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1661 E PARK TER FNCE20-0141 �sr '-. Jr,;,Jr,;,, Building Permit Application Updated 10/9/18 i; City of Atlantic Beach Building Department **ALL INFORMATION v 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY --r st 9r IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: t'b6>l ?Iq/ itree.Acc E Permit Number: 1- (V c€20- 014 ( Legal Description 3Q-51 (A-25 'a9r Sel.1/3 0113tk^4 Jm.1,,t0ib 4`4 13 RE# I 1 ZUZc.) 't0 116 Valuation of Work(Replacement Cost)$ Vpp Heated/Cooled SF Non-Heated/Cooled • Class of Work: VI-New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial QResidential • If an existing structure,is a fire sprinkler system installed?: ❑Yes O'No • Will tree(s)be removed in association with proposed project? DYes(must submit separate Tree Removal Permit) ❑No Describe in detail the type of work to be performed: Vc,A't '01-0 c .ici,;, i IN) N 1`, kit i ZON' t.— Florida Product Approval# for multiple products use product approval form Property Owner Information ---- Name Name LALJ(;Y 14—rrC el/1/4";IA4M Address tio§/ }DAILY TKe.A. Au: c City I411AW`f f L 6i.. AC (e- State Ft-- Zip -SZ 3. Phone 1.7 (o zd 8'gaZ E-Mail Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Cr Name of Company COGS 1 v"fit% CO Qualifying Agent -.61,4,-"""•-• .it„2 J !S' t Address 'ZIA 6 1946- 12 S City On,_ 6c,si State `Zt_ Zip 5z z..?.? Office Phone g 70K 7 7,5 Job Site Contact Number State Certification/Registration# E-Mail C-To( Fi;�T)C* 6 r"',e1/4- . Ca`.-. Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Insurer OR Exempt/ Expiration Date 7//f/Zv2-- 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 FLNANC--1-N6-;CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDIN e • R NOTICE COMMENCEMENT. .....-- -----41,I = --A d m - A /,r„ ••Tee Agent.) ii4.A �_ ,��N( ignature of Contractor),' Sine.,.nd sworn to(or affirmed)before me this � It day of Signed and sworn to(or affirm' ed)before me this I ( day of A) • v .202 e u E? -rrE2t /U o✓ , 2_02_0 w 303.-,An-k- " b,z_ s N' OP (Signature of Notary) (Signature of Notary) : a�Y°�a.. No ary Publir,State o Ftortda04" bi �g o' f F o da .. Roberta D C.3rtisle NotaryRD Cariisfe irt....„ tnagy Krlpgm scion GG 251658 [y't ersonally Known O a4 QiJOffA �, •s My���rylission GG 251658 P Aced I ffit ai$/2022 [ ]Produced Identificati :y,;- Type of Identification: Of� E�pK@4 Aa11 X12022 MAP SHOWING FINAL 'AS-BUILT" SURVEY OF LOT 6, BLOCK 13 AS SHOWN ON THE MAP OF SELVA MARINA UNIT NO. 6 AS RECORDED IN PLAT BOOK 34 PAGES 51-5/B OF THE PUBLIC RECORDS OF DUAL COUNTY, FLA. CERTIFIED 1. TO: B4RNEY B. KETTERINGHAM &ALINA M. G4LLUWO PARDO L ■n 17tH. STREET 'J' (60' RIGHT OF WAY) 6 '- war,D N.A/1 Zv n/7-...zi P.c.,, --/ 'U/L0 I T 7 $8 � L 0 C K 1 3 A SS 1 BL is >E _ >E \7. it "`r ( - 137.56'0-A'� . �- I N83'43'S0•E 137.7T(ACT� 6.1111TOD Fe. , . c NBS4a`�55_E--. ..- TA N! 'LA_ f r O m w - 26 0' 005) w 0 at) ; .-: .i;Tb t „.#��.I:�' s 38 B. II . F V CO rn Z Z 1•Iilj I _ 4. p�$-ijj ?iii 4!111di�i iii•. 9(�� Z Y N '1i�ii�ililililililililili'1'1''i 11 Y L 0 T 6 c "cn+ 1110 i.,,Wi,11,1,0,1,1i� TWO STORAE WOOD FRA► IIIIIII (9.9) BLDCK 13 . f� 11'''1'',11',','1;1,,,;1!1!1.4 RESIDENCE to f I�I�I�ly4�1�14'll .! J ::!.....,:::1111,t,',� A.D. /t1- )cn oI` 10 . � .'010F.F.E.=(A o 1A • i�yiiGT111 .111111 1. .5.9 IRON IP PE =I --i;;;;; 1111111 111111111' 1'�111 It r ii144'14444111111111111A1441..1�y N (n m ii 14:1:1�14:1i1�1y44444i1i'i'� ;•��1�' (9,7) Pi.; o0 111'1�,�'�1�`����444j�i�l�i�i�i�iili 1 i i'",,,,,, 11111 111111111111111111111111111111111i41t 4. _ ^V 1�1�1:,1�1�1111!i!11!x!'!'!'!1!111!d1''1 a 1 D 111111��-- 30.7' 1W0 Y,<3' o �Ai'I 111!!11 I ©�A/O PADS 9 �� 1 1 1. jll!�!' �_ .s.� I / M 11 _ �01V ) • � ,Ezs�s — ,A ro �-_s79.09.40. �3 x $) '09'40, \ . Lll��'.. �1,.D - D. ��� O NDCNAI DISK E 41.66- g83'41' O W 337 4'PLA) " x-� L8 3857 ELEVATION:(7.66) O T 5 u N ELEVATIONS SHOWN L L 0 0 K 1 3 HEREON REFER TO NAVD OF 1988 FINAL N.O./ 153245; 12-22-16(FIELD) LOT&HOUSE STARE OUT(GOOD);W.O./ 148896;03-30-16(FIELD) DENOTES FOUND 1/2' LOT&HOUSE STAKE OUT(GOOD-SET F.F.E.);W.O./ 148359;02-23-16(FIELD) O IRON PIPE:NO LD. UNLESS OTHERWISE N01ED THIS SURVEY WAS PERFORMED WITHOUT THE BENEFIT OF A TITLE COMMITMENT.THERE ACT- DENOTES ACTUAL MAY BE ADDITIONAL EASEMENTS AND/OR RESTRICTIONS THAT ARE NOT SHOWN ON THIS SURVEY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY. UNDERGROUND ENCROACHMENTS NOT LOCATED THE LOT SHOWN HEREON IS IN THE SPECIAL FLOOD HAZARD ZONE •X'AS SHOWN ON FLOOD INSURANCE RATE MAP 0409 H FOR DUNAL COUNTY, FLORIDA.DATED 06-03-13 ALL AMERICAN SURVEYORS OF FLORIDA, INC. LAND SURVEYORS-.1751 SAN JOSE PLACE SLICE 15-JACKSONVILLE FLORIDA. .3.2257- 904/279-01088-LICENSED LAND BUSINESS NO 3857 L 22_, - :75 �N. CO.ETED FrE .n5ca.tNlr00�oNru�AnoN THIS IS TO CERTIFY THAT THE ABOVE LANDS WERE SURVEYED UNDER MY RESPONSIBLE `aan a' FWD 'VC 10ENTIRCATION SUPERVISION AND DIRECTION,THAT THERE ARE NO ENCROACHMENTS EXCEPT AS SHOWN _—41 CONC CONCRETE PALL PERMANENT REFERENCE AND THAT THE SURVEY SHOWN HEREON MEETS THE MINIk1FUN YECNNIQ►I,STANDARDS RT. PLINK a:TUNaNn SET FORTH BY THE FLORIDA BOARD OF PROFESSIONAL URY moN ) (jS,A}IOAIAPPERS AL./. Lx WAWA RW FC) °F R"ARENT cativo.POINT PURSUANT TO CHAPTER 472RVE .027 / CHAPTER 69 ?. 6• 'FLOiN DA'¢.T TUTES. AM ERICAN CR▪ DELTA CMNO C P.R.C. GOY OF REVERSE CUM (' RVEYORS W _ S ui a RLINNO POOR OF COMPOUNO o'er SURVEY NOT 4'AL1b Uf0.ESY fiI}NG ED�9j_SEAL OF (cut.)_ TED EARL.. RCM.pp.A UwE JAMES 13. 1rRRP,!DN,JR,.•No.21iW (rov -RUT (INTACAL Now NATIONAL DETRICOC VERTICAL 111GHAE�A. ,-: WC. (R) -corr LATE o. sCALE 1'>.20' ' ---,...,,s.,:. ., ? `-[a 1,t1�/^+pL`mTiu1 V R.EI -PC1EI-Of AWAY NAND pANM+.Lor VERIKAL ' ','� ♦FL ; 9 EMT EOW6 KW a WA ipN 02-23-16 �'�� • 5; i4AVPER t=8I 60 -'WITNESS roe IOP a DANN diprDATE EG (T.'SU'T....•; / ES OC 153245,PRINT DR. BY BRB on P.\2016\79965-153245-fnl ORDER NO. 153245 FILE 79985 g'-' . L... , REVOCABLE ENCROACHMENT AGREEMENT L\o', City of Atlantic Beach **ALL INFORMATION j. '� 800 Seminole Road,Atlantic Beach,FL 32233 HIGHLIGHTED IN GRAY \ ,s-„ 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 G/f‹.T-ru Oi- ‘'v"/6 G C4..) 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 } -C^'66 &Ul L . 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 o USER,said notice to USER shall be given by certified mail, return receipt requested,to the following address )h(o/ me -r-a24e� c /rr. - c../1_ F[- . • 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 hereb assumed by the USER. Date /2/41402d Property Owner/Agen igned in presence of Notary Public) j Java 7 1-/A ti •➢J L.6/4/\ S STATE OF FLORIDA, COUNTY OF DUVAL The foregoing instrument was acknowledged this /� day of eQ__. , 20 Z 0) by ,who personally appeared before me and 'rinted name of S : er) ack • ledged t at s - .igned the ins rument voluntarily for the purpose expressed in it. lair � I r 01 u.,.. TONI �r Department Approval: Signature of Notary Public, tate of Florida :12--1,..._,...,;:)....77., MYr GIN`., #GG35R `` ��� OrtndrSorJN#GG 353178 L s�''��..:�,c �[�Personally Known F•.... P; EXPIRES:-:�c;-;h�r 8,2023 I ',�'.,ar F1.�r Qcnded Thru Nater [ )Produced Identification (Type) yPut. Jn erwrlters ott Williams, Public Works Director H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18