1065 Little Cypress Key DWAY21-0002 Paver DRIVEWAY PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH DWAY21-0002
ISSUED: 1/8/2021
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233 EXPIRES: 7/7/2021
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.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
1065 LITTLE CYPRESS KEY DRIVEWAY SINGLE OR TWO PAVER DRIVEWAY $5000.00
FAMILY DRIVEWAY
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172027 5828 SELVA LAKES UNIT 03
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
WHITE NANCY 3780 VALLEY PARK WAY LAKE WORTH FL 33467
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT II\
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.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL
Notes:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line(904-247-
5814)to request an Erosion and Sediment Control Inspection prior to start of construction.
7 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
Issued Date: 1/8/2021 1 of 2
Sr �Ai.f„J', DRIVEWAY PERMIT PERMIT NUMBER
r :_ ,, DWAY21-0002
CITY OF ATLANTIC BEACH
J vJ 800 SEMINOLE ROAD ISSUED: 1/8/2021
\ , yr EXPIRES: ?/7/2021
ATLANTIC BEACH, FL 32233
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 DECKING REMOVED INFORMATIONAL
Notes:
All old decking 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.
8 PUBLIC WORKS OTHER PUBLIC WORKS CONDITION INFORMATIONAL
Notes:
No impervious area can be added to this permit-property is maxed out.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 325.00
ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 3100.00
TOTAL:$125.00
Issued Date:1/8/2021 2 of 2
t=om'-,. Building Permit Application
•
\l=;l City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
-vv.).- IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 10 65 4117% Cy fre55 i L1 Permit Number: t- Of1L1 Z...1 —000 Z-
Legal Description 4/4-14, 0 17 -a5- c
,19 p � 1Va/mkeS L/ -f 3 RE#
�� //
Valuation of Work(Replacement Cost)$---....:Th 000 Heated/Cooled SF h.0-7-
Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move [Memo DPool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s)be removed in association with proposed_proiect?❑Yes(must submit separate Tree Removal Permit) r]No
Describe in detail the type of work to be performed: '-P Ck‘i e- r d
T 1‘41'Ct1t7cLCI
Florida Product Approval# for multiple products use product approval form
Property Owner Information n
Name . ' /• -t I . _�C J,4-._1.—
Name Address 10(.5 Ltt l�U per-5_5R sig
City , f jq mL%c et/t State t'L Zip 3 a3 Phone J C5 lot) t '6 y-s-7 3
E-Mail NjILei 1/5'Y _.q.rrx4.11 .ec n
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 0 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, CO .•ULT WITH YOUR LENDER OR AN ATTORNEY B
RECORDING , •UR ► 9T 4 i MENCEMENT.
(S Nature of Owner or Agent) /n (Signature of Contractor)
ned and sworn to(or affi010 befo e me th•s . day ,f Signed and sworn to(or affirmed)before me this day of
ark 70 , • id �./�by
111111111111all ME
IPgtafrre ot.�P 4 (Signature of Notary)
[ ]Personally Known OR �"°`�•''•• TONI GINDLESPEIkd rsona y Known OR
F
[ 1 Produced Identification � ?. "
; .. MY COMMISSION#Gt ttp4i4c4i Identification
Type of Identification: I=t:;- 4- EXPIRES:October arenof Ido ttification:
( .°.'f ti' Bonded Thru Notary Pubic Undernriters
��;=- ; REVOCABLE ENCROACHMENT AGREEMENT
�f-
HIGHLIGHTED
,1,d1 City of Atlantic Beach "ALL INFORMATION
,fl i 800 Seminole Road,Atlantic Beach,FL 32233 IN GRAY
, ii 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
f11 Ch
eae_/ /,A1`j 1 f� 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• Gl rl✓e. .Y'i1 tlie(5
Any facility maintained, repaired, erected, and/or ins alled 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 /OG 5 L r ff'/�, Ct1 JD re5-s Ic y, /4 tIar1/-rc 6each, t"L--
J 30 . 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 rom any of the work herein under the terms of this permit and that all of said
7sare7ebYassusurndbYtheUSER.� Date /;,2 /
Property Ow /Agent(signed in presence of Notary Public)
STATE OF LORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this day of JaK J 4 r , 20J./ ,
by / 'ciiae, k Iii he ,who personally appeared before me and
(printed name of Signer)
a no ledged at,h e signed tie instrument voluntarily for the purpose expressed in it.
C4--- �--/ Department Approval:
Signature of Notary Public,Sta of lorida • ;o,, vbt TONIGINDLESPERGER
':„"iMY COMMISSION#GG 353178
( ]Personally Known _�;` ,._
( ] Produced Identification(Type) 0 ---,-;;;•52•••.:7.,' EXPIRES:October 6,2023 Scott Williams, Public Works Director
`Ot`;°e` Eended Thru Notary public Underwriters
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
• , vs? Owner Builder Affidavit **ALL INFORMATION
��� HIGHLIGHTED IN
: ',., City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
`_oil'" 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: /o/..4"_jj.L.iftlr,L'
rens > - fJ¢r7f« &e¢c�i, FL ,3 X33
Owner Name: f- icer e/f ,/t/ang 4.)A;71-e- Phone Number: (511) d 54-15-7347I
Mailing Address: 5onrC- City: �-i'/a4 frc/0C'/'t State: FL Zip: 3AQ-33
Notarized Signature of Owner ,
The fo oing ins rument was acknowledt-d before me this a day of 't , 20;x`, in the State of Florida, County
of VJvc
CY
Signature of Notary Public CT— fL_
a r
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: j"..' C----
-
E---
IoNtt
it TONTGNQLESFERGER�, '•;,�, MYCOId`d1SSGG 353176 updated 10/24/18
' ;= EMPIRES:Oct3ber6,2023c:` PebiicU^derNTfters
if;°� Bendzd Thru N•��ry
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 ) SELVA LAKES ASSOCIATION, INC.
.
WATER OFFICIAL RECORDS
X" IP • B- OK 8634, PAGE 1900
/ NO CAP \ /NF
/ \ 1
/ \
/ LOT 117 \ IP • 3618' S68'47'40"E (P)
// LOT 118 \\ NO CAP r 36.12' S69'20'47"E (M)
/ TOP OF \ Z LINE 2
/ 1 ro I�=A`K�J\\ m 24.13' S14'26'11"E (P)
/ _\ ` \18,4~] N 1 ) 24.47' S14'03'14"E (M)
• `S ! •---��o�r SCREENED
--- "Rift1 IN PATIO \ , _ —_
7 2, M 8.7'2.3 '4 S, X2" IP \\
Q �i (76 NO CAP \
Qr.� 0 •6). \
4k/ l� W o A/C LOT 119
INTERIOR PARTITIONp Q_0 co' \
WALLS NOT LOCATED ,,_CO '- act
OR SHOWN HEREON (\I O� \0
„� In z? -i ?'
p n' CURVE 1
0 O,-.-.! s r,' Alt ARC LENGTH - 17.80' (P)
IN u
O S- I a t. 17.79' (M)
fi NI RADIUS - 50.00' (P & M)
In \V \ \i CHORD BRG - N66'45'31"W (P)
N r'1 +'V` \P N65'52'12"W (M)
7.5' JEA q. ,q, .RPS CHORD DIST – 17.70' (P)
EASEMENT 20' �tij4 �co
h- IP fr
A(-a) 45_ NO CAPWPY/�. (1 g, J
• J)10'X10' JEA CONCRETE ,, .. .
(� ', EASEMENT
�/ R/50' !�� 4'CHAINLWK FENCE—x —x
�liF • it. TRANSFORMER 6'WOOD FENCE❑ a a a
I1 `\ CAA\ 6'VINYL FENCE 0 0 0 0
/ / RM.....X. SET 0 FOUND()
/ R=50' \ \
r. / \ \
0 X17 \ \
0)....<
• \ \ ABBREVIATIONS
WM=WATER MJ 11 R
LITTLE' CYPRESS KEY \ R/W-RIGHT OF WAY
PC-POINT OF CURVATURE
/W VARIES PT-POINT OF TANGENCY
/ R-RADIUS/RADIUS POINT I P m PLATTED
(h./ XI" IP NO CAP M-MEASURED FIELD DATA
I 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 ADMINI TRATIVE CO E,PUR UANCHTPTO SECTION 447ER 5J-17, ARIDA
0227,
FLORIDA STATUTES,UNLESS OTHERWISE SHOWN AND
LAND SURVEYORS INC. STATED HE
3780 KORI ROAD SUITE#7 JOB#: FL-14-6488 J/��/ .'
JACKSONVILLE,FL.32257 FIELD SURVEY
OFFICE (904)625-2006 DATE:11-18-2014 C.H.WRIGHT,III,PSM
DRAFTED BY:TS FLORIDA REGISTERED CERTIFICATE 41 4083
NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL
LICENSED BUSINESS#7969 SCALE:1"=20' ,, a ; • • 4 a ,,, j,J. •: .41, .. .
,,rT�1, jy,
3 , , .. i 3 s er Re,; teceipt Number
r
City of Atlantic Beac' R14541
DESCRIPTION ACCOUNT
PermitTRAK $125.00
DWAY21-0002 Address: 1065 LITTLE CYPRESS KEY APN: 172027 5828 $125.00
PUBLIC WORKS PLAN REVIEW $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
ZONING PLAN REVIEW $100.00
ZONING REVIEW SINGLE AND TWO FAMILY
USES 001-0000-329-1003 0 $100 00
TOTAL FEES PAID BY RECEIPT:R14541 $125.00
Date Paid: Friday,January 08, 2021
Paid By: WHITE NANCY
Cashier:11
Pay Method: EMV 04103D 1411869259
Printed:Friday,January 8,2021 1:00 PM 1 of 1 '.*; CENTRALSQUARE