1306 beach ave rfence21-0005 Building Permit Application Updated 10/9/18
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City of Atlantic Beach Building Department **ALL INFORMATION
I/ 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 1506 ` 7eAc_ A.v6 Permit Number: RRNC.EZ( — OS
Legal Description to-II tb-ZS—2446MANDAL . 'I f2t.OT4,LOTSJ%LK �Z RE# 17t s11- GOoc
Valuation of Work(Replacement Cost)$ ?ZOO Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration Klepair OMove ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Vesidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes Flo
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) I No
Describe in detail the type of work to be performed: 'QE,^1076 t ' C P1✓?C.t: E C/s7- +''Gr "c-
Florida
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name CAM afleei NE Address 1?j p(Q $E'•AG J# A'.
City 4-M.4/v T f G ePFP Cti-frState Pt-- Zip 32 Z�? 3, Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company COO-Sr To Q7/¢$'1-- F r—' 1c Qualifying Agent J c,"" '17 7?_6 L J /4
Address / e',40-47t ,4I 5 0 City AT'L . se./f State E- Zip 37 z 33
Office Phone ? ( 70$' 7'75-5— Job Site Contact Number
State Certification/Registration# E-Mail C.TOCP- �tl� 4� 4-#'19f L- - GtJY`�
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt(Expiration Date 717:
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 N NG, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECOR N MMENCEMENT. -
(Signatur Owner or/,gent) � (Signature of C .�J 'or)
1 '( L' 12 ter' .Jo -Poz-61v, yr—
Signed and sworn to(or affirmed)before me this • day of Sig ed and sworn to(or affirmed)before me this Y day of
, ► 6>.�G� , -202-1
r °�, (Sip.r{ t�f, iafure of Notary)
Roberta D Cgrligie `Nr PG
+310 _p MYomitliss:orrGG 251058 'P + Rc;ie�iauD�lic S6�te of FlpriQa
r.. .. a C3hiSkg
rsonally Known • ersonally Known "�,` °p MY ommissimGG
• Eroir�s(9/15!2022 251658
[ ]Produced Identification [ ]Produced Identificon
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Type of Identification: Type of Identification: - `" - -
r.-S'- Fence Addendum Updated 1/7/2021
� City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Property Type:
c2"Residential
❑ Commercial
Lot Type/ Features:
❑ One Street frontage (interior lot)
More than one street frontage (corner lot,through lot, etc.)
❑ Swimming Pool
Fence Material:
VWood
❑ Chain Link
❑ Vinyl
❑ Block/Stone (Plan details required for footings and/or retaining walls)
LI Other
Fence Height:
❑ Four Foot(4ft)
Ii'Six 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?
LI Yes(must submit separate Revocable Encroachment Agreement)
,12"-No
Will tree(s) be removed in association with proposed project?
❑ Yes(must submit separate Tree Removal Permit)
Il 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.
L U I O
FOUND 3/4'IRON 88.44' FIELD
:PIPE ':/HOER WALL � '�' SET 1IRON
07' PIPE ''..D 9.. 3672'0
T25.00• - .00' � 63.40'
G 87.27'34''
0.
18.
110 v, '1
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25.6'
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, [I caNCRETE D
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I 89'40'39" 92'32'49"
25.00• i 260D• 55.20' F tV- 1
PPE"1- 19/2'
�°" 84.20' at�N6 a
84 55' =IE-C
13th STREET
NOTES
- THIS IS A BOUNDARY SURVEY. ;40' RIGHT WAY:,
- ANGLES 9-IOWN ARE PER FIELD MEASUREMENT.
- NO BUILDING RESTRICTION LINES PER PLAT.
- NORTH PROTRACTED FROM PLAT.
THE PROPERTY SHOWN HEREON APPEARS TO LIE IN FLOOD
ZONE "X" AS WELL AS CAN BE DETERMINED FROM THE FLOOD THIS SURVEY WAS MADE FOR THE BENEFIT OF CAMERON
INSURANCE RATE MAP COMMUNITY PANEL NUMBER 120075 AND KIM GREENE. GIBRALTAR TITLE SERVICES, INC.,
0001 D. REVISED APRIL 17. 1989 FOR THE CITY OF ATLANTIC FIRST UNION NATIONAL BANK AND FIRST AMERICAN
BEACH, FLORIDA. TITLE INSURANCE COMPANY AND THAT THIS SURVEY
WAS MADE IN COMPLIANCE WITH THE MINIMUM TECHNICAL
STANDARDS SET FORTH IN FLORIDA ADMINISTRATIVE
CODE (REVISED 1996).
VNIESS IT REARS THE S1ERM RAE AND ....4112.‘
RIE ORKINA.RAISED SEAL OF A FLOROA DONN W. BOATWRIGHT. P. M. '
JCENSE° SURVEYOR AND MAPPER. TMS
MAP IS FOR INFORM A110NAL PURPOSES FLA. REG. SURVEYOR AND MAPPER No. 3295
')N'_V AND S NOT VAUD
1 I
SCALE: ' - 2°- I 1 BOATWRIGHT LAND SURVEYORS, INC. I A TE:
1.,6
DRAWN BY: NOV.
FILE: as-746 L 1711 SOUTH 5th STREET, JACKSONVILLE BEACH, FLORIDA 241-8550 L SHEET OF ' I)
.IS-06-23
REVOCABLE ENCROACHMENT AGREEMENT
**ALL INFORMATION
• \so, City of Atlantic Beach HIGHLIGHTED IN GRAY
50". 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 under the laws of the State of Florida, hereinafter referred to as "CITY"and
C014cT- 1-OC0/4— i0 ti tj C_o 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 Fir ^' Wit.'_ !sv t 1-0
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 130 44'c $✓t
• 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 fro i any of the work herein under the terms of this permit and that all of said
liabilities are hereby assumed : the USER.
Date /4,;/?i
Prope Qh �ty Owner/Agent( :nedln r Bence of Notary Public)
Property
;N P► rl v 5-,--
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrumen was acknowledged this day of Q(N , 20R–
by cr \ (1 cD� C� \ ,who personally appeared before me and
nted na - of Si:ner)
ac wledged t at he/ - signed the instrument voluntarily for the purpose expressed in it.
TONT GINDLESPERGER
MY COMMISSION#GG 353178 Department Approval:
'!'t•, lInIL i
Sign re of Notary Public,State o Florida �4...f EXPIRES:October 6,2023
PersonallyKnown F° Bonded Thru Notary Public Underwriters
I loft
[ ) 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