909 Amberjack Ln FNCE20-0133 Permit PacketOWNER:ADDRESS:CITY:STATE:ZIP:
CHRISTOPHER CORSON 909 AMBERJACK LN ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
Frontline Fencing, Inc.14286-19 Beach Boulevard, #111 Jacksonville FL 32250
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
909 AMBERJACK LN FENCE WALL OR BARRIER FENCE install 4-ft. chainlink fencing $1700.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 PUBLIC UTILITIES UNDERGROUND WATER SEWER UTILITIES INFORMATIONAL
Notes:
Avoid damage to underground water and sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is
needed, call 247-5878.
2 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
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.
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.
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.
1 of 2Issued Date: 12/2/2020
PERMIT NUMBER
FNCE20-0133
ISSUED: 12/2/2020
EXPIRES: 5/31/2021
FENCE WALL OR BARRIER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
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
3 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.
4 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required.
5 PUBLIC WORKS RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site. Cannot raise lot elevation.
6 PUBLIC WORKS FENCING REMOVED INFORMATIONAL
Notes:
All old fencing and debris must be removed from job site by Contractor.
7 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
2 of 2Issued Date: 12/2/2020
PERMIT NUMBER
FNCE20-0133
ISSUED: 12/2/2020
EXPIRES: 5/31/2021
FENCE WALL OR BARRIER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $81.50
FNCE20-0133 Address: 909 AMBERJACK LN APN: $81.50
BUILDING $35.00
FENCE 455-0000-322-1000 0 $35.00
BUILDING PLAN REVIEW $17.50
BUILDING PLAN CHECK 455-0000-322-1001 0 $17.50
PUBLIC WORKS PLAN REVIEW $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R14253 $81.50
Printed: Wednesday, December 2, 2020 1:26 PM
Date Paid: Wednesday, December 02, 2020
Paid By: Frontline Fencing, Inc.
Pay Method: CREDIT CARD 400327984
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R14253
~+; CENTRALSQUARE
Building Permit Application
City of Atlantic Beach Build in g Department
800 Seminole Ro ad, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Updated 10/9/18
**ALL INFORMATION
HIGHUGHTED IN GRAY
IS REQUIRED.
JobAddress: 96'1 B,..,her,/e:cc.J::. u/flf/;,,.,f,tb..,lhE.3/233 PermitNumber: _________ _
Legal Description JO-{,~ 17-:J.:S-jj,f goy"l /?3 7,n) /f":;'-t-/t..,d7' ~.) RE# ________ _
Valuation of Work (Replacement Cost) $_._/~7_di_C, ____ Heated/Cooled SF ____ Non-Heated/Cooled ____ _
•
•
Class of Work: □Ne w □Addition s(Iteratl on [Q1(e"pair □Move □Demo □Pool □Window/Door
Use of existing/proposed structure(s): □Commercial lt3'!fesidential
• If an existing structure, is a fire sprinkler system installed?: □Yes ~o
Describe In detall the type of work to be performed :
k
Florida Product Approval # __________________ for multiple products use product approval form
Property Owner Informati on
Name O,c;~ Gpr~n
City ttf: /&.l!ht;, c,;.; h
E-Mail _______________________________________ .....;
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) __________________ _
Contractor Information
Name of Company ~~,..f-~i.,.e~7 .IA.C Qualifying Agent .d,".-i ~ ~
Address /4<!-~ "iiiJ I ~ G@___«v-J City .J•1'-#'~f (., State~ Zip J;1,,2 ,\,>
Office Phone ~q:'-LI~[: $:'6$'0 Job Site Contact Number ,,.....eri...,()(.J:---c=--.._J.;;._3.~'J_-_;r""'-ct.-='l_tJ __ ---,,.-:--;_---,--.
State Certification/Registration#--------E-Mail • , m AcL-E ao e. fa?ntl• ~e fd.!:J , · ,._, eJ:
Architect Name & Phone# ________________________________ _
Engineer's Name & Phone#----..---------------------------.--..-----
Workers Compensation Insurer A,., .;;,;_sf-OR Exempt □ Expiration Date 7/u./j I
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 t he standards of all the laws regulati ng
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMB IN G, 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 i n compliance with all
applicable laws regulating construction and zoning.
WARN ING 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
RECORDING YOUR NOTICE OF COMMENCEMENT. 11 t¼-e ~ --,,q.......,c......:...--lL---_____ _
(Signature of Owner or Agent)
Signed and sworn to (gr affirme9l before me this u t½av of , iu b-,, N s L-o
Produced ldentificatio 'r---1 ......._1 I' I '1C -iU:>-' ? ,...
Type of Identification: _ _.t:,_..,__v_V_v __ \.,_\0_<.,:_~.,) ____ ~_7 _
c?-\5 -0
(Signature of Contractor)
Signed and sworn to (or affirmed) before me this jJ_~y of
; • .' · :\ Notary Publ
' Commlnlon = GG 2
My Comm, Expire1 Aug
ded through N•tional Not
NELS SLO'tU
Notary Public ,1 .. :. ,l' ; .orida
Comm1t,10r ~ .. " ~ 1'6 l o
I l d d f .,., ... My COl!lm. b ,1, • '2
Produce I enti !cation "'"""soc1o~ trttoufh Nat• ,,n,
Type of Identification: ___ --1 .......... .,..,.. ___ 194
I :
®
Frontline
FENClNG
Submitted To: Tracy Corson
Street: 909 AMBERJACK LN
City, State, Zip: Atlantic Beach FL
Phone: (904} 524-2249
Email: chriscorson41@gmail.com
DATE:
QUOTE GOOD UNTIL:
11/11/2020
11/26/2020
Financing Available ~•LJGHTSTREAM·
A o,vur>OH or SuNTlfl.JST DAN~
Representative: I John Macleod
Phone: l 904-333-3410
Email : I jmacleod@frontlinefencing .net
75' Chain-link fencin.,. 4' r-~11 I
~-15' Chain-link ~ I • ..
4' tall I \!)
r I u, ... 9' Chain -I
25' Chain-link 4' tall Shed .
4' tall
~Gate
I I
I I
House -
-. I
I " I
Hang fencing on left side
Posts and top rail are in ground
Home owner supplied
Provide labor, materials & equipment to build and install 136 linear feet of 4' tall galvanized chain-link
(1) 5' wide chain link gate (1) 12' Double Chain-link Gate
Price: $ Deposit:
REMOVE/DI SP NO POST SPACING: 10' # OF 3' or 4' GATES:
FINISH SIDE: OUT CONCRETE: YES # OF 5' or 6 ' GATES: 3
TYPE CHAINLINK POST SIZE: 2X2X72 LATCHES: Post Mount
STYLE: LINEAR FEET: 151 ATTACHMENTS: IN GROUND
GRADE: FOLLOW GATE FRAME: STEEL COLOR: I Galvanized
HEIGHT: 48" GATE STYLE: Chain link GATE SWING: OUT
WARRANTY: 2 YEARS ON CRAFTMANSHIP & HARDWARE
l/WE, THE OWNER/AGENT OF THE PREMISES MENTIONED HERIN, HEREBY CONTRACT W ITH YOU AND AUTHORIZE YOU AS THE CONTRACTOR TO
FURNISH ALL N ECESSARY LABOR AND MATERIALS TO CONSTRUCT THE IMPROVEMENTS DESCRIBED HEREIN. IN THE EVENT THE PAYMENT IS NOT
MADE AS SPEC IFI ED, Frontline Fencing Inc RESERVES THE RIGHT TO EXERCISE THE PROVISIONS PROVIDED FOR UNDER THE FLORIDA MECHANICS
LIE N LAW. ALL EXPENSES ASSOCIATED WITH COLLECTION, INCLUDING BUT NOT LIMITED TO ATTORNEY, COURT FEES, AND ASSOC IATION COSTS.
LL MATERIALS ARE GUARANTEED AS SPECIFIED. ANY ALTERATION OR DEVIATION FROM THE ABOVE SPECIFICATIONS INVOLVING EXTRA COSTS
ILL BE AN EXTRA CHARGE OVER AND ABOVE THE AGREED UPON PR ICE INCLUDING A REASONABLE CHARGE FOR ADDITIONA L PROFIT AND
VER HEAD. ADDITIONS, CHANGES OR DEVIATIONS WILL NOT BE EXECUTED WITHOUT WR ITTEN ORDERS BY THE OWNER OR OWNERS AGENT. THE
WNER/ AGENT ACCEPTS FULL RESPONS IBILITY FOR LOCATING, STAKING AND CLEARING FENCE LINES, AS WELL AS DEED OR SUBDIVISION
RESTRICTIONS. Frontline Fencing Inc IS NOT LIABLE FOR DAMAGES OF ANY NATURE DUE TO UNDERGROUND OBSTRUCTIONS. IN CONSIDERATION
F SAID WORK AND SERVICES BY THE CONTRACTOR, CONTRACTS ARE GOVERNED BY TERMS A N D CONDITIONS AS STATED ON SECOND PAGE. THE
WNER/AGENT ACCEPTS T H E SPEC IFICATIONS AND TERMS OF TH IS AGREEMENT. 3.5% WILL BE ADDED F
HIS PROPOSAL IS VALID FOR 30 DAYS.
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Revision Request/Correction to Comments
City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
**ALL INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: _______ _
D Re v ision to Issued Permit OR D Corrections to Comments Date : ______ _
Project Address : 702 /1:r?b ifr, 1&,Y (n
Contractor/Contact Name : &a~).vc, Ee.--uy J;.u..c ,l)C,,, r1 p'l4 c) -el
Conta ct Phone : <Joq.~ 4)S--¥PSQ Email : ...,Jtv,c,c/eotl(;_, bH ,-:e.~041':"e}
Description of Proposed Revision/ Cor rections :
_____________ affirm the revision/correction to comments is inclusive of the propo sed change s.
(printed name)
• Wi ~posed revi sion/correction s add additional square foota ge to original submittal? BN ~ D Yes (additional s.f. to be added : ____________ )
• W i proposed revi si on/corrections add addition al i ncrease in bu ildin g valu e to original su bmittal?
No D *Ye s (add itional in crea se in bu i ld i ng va l e : $~_,.,.. _______ ) (Contractor must sign if increase in valuation)
(Office Use Only)
D Approved D Denied D Not Applicable to Department Permit Fee Due$ _____ _
Revi sion/Plan Review Comments _____________________________ _
Department Review Required:
Build i ng
Planning & Zoning
Tree Administrator
Publi c Wo rks
Public Utilities
Publi c Safety
Fire Service s
Reviewed By
Date
Upd ated 10/1 7/18
JOB COPY /21 ·~~ r'\. Building Permit Application
~~ \, City of Atlantic Beach Building Department
..,..:,"'1ef 800 Sem in ole Road , Atlantic Beach, FL 32233
Phone : (904) 247-5826 Email : Bu i lding -De pt @co ab .u s
RECEIVED
B y Jennifer Johnston at 3:3 3 pm, Nov 12, 2020
Updated 10/9/18
**ALL INFORMATION
HIGHLIGHTED IN GRAY
IS REQUIRED .
Jo b Address : 9 ~ flf'/; .. ,}-1 L ':133 Permit Number: FNCE20 -0133 -----------
Leg a I Descr i ption •• --oy" ,.,. lJ / /j T' ,:Z.) RE # ----------
Valuation of Work (Replacement Cost)$ 17 1o Heated/Cool ed SF ____ Non-Heated/Cooled ____ _
• Class of Work : □New □Addition S1(1terat i on [91(e"pai r □Move □Demo □Pool □Window/Door
• Use of exist i ng/proposed structu re(s): □Commercial esidenti al
• If an existing structure, Is a fi re sprinkler system in stalled?: □Yes o
• W II tr e s be remove d i n association w ith ro ose d ro ·ect? □Yes arate Tree Remova l Permi t □No
Describe In detail the type of work to be performed:
k
Florida Pro duct App roval # __________________ for multiple products use product approva l form
Property Owner Information
Name C he ,!. CD f &o:(\
City Af Jc.&,, hy {>u , h,,
Addres s 70 I /1).,,Jx.<,Ytl. lN
State ff Zip J ~;)SJ Phone Cjol./ !,-J '(: ~ :12 4 f
E-Mail _______________________________________ _
Owner or Agent (If Agent, Power o f Attorney or Agency Letter Required) __________________ _
Contractor Information
Nam e of Company ~,_t),,-,,cfu4 .IA,(; Qual ify ing Agen t <X}l..-, J'.!1" ~
Add ress Jt{(). f4 ~ J p._ (;<J....£!:-_lh(>d City 5 \1'-~(f c,, State F'-Zip J ~J \-0
Office Phone ~¢ -l/ .Z) ~ 8() .$11 Jo b Site Co ntact Number _q_Ot.1_..,...--J_3._J_-_r_ct.--='/_v ___ .,--,-----
State Certification/Registration# ________ E-Ma ii , l(>]lf L£oDe,. FrvnH• "-Gfece ~"'), AJef,
Architect Name & Phone ti :.,
Engineer's Name & Phone#----...--------------------------,,---+-----
Workers Compensat ion Insurer -'------"---'--f-__________ OR Exempt o Expiration Date -----<J...:..---+--""--.,__ __
App li cat i on is hereby made to obtain a permit to do the work and i nstallat ions as indicated . I certify that no work or installation has
commenced prior to the issuance of a permit and that all work w i ll be performed to meet the st andards of all the law s regulat i ng
construction in th is ju r is d iction. I un d erstand that a separate permit mus t be secured for ELECTR ICAL WORK, PLUMBING, SIGNS,
WE LLS, POOLS , FURNACES, BOILERS , HEATERS, TANKS, and AIR COND ITI ONER S, etc . NOTICE : In addition to the requirements of this
permit, there may be add it ional restr ictions app l icab le to this property that may be found in the public record s of th i s county, and
there may be additi onal permits required fr om other governmental entiti es such as water management districts, state agencies, or
federa l agencies .
OWNER'S AFFIDAVIT : I cert ify that all the forego i ng information is accurate and that all work w i ll be done i n compliance with all
applicable la ws regulat i ng constru ction and zon i ng .
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
RECORDIN~ YOUR NOTICE OF COMMENCEMENT. ~!
C!A < C!ct,,~ _---,q._~..JC...tc_-'---------p-(Signatu r e of Contractor} (S ignature of Owner or Agen t )
Signed and sworn to or affirme~:fl befo r e me th is \ ,t½ay of . z by N s
Signed and sw orn t o (or affirmed ) before me th is JLfty of
by (· ~
Nornry Pub li< ,1..:, .1· • ,Qf 1
COtll ml n lor , , -) 1 •~ 1<
I I Prod uced lde ntificatl on ·.. ,. Aly Com m. E• i i• • •2
'·-~ 8011dt~ IMIOU !Jh ~dt• ,n.
Type of Identification:----'-----------"
LDT 23, BLOCK 4, ROYAL PALMS UNIT ONE
AS RECOROED IN PLAT/0£[D BOOK .$0 PAGE(S) 60 -60 f\Of' lHE OJRRENT PU9UC RECORDS a J)U'v'\, L COUNTY, F\.ORIOA
LOT 2Z
a z3037'ar" w
2,1 .79
--
L--49.86 R•1
s 35"3 1 '45•
t.,
AMBERJACK LANE ( 60' R/W)
2a .oo·--
..., DC>U6U; t-.>
(11 GAA.N:;r. a, & (CONC. BLOQ:J ~
28.00'
....._____
.............
IUllV r ~ouno 1,
FNCE20 -0133
RECEIVED
By Jennifer Johnston at 3:34 pm, Nov 12, 2020
-JOB COP
-
,
•
Ci) JOB COPY
Frontline
r E (' I I (,
RECEIVED
By Jennifer Johnston at 3:33 pm, Nov 12, 2020
DATE :
QUOTE GOOD UNTIL :
FNCE20-0133
11/11/2020
11/26/2020
Financing Available LIGHTSTREAM
Submitted To : Tracy Corson Representative: I John Macleod
Street: 909 AMBERJACK LN
City, State, Zip: Atlantic Beach FL Phone : I 904-333-3410
Phone : (904) 524-2249 Emai l : I jmacleod @fr o n t linefencing.net
Email: chriscors on 41 @gmail.com
75 ' Chain-link fencine 4' tall _J_
15 ' Chain -link I ~ L .
4 ' tall ,, ~
r I V\ ,. 9 ' Ch ain -I
25 ' Chain -link 4' tall Shed •
4 ' tall hte I I
j I
House -
. I
I I
Hang fencing on left side
Posts and top rail are in ground
Home owner supplied
Provide labor, materials & equipment to build and i nstall 136 linear feet of 4' tall galvanized chain-link
(1) 5 ' wide cha i n link gate (1) 12' Double Chain -link Gate
Price: $ Deposit:
REMOVE/DISP NO POST SPACING: 10' # OF 3' or 4' GATES:
FINISH SIDE: OUT CONCRETE: YES # OF 5' or 6' GATES : 3
TYPE CHAINLINK POST SIZE : 2X2X72 LATCHES : Post Mount
STYLE: LINEAR FEET : 151 ATTACHMENTS : IN GROUND
GRADE: FOLLOW GATE FRAME: STEEL COLOR : I Galvanized
HEIGHT: 48" GATE STYLE : Chain link GATE SWING: OUT
WARRANTY: 2 YEARS ON CRAFTMANSHIP & HARDWARE
I/WE, THE OWNER/AGE OF TH PREMISE ME TIO ED HERIN, HEREBY CONTRACT WITH YOU AND AUTHORIZE YOU AS lHE CO RACTOR TO
UR ISH A ll NECESSARY LABOR A D MATERI ALS TO CONSTRUCT THE IMPROVEMENT D RIB D HEREIN IN T H E EVENT THE PAYME I N T
MADE AS SPECIFIED, Fronthn, Fencing Inc RE EAVES THE IGHT ro EXER CI THE PflOV ISIO PROVIDED FOR U O R THE FLORIDA MECHANICS
W . ALL EXPE ES AS OCIATEO WITH COLLECTION, INCLUDI G BUT OT LIM11ED TO ATTOR N EY , COURT FEE , A N O ASSOCtATI N COSTS.
LL MATERIALS AR GUAl1A TE DAS SPECIFIED. ANY A LTE RATIO N OR DEVIATION FROM THE ABOVE SPCCIFICATIO S INVOLVING RA COSTS
IU. BE A N EXTR A CH A RGE OVER AND A BOVE THE AGREED UPON PRIC E I CLUO ING A RCASON A BL(. CHA RGE FOR A DDITIO NA L PROFIT AND
VE HEAD. ADDITIO NS, CHANGES OR DEVIATIONS W IL NOT OE ECUTCD W ITHOUT W RITTEN ORDERS BY THE OWNER OR OWNERS AGENT . HE
w ER/ AGENT ACCEPTS ruLL RESPONSIB ILITY FOR LOCATI NG . STAKING ANO CLE A RING FE E LI ES, AS WELL AS DEED OR SUBDIVISION
RESTRICTIONS. rront line Fencing Inc IS NOT UABLE FOR DAMAGES OF ANY A URE OUETO UNO RGROUND OB TRUCTIONS. IN CO IOERATION
F SAID WORK A ND SERVICES BY THE CO RACTOR . CONTRACT ARF. GOVERN D BY T RM A N D CONDITIO SAS STATED O ECO ND PAGE. THE
WN R/AGENT ACCEPTS TH E SPECIFICATIO A D TERMS OF TH IS A R EMENT. 3 .5 " WI U BE ADD ED F
HIS PROPOSAL IS VALID FOR 30 DAY .
Revision Request/Correction to Comments
City of Atlantic Beach Building Department
**ALL INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: {904) 247-5826 Email: Building-Dept@coab.us
~ Revision to Issued Permit OR , ~rrections to Comments
ProjectAddress: 'fO~ Amberjack Ln
Contractor/Contact Name : £rontt t M R.Ytci Y\0
PERMIT#: FNC'£2{) -o t 3 3
Date: If /21 /Z.. 0
ContactPhone : 904-415-"6050 Email: Jmacteoqd tNITOnthVJefljn(jnq-t\i--\-
Description of Proposed Revision/ Corrections:
affirm the revision/correction to comments is inclusive o~eQV e
2
..
2
~
020
~
(printed name) 'T
•. W.iKproposed revision/corrections add additional square footage to original submittal?
0N~ [!I Yes (additional s.f . to be added : ___________ ) BY: ------
• W~roposed revision/corrections add additional increase in building value to original submittal? 0N~ ~*Yes (additional increase in building value:$ ________ ) (Contractor must sig n if i ncrease in valuation)
*Signature of Contractor/ Agent: ____________________ _
(Office Use Only)
D Approved D Denied D Not Applicable to Department Permit Fee Due$ _____ _
Revision/Plan Review Comments __________________________ _
Department Review Required:
Building
Planning & Zoning
Tree Administrator
Public Works
Public Utilities
Public Safety
Fire Services
Reviewed By
Date
Updated 10/17 /18
REVOCABLE ENCROACHMENT AGREEMENT
City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FL 32233
**ALL INFORMATION
HIGHLIGHTED IN GRAY
IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlant ic Beach, Florida, a municipal corporation organized and
existing under the laws of the State of Florida, hereinafter referred to as "CITY" and
Ch r : s foflh ,..,,,,, C,, I" S' o rl of Atlantic Beach, Florida, hereinafter
I
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 i?.. .,,.e ]c,r e <.J ' ·:r r.::1-, 1 Ch~y li ~ / .i' J;\ t:: fc"-ti', .
Any facility maintained, repaired, erected, and/or i nstalled 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 9 t ) o/ A f"l b,.r d fh~~ Led', flt:/,,..,~ t lk...,, h + L j'.J;l..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 so le expense,
any and all materi al necessarily displaced during the action of maintaining, repairing , operating, replacing or
adding to of the utilities and fac i l it ies of the CITY or franch ise 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 p lans and/or method, must obtain written approval
from the City of Atlantic Beach Publ ic 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 .
~~ Date \\ -2<-\ -£<X0
Property Owner/Agent (signed in presence of Notary Public)
,20 2&_,
acknowledged that he/she signed the i nstrument voluntarily for the purpose expresse
V\Qs ~
Signature of Notary Public, State of Flor ida
[ ] Personally Known I'\
[~duced Identification (Type) ~ { _;..\Jl----Scott Williams, Public Works Director
H:\Appl ications & Forms\Word Docum ents\20180831 Revocable Encroachm ent Agre em ent.do cx Rev ision Da t e: 8/31/18