730 BONITA RD FNCE20-0147 ,. Building Permit Application Updated 10/9/18
r -i City of Atlantic Beach Building Department **ALL INFORMATION
, 1'�, 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
.J3
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 1-3o 15,1-A 12-A - Permit Number:r NCE ZO _ O( 47
A- Legal Description 'k "30-40 17-2$ -2.1e 1 Q•r d Fttk.is tlyi r a., Lo+ 9 5\\ 1. RE# 17107q- 00D0
Valuation of Work(Replacement Cost)$ (j 76.C G 0 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ANew DAddition DAlteration ❑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 ❑No
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) .INo
Describe in detail the type of work to be performed:
SO 0--• Nem„ pi-- 17: -1. ..-1,Le 1 to__
FloridaProduct Approval# for multiple products use product approval form
Property Owner Information
Name M:ctn.4 1AO4-. Address i5 cl6c''• 4
.. RC) '
City A- K.wt c 'Be ctc L r State -F`L Zip 3273) Phone '7/ (62 - 1 I6- 0607
E-Mail j{641,14,.L3 Jpt . c c..-,.
Owner or Agent(If Agent, Power of Attordey or Agency Letter Requir-.
Contractor Information
Name of Company .00' ..-,c.'-',1 Qualifying Agent
Address 13'3 ce n e/— Ctc k.e A]. City J,k.kSo«v.((.e State FL Zip 33Z 2-2 r
Office Phone ` r^q - '3.12 3e"T b Job Site Contact Number
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt❑ Expiration Date
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
RECORDING YOUR NOTICE OF COMMENCEMENT.
_'// [a c.- P-
(Signature of Owner or Agent) (Signature of C.• ractor)
�igned and sworn to(or a� ed)bef• e me thisZ9day of Signed and sworn to(or affi ed)before me this day of
,Z�za . I ala _ , •y
-ma/ 4 '•na 'e of" (Signature of Notary)
'',f"'tee' TONI G'NDLESPERGER]Per nally Known OR
[ ]Personally Known OR ;2�• •��:,
[ ]Produced Identification =•: .fA :,, MY COMMISSION#GG 3t�31Tero ced Identification
= /��1.o.' EXPIRES:-' ' ,er 6,20A9pe o dentification:
Type of Identification: "''•si; ..oe:
„ ;:.• Bonded Thru Nat.' r.blic Underwriters
.-SLAiiri„� Owner Builder Affidavit **ALL INFORMATION
-4 HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
Sl
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
I. FLORIDA STATUTES;CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES
OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED
FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER
OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A
LICENSE.
YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF.
YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY
ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS.
THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE
CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH ;
IS IN VIOLATION OF THIS EXEMPTION.
YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS.
IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES
REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT
SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. .
III. IRS WITHHOLDING;OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING
TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT
TO$5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY"OR THE FLORIDA"CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON ISA LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: 730 601/. dk
Owner Name: I':cka.tA Phone Number: 71 b- f 6.-0(007-
Mailing
O&o`}Mailing Address: AA,t0k137 rthdd,cvw City: Ai- Ifewai State: Vii- Zip: 3 223 3
•
Notarized Signature of Owner y e
Theo oing instr ment was acknowledged before me this day . ,22 the State of Florida, County
of tr
Signature of Notary Public •
[ ] Personally Known OR [ ] Produced Identification
c{410 -s s5 - cB //0�
Type of Identification: o --Z � —V
.4,114;,,• TONI GINDLESPERGER Updated 10/24/18
,. ,,: MY COMMISSION#GG 353178
°'r�i��•e EXPIRES:October 6,2023
:FOF F;° Bonded Thru Notary Public Underwriters
REVOCABLE ENCROACHMENT AGREEMENT
**ALL INFORMATION
o� City of Atlantic Beach HIGHLIGHTED IN GRAY
JJv:J 800 Seminole Road,Atlantic Beach,FL 32233 IS REQUIRED.
1�J ✓ /
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
M:cQ t p- 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
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 ?3C) t•.-1'-c& RA • r4'Oax,t-c. 06ac,11 FL 3227.3
• 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
liabilities are hereby assumed by the USER.
�
t / 16A/44___
Date 12//
, ��t®/��'1/ � % //l v
Property Owner/Agent(signed in presence of Notary Public) /
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this Z- day of J�
l �� , 20 c;)
by (t&akQ ,who personally appeared before me and
• ted name of Signer)
ackn• -dge• t • she signed the instrument voluntarily for the purpose expressed in it.
MIR
.�;c,:f.i q TONI GINDLESPERGER
MY COMMISSION#GG 353178 Department Approval:
nnr
Signature of Notary Public,State of F rida • EXPIRES:October 6,2023
f°'
[ ] Personally Known -FOFBonded Thru Notary Public Underwriters
[ ] 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
BOUNDARY SURVEY
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BLOCK 1 #730 N
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—_ LB#7853 ——ruTinN SET 1/2"
— — '•' IRON ROD
x.1'0 "— " LB#7893
LOT 30 —--_- N85°20'02"W 80.65' __
BLOCK I LOT 31 —— �`
BLOCK I LOT 32
BLOCK I
SURVEY NOTES I
CONCRE FE DRIVE CROSSING INTO RNV
ON NORTHERLY SIDE OF LOT.
THERE ARE FENCES NEAR THE BOUNDARY
OF THE PROPERTY AND CROSS INTO THE
5'U.E./D.E.AT REAR OF PROPERTY.
44
P4• 1 1 F I C 6°
: �a TARGET
k'G No.6415 F 4 SURVEYORS CERTIFICATE
t P
I HEREBY CERTIFY THAT THIS BOUNDARY SURVEY ""'c. """`""':"'-: ,.-: ^ . ��= �^y-= _IS -
o ISA TRUE AND CORRECT REPRESENTATION OF A jjj C'�1<TRT TL�ZTf•1�TG'LLC
.. SURVEY PREPARED UNDER NY DIRECTION. a V jt v 1:/j ur �■
NOT VALID WITHOUT AN AUTHENTICATED ELECTRONIC
..... SIGNATURE AND AUTHENTICATED ELECTRONIC SERI, ` - •h - ' LB#7893
STATE OF • - -
°..• < ORA RAISED EMBOSSED SEAL AND SIGNATURE
''` 111 R V`�° KENNETH Digitally signed by SERVING FLORIDA
KENNETH OSBORNE 6250 N.MILRARY TRAIL,SUITE 102
Date:2020.01.09 WEST PALM BEACH,FL 33407
OSBORNE PHONE (561)640-4800
(SIGNED) 12:49:23 05'DO' STATEWIDE PHONE (800)226-4807
KENNETH J OSBORNE OT C01tPeo STATEWIDE FACSIMILE (800)741.0576
i PROFESSIONAL SURVEYOR AND MAPPER 0/6415 (N L I) WEBSITE:hflp/Nargetsurveying.net
LEGAL DESCRIPTION AND CERTIFICATION
Lot 4,Block 1,Royal Palms Unit One,according to the Plat thereof,as recorded in Plat Book 30,Pages 60 and 60A,of the Public Records of DUVAL
County,Florida.
Community Number:120075 Panel:0408 Suffix:J Flood Zone:X Field Work:1/8/2020
Certified To:
H&H REAL ESTATE INVESTING,LLC;MCKILLOP LAW FIRM;CHICAGO TITLE INSURANCE COMPANY;REAL ESTATE INVESTORS LOAN
SOURCE,LLC,its successors and/or assigns.
Property Address:
730 BONITA ROAD
ATLANTIC BEACH,FL 32233
Survey Number:399833
Client File Number.19-1667
ABBREVIATION DESCRIPTION:
SYMBOL DESCRIPTIONS:
A.E. ANCHOR EASEMENT F.F.EL FINISH FLOOR ELEVATION O.R.B. OFFICIAL RECORDS BOOK
A/C AIR CONDITIONER F.I.P. FOUND IRON PIPE (P) PLAT �
B.M. BENCH MARK FIR FOUND IRON ROD P.B. PIAT BOOK 1---1 •CATCH BASIN - --. =MISC.FENCE
BR BEARING REFERENCE F.P.K. FOUND PARKER-KALON NAIL P.C. POINT OF CURVATURE
(C) CALCULATED (L) LENGTH P.C.C. POINT OF COMPOUND CURVE •CENTERLINE ROAD 0 •PROPERTY CORNER
BEGINNING
A CENTRAL I DELTA ANGLE LAE. LIMITED ACCESS EASEMENT P.O.B POINT OF COMMENC ®=COVERED AREA ,,,,u 13 IN . •UTILITY BOX
CH CHORD LM.E LAKE MAINTENANCE EASEMENT P 0 C POINT OF COMMENCEMENT •
UP
(D) DEED I DESCRIPTION (M) MEASURED I FIELD VERIFIED PRC. POINT OF REVERSE CURVE +y,AL•EXISTING ELEVATION cQ_ •UTILITY POLE
P.T. POINT OF TANGENCY HYDRANT WATER METER
D.E. DRAINAGE EASEMENT M.H. MANHOLE • wM
D.H. DRILL HOLE N&D NAIL 8 DISK RAN RIGHT-OF-WAY
DAN DRIVEWAY N.R. NOT RADIAL (R) RADIAL/RADIUS 05 •MANHOLE •WELL
E.O.W. EDGE OF WATER N.T.S. NOT TO SCALE S.I.R SET IRON ROD
F.C.M. FOUND CONCRETE MONUMENT 0.H.L OVERHEAD UTILITY UNES T.O.B. TOP OF BANK -- — ••METAL FENCE =WOOD FENCE
U.S. UTILITY EASEMENT
-•at *rw , to --�====.1ce,. ..-.v;e.. ,-1.1"-`.-...=.4r.= ,.,..n.,..,ax .;e;. ., ur.:: .-.,_.;: ::,,scz..^- <_.,.._.,>c
PAGE 1 OF 2 PAGES
(NOT COMPLETE WITHOUT PACE 2) _
GENERAL NOTES:
TARGET
1 LEGAL DESCRIPTION PROVIDED BY OTHERS
2) THE LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR EASEMENTS OR OTHER ;--
! RECORDED ENCUMBRANCES NOT SHOWN ON THE PLAT. SURVEYING VI�TG T T C
f 3) UNDERGROUND PORTIONS OF FOOTINGS,FOUNDATIONS OR OTHER IMPROVEMENTS Vit Li i it�(<J ■ •�
WERE NOT LOCATED.
':i 4) WALL TIES ARE TO THE FACE OF THE WALL AND ARE NOT TO BE USED TO RECONSTRUCT LB#7893
BOUNDARY UNES.
5ONLY VISIBLE ENCROACHMENTS LOCATED. SERVING FLORIDA
6 DIMENSIONS SHOWN ARE PLAT AND MEASURED UNLESS OTHERWISE SHOWN,
7 FENCE OWNERSHIP NOT DETERMINED. 6250 N.MILITARY TRAIL SUITE 102
8 ELEVATIONS INDICATED HEREON ARE IN FEET AND DECIMALS REFRENCED TO N.G.V.D.1929 WEST PALM BEACH,FL 33407
9 IN SOME INSTANCES,GRAPHIC REPRESENTATIONS HAVE BEEN EXAGGERATED TO MORE PHONE(561)640-4800
CLEARLY ILLUSTRATE RELATIONSHIPS BETWEEN PHYSICAL IMPROVEMENTS AND/OR LOT UNES. STATEWIDE PHONE (800)226-4807
IN ALL CASES,DIMENSIONS SHALL CONTROL THE LOCATION OF THE IMPROVEMENTS OVER STATEWIDE FACSIMILE(800)741-0576
SCALED POSITIONS. http://targetsurveyIng.net
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