1065 LITTLE CYPRESS KEY DWAY21-0002 rt='p. Building Permit Application Updated 10/9/18
a -[ City of Atlantic Beach Building Department **ALL INFORMATION
‘�1 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
4 j
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 1043 Lr file c 'pr'e55 '_ (i Permit Number: i\� al -00( Z-
Legal Description 11—(e 0 17 -„,ls-a9 E ---ei1/4aLakeS 2144 - 3 RE#
(DOL..) A.wT//8
Valuation of Work(Replacement Cost)$-----... ”. wv Heated/Cooled SF Non-Heated/Cooled r
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ENo
• 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:
`P0.fC r - d r Iv^C(A) a.c--/
Florida Product Approval# for multiple products use product approval form
Property Owner Information 1 1, ' �j
Name 41.(0hae14.A/ ,-C Ai7P. Address 1O(r5 ,Cttfk l:G{`J✓'r55K
City /7f'IAn�ic ie State L. Zip sn,g 013 Phone J (5/c/� 076 ei—S--73i
E-Mail M 1 Le.) l/s"? ..gme.tt1 ,ecYY1
Owner or Agen (If Agent, Power o Attorney or Agency Letter Required)_
Contractor Information
Name of Company Qualifying Agent _
Address City State Zip
Office Phone 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 an ' stallations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all wor will be performed to meet the standards of all the laws regulating
construction in this jurisdiction. I understand that a separa 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, CON ULT WITH YOUR LENDER OR AN ATTORNEY BUORE
RECORDING, UR SIO TFEfr, f CO1VIMENCEMENT.
iature of Owner or Agent) (Signature of Contractor)
ned and sworn to(or affi befo e me th's to day if Signed and sworn to(or affirmed)before me this day of
�2-1 , . !, L a A.I.P. ` , , by
=MEW11•111�gi .*re ow 4 (Signature of Notary)
w��11.r v
[ ]Personally Known OR < �`� ., TONI GINDLESPEfidEfrson< y Known OR
' ': - MY COMMISSION#G�S PF '
[ ]Produced Identification _.; "` :.. c Identification
N, J.
Type of Identification: s' '��bi` EXPIRES:October 6T1gg3f Ide ttification:
-,`V, " Bonded Thru Notary Public Underwriters
4
i,--;, REVOCABLE ENCROACHMENT AGREEMENT
**ALL INFORMATION
^'`' , City of Atlantic Beach HIGHLIGHTED IN GRAY
• 7-,SV /� 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 underhe laws of the State of Florida, hereinafter referred to as "CITY"and
n icuiae-1 /IA i fly 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. dr ✓e. fast'/ers •
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 /O4 5 L I?/r . Ccl1 f tss keV, /Q flan/-sc Beach) f'L-
JJ 3023
• 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 rom any of the work herein under the terms of this permit and that all of said
Iiab' ies are h- eby assum•d by the USER.
� ��� Date /f
1 CI 42./
Property Ow /Agent(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
6 The foregoing instrument was acknowledged this day of _ .K1Qr , 20).! ,
by f iCAi2C. ►,/hl i-e, ,who personally appeared before me and
(printed name of Signer)
a no ledged a h- • e signed t e instrument voluntarily for the purpose expressed in it.
_ ,_ � Department Approval:
Signature of Notary Public,Sta - of lorida
ot""W°°� TONI GINDLESPERGER
[ ] Personally Known *: AA MY COMMISSION#GG 353178
[ ] Produced Identification (Type) =;+.7^�p:` EXPIRES:October 6,2023 cott Williams, Public Works Director
',9,'t°' Bonded Thru Notary Public Underwriters
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
45.4 Owner Builder Affidavit **ALL INFORMATIONHIGHLIGHTED IN
1; City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
'j 'A' 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 IS A 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: /oGS//L #1 Cyress jc S �}f/ard;c aeac/, FL .v.2..2_33
Owner Name: /�'1 eCl1Ce.i't 1/Wig (vht Phone/ Number: (56� a 5-41— 731-11
Mailing Address: ,Saife. City: ,q--t/ahfrci cA State: FL Zip: 3.'.Q.33
Notarized Signature of Owner -�
The fo oing ins rument was acknowled d before me this (p day of �J , 204, in the State of Florida, County
of VJvJ`
Signature of Notary Public ` ... it-'k S
At
[ ] Personally Known OR [ ] Produced Identification
Type of Identification:
,ti�Fly p•,• TONI GINDLESPERGER
MY COf,1M1SSI0N#GG 353178 Updated 10 24/18
EXPIRES.Jctober 6,2023
U;`�`•e= Public Underwriters
'•`,, ,pO Bonded ThruNotary
MAP SHOWING BOUNDARY SURVEY OF
LOT 118, SELVA LAKES UNIT THREE,
ACCORDING TO PLAT THEREOF AS RECORDED IN PLAT BOOK 44, PAGES 60, 60A & 60B,
OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA,
SUBJECT TO COVENANTS, EASEMENTS, AND RESTRICTIONS OF RECORD
CERTIFIED TO: NANCY WHITE AND MICHAEL J. WHITE - BANK OF AMERICA, N.A.
FIRST AMERICAN TITLE INSURANCE - MCCABE LAW GROUP, P.A.
EDGE OF N „. LAKES ASSOCIATION, INC.
WATER OFFICIAL RECORDS
,• IP O 'BQOK 8634, PAGE 1900
// NO CAP \\ `��4` J
/ \
\ • LINE 1
/ LOT 117 \ NO ICAP 36.18' S68'47'40"E (P)
// LOT 118 \\ �,, 36.12' S69'20'47"E (M)
/ TOP OF \ Z LINE 2
/ ', ;-.. BANK -----N In 24.13' S14'26'11"E (P)
/ Vc
CI3 ...7 .• N
N �j 24.47' S14'03'14"E (M)
.. / -—f SCREENED
�' , ° IN PATIO N 0 _ _ _ _
v N h Z 2' P'S 8.�' 2.3'4 6'� \
�, \
Q Q c\ -7.6 NO IF,CAP \
O'1(v J LOT 119 \\
INTERIOR PARTITION Qo p Q LI LO
O co'ZO
A/C \\
WALLS NOT LOCATED .N) ' )- C \
OR SHOWN HEREON c is % 1
it, C 2 2 1 7'
h`' n' CURVE 1
o s.\‘// �1 A V ARC LENGTH - 17.80 (P)
17.79' (M)
", ��. RADIUS - 50.00' (P & M)
In ' '� V CHORD BRG - N66'45'31"W (P)
;,� �(I//N 44 O\P N65'52'12'W (M)
7.5' JEAin. ,� �P CHORD DIST - 17.70'. 0' (M)
EASEMENT 20' �Aj� (C0
At
__ V
ji" IP I
-SQClCRETE e 3NOOCAP DRIVEWAY (i9J 10'X110' JEA CONCRETE
� ' R/W/ • EASEMENT
. 4'CHAINLINK FENCE—x —x —
R=50 1�P1/,Q /
Pe• • X" TRANSFORMER 6'WOOD FENCE
NO CA' \ 6'VINYL FENCE 0 0 0 0
/ / R/W \ SET O FOUNDO
/ R=50' \ \
0 / \
�0.
Lo
• \ \ ABBREVIATIONS
WM=WATER METER
LITTLE CYPRESS KEY R/W=RIGHT OF WAY
PC=POINT OF CURVATURE
I /�P VARIES PT=POINT OF TANGENCY
R=RADIUS
P=PLATTED
/RADIUS POINT I
6 R" IP NO CAP M=MEASURED FIELD DATA
1 IP=IRON PIPE
i
NOTES 4.THIS SURVEY WAS MADE WITHOUT THE BENEFIT OF
1. LEGAL DESCRIPTION PROVIDED BY CLIENT ABSTRACT OF TITLE. NOTICE:THERE COULD BE
2.THIS SURVEY REPRESENTS A BOUNDARY SURVEY TO SHOW ADDITIONAL EASEMENTS, COVENANTS AND RESTRICTIONS
ABOVE GROUND IMPROVEMENTS; UNDERGROUND OR OTHER MATTERS OF PUBLIC RECORD THAT MAY AFFECT
IMPROVEMENTS OR INSTALLATIONS NOT LOCATED EXCEPT AS THIS PARCEL.
SHOWN. 5.BEARINGS SHOWN ARE BASED ON THE SOUTHEAST
3. USE OF THIS SURVEY FOR PURPOSES OTHER THAN THAT PROPERTY LINE S. 33'26'21”W.
WHICH IT WAS INTENDED,WITHOUT WRITTEN VERIFICATION, 6. PROPERTY HEREON LIES IN FLOODZONE X ACCORDING TO
WILL BE AT THE USER'S SOLE RISK&WITHOUT LIABILITY TO FEMA FLOOD INSURANCE RATE MAP NO. 12031C0409H
THE SURVEYOR. NOTHING HEREON SHALL BE CONSTRUED TO DATED 06-03-13.
GIVE ANY RIGHTS OR BENEFITS TO ANYONE OTHER THAN
THOSE THE SURVEY WAS PREPARED FOR. THIS SURVEY MEETS THE STANDARDS OF PRACTICE SET
FORTH BY THE FLORIDA DEPARTMENT OF AGRICULTURE
TOP PRIORITY AND CONSUMER SERVICES, IN RIDA
ADMINISTRATIVE CO E,PURSUANCHAPTER O SECTION 4702 0227,
FLORIDA STATUTES,UNLESS OTHERWISE SHOWN AND
LAND SURVEYORS INC. STATED HEREON.
3780 KORI ROAD SUITE#7 JOB#: FL-14-6488 /,j' /����
JACKSONVILLE, FL. 32257 FIELD SURVEY Y
OFFICE (904)625-2006 DATE: 11-18-2014 C.H. WRIGHT, III, PSM
DRAFTED BY: TS FLORIDA REGISTERED CERTIFICATE # 4083
NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL
LICENSED BUSINESS#7969 SCALE: 1"=20' RAISED SEAL OF A FLORIDA SURVEYOR AND MAPPER