1660 SEA OATS RFNCE21-0004 ,S Building Permit Application Updated 10/9/18
of
.Y , City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
u p IS REQUIRED.
Phone:/ (904) 247-5826 Email: Building-Dept@coab.us �y.�/�
Job Address: /660 SEA T-S Permit Numb VC's Z t — 000�--
Legal Description 3%4-5-I 09{2s 2gt.SEZ4m4tv✓a0n/11-(o Lon ZaLK i3 RE# 11W2O -0 Z2 6
Valuation of Work(Replacement Cost)$ ? ? Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition DAlteration repair [Wove ❑Demo EPool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ,gesidential
• 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) )N'No
Describe in detail the type of work to be performed: -26,4-101e- cuL? Fe#---C.e (r'$ l)l U� A"-- ----4,.)
/74t& 1,,e/v._,
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name Via 401 4 1--eiGH GRAFI' Address 1660 Sea 0)+3 Irl
City 'im+Jc "geo,ch State f L• Zip 3aa33 Phone $4o-g77.0gg 3
E-Mail tophi * CoMt.&S+. net
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Companyejf}ST To C)41-- Coc.v)4, Qualifying Agent
Address (22(GALAP/ GOS dub c , City A-rt. beta- State PZip 3z2-3 3
Office Phone coif 7O S ?73'5' Job Site Contact Number
State Certification/Registration# E-Mail C I OC ceN6E-@ Q'M14/L--
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt' Expiration Date If///2/
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 B FORE
RECORDING YOI. R OTICE OF COMMENCEMENT. ----
AgervAllIPP
/(Signat e of Owner or Agent) (Signature of=tractor)
vV /I,Com, .J. 6 -r4 'Ja� � v,
Signed and sworn to(or affirmed)before me thisaay of Signed and sworn to(or affirmed before m hisay of
<AA-0 , '25:)"__ - .... ...t.100.k• • - '• .' 7,t ---1-et ki -,2sY--z_t , f__. .%-ac.)(2vc ‘.(-
X• ' 5177 9(141004Y1 (Signature of Notary) •
r'
r
•. R�+lR!143 Vk3'Wglh • .'
[ ]Personally Known i.e':, •s' r
• ` 73". '232? Personally Known I. v�"N,, Notary Public State of Florida •
A.. -� ''.�r n •.+vti,. �' Roberta D Carlisle
roduced Identification [ ]Produced Identifica•on7 My Commission GG 251858
Type of Identification: _IL-6(cii b R.30- 2-26:5-•-e) Type of Identification: Va�dr Exoires 09/15/2022
Y ' „ Fence Addendum Updated 1/7/2021
Jt
City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Property Type:
Residential
❑ Commercial
Lot Type/ Features:
I(One Street frontage (interior lot)
❑ More than one street frontage (corner lot,through lot, etc.)
❑ Swimming Pool
Fence Material:
gi Wood
❑ Chain Link
❑ Vinyl
❑ Block/Stone (Plan details required for footings and/or retaining walls)
❑ Other
Fence Height:
❑ Four Foot(4ft)
itSix Foot(6ft)
❑ Other
Fence Location:
Please submit an accurate boundary survey required showing all existing improvements(including building footprint,
driveway, swimming pool, etc.) and location of fence/wall and any gates. Plan details required for block wall footings and/or
retaining walls and any portion or fencing above 6ft in height.
Will the fence be built in an easement?
❑ Yes (must submit separate Revocable Encroachment Agreement)
.t No
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
No
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.
-r` REVOCABLE ENCROACHMENT AGREEMENT
r /��.(e''
:�� City of Atlantic Beach **ALL INFORMATION
"! Beach, FL22 3 HIGHLIGHTED IN GRAY
+� `' 800 Seminole Road Atlantic 3 3
j ' 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
eUrciS1.- to Cc)✓-4 pe.,.....)-ice 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 describedrin the City of Atlantic Beach.F
This work is generally described as '^' 6 (t i 7 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 to USER,said notice to USER shall be given by certified mail, return
receipt requested,to the following address / (.06o +4 7 '> .
• 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.
Date ///3/2 )
Property Oner/Agent(signed in .resence of Notary Public)
r/p^/B i 11, 4.A— 771Z 6,?v , 5-7--
STATE
/STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument w s acknowledged this I day of ..\ CL,a , 202 ( ,
by �� 1 (�(� ( C, ( S ,who personally appeared before me and
(p ' ted name of Signer)
acknowle ged that h:/s e s':n-d the instrument voluntarily for the purpose expressed in it.
, _E � . gip.. �.�..e.�.�.
;t. c TONT G:NDLESPERGER
I 4 '! a. .;`• MY COMMISSION#GG 363178 Department Approval:
Signature of Notary Pub ic,State of Flori'. >Q` = EXPIRES:October6,2023
. '''';;;Y,,;;.?-'s.FP,.n"' ' c'„nderwriters
personally Knownr
[ ) 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
FIELD WORK DATE:6/9/202o 'DATES: (REV.06310/2020)
IR CROCKETT LAW P.L. FL2005.6518
REAL ESTATE LAW BOUNDARY SURVEY i TO Ll.
DUVAL COUNTY 1
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PROPERTY ADDRESS : FL2005.6518 N G°27115'W 84.92'(M) _t{/
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WILLIAM J.GRAFF AND LEIGH M.GRAFF;CROCKETT LAW P.L; N Lai- ' 2 '� �� l�
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LOT 12,BLOCK 13,SELVA MARINA UNIT NO 6,ACCORDING TO �I������•'
THE PLAT THEREOF,AS RECORDED IN PLAT BOOK 34,PAGES LOT 5 ���� ��, �� ��
51,51A AND 51B,OF THE PUBLIC RECORDS OF DUVAL
MK.13 PI';j*,,se4f-,is*,,*,A,'• I '
COUNTY FLORIDA. ������,-,���'�����'� —� 1
o.a•' - —— 5 g3°43 43'S0'W 139.60 (M) w
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SETBACK II II ORMATIUI!SNOW!!OII PWT.III/1�'tlili ICL `"'
BY PERFORMING A SEARCH WITH THE LOCAL GOVERNING r / or nrvFnR 10 BF SERVICED 00 BUM IC WATER AND SPNFR
MUNICIPALITY OR WWW.FEMA.GOV,THE PROPERTY APPEARS TO �� �.k� � ecce OWTIEKSIIIP 1101 DErERnnueD. �w�M
BE LOCATED IN ZONE X.THIS PROPERTY WAS FOUND IN THE , ; • ,�
CITY OF ATLANTIC BEACH,COMMUNITYNUMBER120075, heFb •c9dilyt � �undpryS�ieyand Plot Plan o/the he eondeschbed
law)11/02/2018. prop&cbas.• madeR Sikrm Apecbb2 and to the best of my knowledge
and bette, ugg a(roe adt!acro, Representation of survey that meets the 30 0 15 30
Standards DC�CaNc'gAgdo/'i rdy the Florida Board of Professional Surveyors&
Mappers in ChadtAPSJ!ri o/the Florida Administrative Code.
THE BEARING REFERENCE OF S83.43'50'W IS BASED ON THE DATE SIGNED:6/10/2020 LASTDAFEOFFIELDWORK:6109/20 GRAPHIC SCALE (In Feet)
SOUTHERLY PROPERTY LINE OF LOT 12,BLOCK 13,SELVA
1 inch = 30' ft.
MARINA UNIT NO 6,AS RECORDED IN PLAT BOOK 34,PAGES • "
51,51A AND 51 B,OF THE PUBLIC RECORDS OF DUVAL
COUNTY,FLORIDA.
Use of this survey other than intended,without written verification,will be at the users'sole risk and without liability to the surveyor itItiR101
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