665 SAILFISH DR RFNC21-0016 ,$ slf,', Building Permit Applicationitift Updated 10/9/18
tw City of Atlantic Beach Building Department **ALL INFORMATION
V4
v 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
oft 9Y IS REQUIRED.
Phone: (904) 247-5826 Email:pBuilding-Dept@coab.usti
Job Address: 665 $ t i t S h p� e `-uS4 Permitr� Number: NC Z l -O O I (a
X Legal Description t I • + • Royal f C/,t t 5 Uni. 1 )CRE#- 17 14c - 0060
Valuation of Work(Replacement Cost)$ 3,OO o Heated/Cooled SF Non-Heated/Cooled
• Class of Work: New Addition DAlteration ❑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 T(lo
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ,Vo
Describe in detail the type of work to be performed: / /
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name C c.2- ("OWt1t`1 / Address (� 6S SC T !Sk D1 'vC e -t-k
City A - 4A-1--;(.. tots)` State FL Zip ��c S )3 Phone 61b CI 31-7 'kto 1 4
E-Mail br i u IJC-Q W f \r t) 0 (.400 , O" -
Owner or Agent(If Agent, Power of Attorney or Ag ''cy 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 and in allations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work wi e 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 NCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
REC• ` 0 OUR.-NOT CE OF OMMENCEMENT.
..----- /
ir .w:ner or Agent) (Signature of Contractor)
S{gned and sworn to(or affifmed) before me thisay of Signed and sworn to(or affrfined)before me this day of
�� C1(\ ,ZQZ ,b .i (,C. . .:.I.Jnil , Aby
( latur r e ; y) (Signature of Notary)
[ ]Personally Known OR [ ]Personally Known OR
[ ]Produced Identification [ ]Produced Identification
Type of Identification: i ( Type of Identification:
);t,....A4-22t.., REVOCABLE ENCROACHMENT AGREEMENT
'. L' **ALL INFORMATION
'' �d City of Atlantic Beach
ti`} �1 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
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
r '/'- (J C"Oi "\ n 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 F e n c--e_ .
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 n tice to USER shall be given by certified mail, return
n. `
receipt requested,to the following address (q 6 5 SC1lq1-
i IS v1 C`,vC. eco`' )-Na. 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
liabi ities ar•-011"x",, . i the USER.
Date I igS/i)\
Proper ner/Ag• igned in . esence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVALQ� 7
The foregoing instrument was acknowledged this day of Gn , 20 L -- I,
;�
by �1((,e 1�t'UI,IM.,1c�]o/ ,who personally appeared before me and
(printed name of Signer)
ackn I wledged than e/s.e signed the instrument voluntarily for the purpose expressed in it.
,4 _ •_ Department Approval:
Signature of Notary '. . ic,State of Fes;, .a
[ ] Personally Known
[ ] Produced Identification (Type) C- Scott Williams, Public Works Director
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
rs` '- Fence Addendum Updated 1/7/2021
: ;= L -j
1 City of Atlantic Beach Building Department
,may_; 800 Seminole Road, Atlantic Beach, FL 32233
U
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Property Type:
X Residential
❑ Commercial
Lot Type/ Features:
One Street frontage (interior lot)
❑ More than one street frontage (corner lot, through lot, etc.)
❑ Swimming Pool
Fence Material:
Wood
❑ Chain Link
E l Vinyl
❑ Block/Stone (Plan details required for footings and/or retaining walls)
LI Other
Fence Height:
❑ Four Foot(4ft)
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?
/`6 Yes (must submit separate Revocable Encroachment Agreement)
❑ No
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
X 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.
Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
1 7;4 City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
'` Phone: (904) 247-5826 Email: B ildin -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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY"OR THE FLORIDA"CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: �6S `,Iue. EL(5i G11$c '&46, S"3
n (� a6
Owner Name: I`j(C/�(-C, �C VWn� � Phone Number: "(0 J��
Mailing Address: E)CS S��[r1 'Cyc G6l){-City: 44-1 Lc, 6440A State: Zip: 3)`)3)
Notarized Signature of Owner /
The re ing instr Giment was ackr wledged •- - me this Say o Q� , 202,fn the State of Florida, County
of 1, J V U\-\
Signature of Notary Public
[ ] Personally Known OR [ ] Produced Identification b
Type of Identification: (. , , l—
Updated 10/24/18
MAP SHOWING SURVEY OF
LOT 7, BLOCK 6, ROYAL PALMS UNIT ONE, AS RECORDED IN PLAT BOOK 30, PAGES 60 AND 60A,
OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
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6 LOT 8 Ic0
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�/�� m � J 99.93' FlELD) 0.4 ' FW4D 1\2. IRON
82 44.50" 100.00' PIPE NO CAP
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8,,4 100.00' I
FOUND 1\4 IR«� 582'43 5 ,' PELD) \ '1
p!' PIPE NO CAP (S82'41.25^W 99.9
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1 I LOT 6
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1
NOTES:
\ I
-THIS IS A BOUNDARY SURVEY.
-BEARINGS BASED ON THE WEST UNE OF LOT 7,
BLOCK 6, BEING N0716'02"W AS PER PLAT.
-25' BUILDING RESTRICTION UNE AS PER PLAT.
-5' EASEMENT AS PER PLAT. THIS SURVEY WAS MADE FOR THE BENEFIT OF
AMERICA'S CHOICE TITLE INSURANCE COMPANY;
BSM FINANCIAL, LP/DBA BROKERSOURCE.
THE PROPERTY SHOWN HEREON APPEARS TO
LIE IN FLOOD ZONE "X" (AREA OUTSIDE 500
YEAR FLOOD PLAIN) AS WELL AS CAN BE
DETERMINED FROM THE "FLOOD INSURANCE
RATE MAP" COMMUNITY-PANEL NUMBER
120075 0001D, REVISED APRIL 17, 1989 ,..) ._ >
FOR ATLANTIC BEACH, FLORIDA. ______D
'NOT VALID WITHOUT THE 9GNAILIRE AND THE DO N W. BOATWRIGHT, P.S.M.
ORIGINAL RAISED SEAL OF A FLORIDA LICENSED FLA. UC. SURVEYOR AND MAPPER No. LS 3295
SURVEYOR AND MAPPER.' FLA. LIC. SURVEYING & MAPPING BUSINESS No. LB 3672
CHECKED BY: 6$tc- BOATWRIGHT LAND SURVEYORS, INC.
DRAWN BY: CSK 1500 ROBERTS DRIVE DATE: MARCH 26, 2004
FILE it 2004-0390 JACKSONVILLE BEACH, FLORIDA 241-8550 SHEET?OF