 TO CO//}ST ra'•14G <,d 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 7 CSB(/r`-17 •
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 e given by certified mail,return
receipt requested,to the following address 3/ S4 '70a,40 -Piece 4 & F<- �2-2..: _z,
• In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter
upon the above described easement or property of the CITY, the USER shall replace at the USER's sole expense,
any and all material necessarily displaced during the action of maintaining, repairing, operating, replacing or
adding to of the utilities and facilities of the CITY or franchise utility provider.
• The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes, Land
Development Code and all other land use and code requirements of the CITY, including City Code Section 19-7(h)
which states"Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but must
be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks."
• The USER, prior to making any changes from the approved plans and/or method, must obtain written approval
from the City of Atlantic Beach Public Works Department, for said change within 30 days after the day of
completion.
• This permit shall inure to the benefit of, and be binding upon, the USER and their respective successors and
assigns.
• USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or
specifications, to include utilities locate requirements and use limitations/requirements of easements, public
right-of-ways and other public land. USER further agrees that the CITY and its officers and employees shall be
saved harmless by the USER from any of the work herein under the terms of this permit and that all of said
liabilities are hereby assumed by the USER.
_—L_r -- ✓a✓a-rges-1 ,oti4r4A 5,--- Date t 4 2/?0
LJ
Property Owner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this 2 day of EC. , 20 2-0 ,
by U >,tt4T -i.A yJ OC..G10k. ( , who personally appeared before me and
(printed name of Signer)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
' . ----e.-_.--2-& 1-..--"0_—_-.0..4---)e)
iP 00,, Notary Public State of Florida Department Approval:
Sign ture of Notary Public,State of Florida Roberta D Carlisle
o` My Commission GG 251658
Personally Known osnp Expires 09/15/2022
( ]Produced Identification (Type) tt Williams, Public Works Director
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
MAP SHOWING SURVEY L.
LOT 22, BLOCK 3, ATLANTIC BEACH VILLA UNIT No. 2 AS RECORDED IN. PLAT BOOK
31, PAGE 13 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
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NOTES , NO C RAL2
1. THIS IS A BOUNDARY SURVEY. qa s
2. BEARINGS ARE BASED ON THE EAST LINE OF LOT /3000
22, BLOCK 3 BEING SOUTH 20'28'35” WEST, AS PER
PLAT.
3. 30' BUILDING RESTRICTION LI NE AS PER PLAT.
THE PROPERTY SHOWN HEREON APPEARS
TO LIE IN FLOOD ZONE "X" (AREA OUTSIDE THIS SURVEY WAS MADE FOR THE BENEFIT OF
THE 500 YEAR FLOOD PLAIN) AS WELL AS WILFRED C. RODRIGUEZ AND ERIN E. RODRIGUEZ;
CAN BE DETERMINED FROM THE FLOOD EQUIFIRST CORPORATION; ATTORNEYS' TITLE
INSURANCE RATE MAP COMMUNITY PANEL INSURANCE FUND, INC.; and LAWRENCE E.
No. 120075 0001 D, REVISED APRIL 17, HAYDEN, JR., ESQUIRE.
1989 FOR THE CITY OF ATLANTIC BEACH,
DUVAL COUNTY, FLORIDA.
I
INN---_______:
-NOT VALID WITHOUT THE SIGNATURE AND THE DONN W. BOATWRIGHT, P.S.M.
ORLGINAL RAISED SEAL OF A FLORIDA LICENSED FLA. LIC. SURVEYOR AND MAPPER No. LS 3295
SURVEYOR AND MAPPER.•. FLA. LIC. SURVEYING & MAPPING BUSINESS No. LB 3672
CHECKED BY: BOATWRIGHT LAND SURVEYORS, INC.
DRAWN BY: SWC 1500 ROBERTS DRIVE DATE: DECEMBER 19, 2006
FILE #: 2006-1499 JACKSONVILLE BEACH, FLORIDA 241-8550 SHEET 1 OF 1