1671 Francis Ave RESO20-0037 Permit PacketOWNER:ADDRESS:CITY:STATE:ZIP:
CITY OF ATLANTIC BEACH 716 OCEAN BLVD ATLANTIC BEACH FL 32233-5428
COMPANY:ADDRESS:CITY:STATE:ZIP:
Pablo Beach Builders Inc 13978 Sea Prairie Lane Jacksonville FL 32224
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
172287 0010 ED SMITH S/D
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1671 FRANCIS AVE
RESIDENTIAL OTHER SINGLE OR
TWO FAMILY RESIDENTIAL
OTHER
COVERED SHELTER $5000.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 BUILDING BUILDING INFORMATIONAL
Notes:
NOTICE OF COMMENCEMENT
ADA access shall be provided to one of two nearby sidewalks, Per D. Arlington.
Not sure if the NOC comment above pertains to this project. MJ.
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.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN
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.
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.
1 of 2Issued Date: 1/15/2021
PERMIT NUMBER
RESO20-0037
ISSUED: 1/15/2021
EXPIRES: 7/14/2021
RESIDENTIAL OTHER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $80.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $40.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $124.00
2 PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL
Notes:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line (904-247-
5814) to request an Erosion and Sediment Control Inspection prior to start of construction.
3 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
4 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list. Approved list can be obtained at the Building Department at City Hall. Roll off container
cannot be placed on City right-of-way.
5 PUBLIC WORKS DECKING REMOVED INFORMATIONAL
Notes:
All old decking and debris must be removed from job site by Contractor.
6 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
2 of 2Issued Date: 1/15/2021
PERMIT NUMBER
RESO20-0037
ISSUED: 1/15/2021
EXPIRES: 7/14/2021
RESIDENTIAL OTHER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
~ ~>U4--
~ City of Atlantic Beach Building Department rf
Building Permit Application Updated 10/9/18
800 Se minole Ro ad, Atlantic Beac h, FL 32 233
**ALL INFORMATION
HIGHLIGHTED IN GRAY
Phone : {904) 247 -5826 Email : Building-Dept@coab.us IS REQUIRED.
1611 64A~l1) At1cr Permit Number: RE:S C:f ZQ -0037
Legal Description Al 1< f<tf / LJ, 1, «U ,fL.oJ 7 /3.//(j f',/<-.4' ~-°"'"•· RE# / 12'kU1 -IJJLI
Job Address:
Valuation of Work (Replacement Cost)$ -&; 1Qt9 ~ Heated/Cooled SF -O-Non-Heated/Cooled ____ _
• Class of Work: ~ew □Addition □Alteration □Repair □Move □Demo □Pool □Wind ow/Door
• Use of existing/proposed structure(s): B"commercial □Resident i al
• If an existing structure, is a fire sprinkler system installed?: □Yes □No
• Will tree s be removed in association with ro osed ro·ect? □Yes must submit se a rate Tree Removal Permit ~o
Flor ida Product Approval# __________________ _
Property Owner Information
Name C,,tJ A 15 Address __________________ __;_
City~-------------State ___ Zip ______ Phone ____________ __..:
E-Mail ________________________________________ __..:
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) ___________________ _
Contractor Information
_ _,_.=... ........ _._~ __ f,._.u ... ; ... rJ ........ t:.,.; _____ Qualifying Agent Ci11l, U~«a
__ ....L..J.'-'-!...:..UJ-¥Jii~-..;J"J--.--------City ,A:f/. l:u.f. State rt, Zip J2 2~3
Office Phone Job Site Contact Number
State Certification/Registration# E-Mail ti\Ai~ ~ ,l.r., 1· /,J J;;;> , I J '1 _J ~ 0Mi-ASN°,, o, ,;:,--.,,,,6> n110 ,r"7,
Architect Name & Phone#---~~~,....,....---~------------------------.,. . .
~=~::~;~:~;e~~~:~~~s:rer t:~A1 CM~ OR Exempt □ Expiration Date _______ _
Application is hereby made to obtain a permit to do the work and instal lations as indicated. I certify that no work or installation has
commenced prior to the issuance of a p ermit and that al l work will be performed to meet the standards of al l the laws regulati ng
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 COND ITIONERS, etc. NOTICE: In addition to the requirements of this
permit, there may be additional restrictions applicab le to this property that may be found in the public records of this county, and
there may be additio na l 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 in formation is accurate an d that all work wil l be done in compliance with all
applicable laws reg ulating con struction 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 ~~~FORE
R MENCEMENT. ~~====
(Signature of Contractor)
Signed and sworn to (or affi rmed) before me this ±day of
D~<l.nlk r , ?.t7~ f ~ c''L.Q'J
Signed and sworn to (or affirmed) before me this __ day of
----~---~by __________ _
(Signature of Notary)
I I Personally Known OR
I I Produced Identification
Type of Identification: _____________ _
,-•t.if•ii>... KY E MATTHEW MURRAY
{f~~":\ Notary Public • Stat, of Florida
M'Personally Known OR \t\A~f Commission# GG 981383
[ ] Produced Identification \ .... Of r.: .. ./ My Comm. Expires Apr 23 , 202-4
.... Bonded through National Not ary Assn. Type of Identification: _____ ..,__,.. __ ..., ____ _....,4,
Revision Request/Correction to Comments
City of Atlantic Beach Building Department
800 Seminole Rd, Atlant ic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
D Revision to Issued Permit OR D Corrections to Comments
**ALL INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED.·
PERMIT#: ( sso2 -003,
Date:
Project Address : -"l...,,{o=--.:........;;..---=.h--=-f'"_Q_C'\_Q.,_~_, S. _ ____._t\y__._____,e.,,""'-------------~--
Contractor/Contact Name : _ _..B_b-b_-..=_..,_l _ca __ ~~_...€,;_Q'--Q-=-_.h'-~ ~-------------------
Contact Phone : .~z Z-3 -4 f ::> 9 Email : Qot\Sft'oe-ion@; (6eo..cb, H~b~+Q._,+ I
or-~
Description of Proposed Revision / Corrections:
l? ·evo~a.b l:e___. o. D d. J Fro..m.,D5
-------------affirm the revision /co rrection to comments is inclusive ofthe proposed changes.
(printed name)
• Will proposed revision/corrections add additional square footage to original su bmittal?
D No D Yes (additional s.f. to be added: ____________ )
• Will proposed revision/correction s add additional increase in building value to original submittal?
D No D*Ye s (additional in crease in building value :$ ________ ~ (Contractormustsignifin creaseinva l uation)
*Signature of Contractor/ Agent : ______________________ _
(Office Use Only)
tsrApproved D Denied D Not Applicable to Department Permit Fee Due$ _____ _
Revision/Plan Review Comments _____________________________ _
Department Review Required:
Building
Planning & Zoning
Tree Administrator
Public Works
Public Utilities
Public Safety
Fire Services
Reviewed By
Date
Update d 10/17/18
Revision Request/Correction to Comments
City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab .us
D Revision to Issued Perm it OR D Corrections to Comments
**ALL INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED.
PERMIT#: i sso2 -od3 ,
Date :
Project Address: -'l-"0""'--"-----'-N-----'-r-_Q_C\Q.,_l.._, s. _ __._P<____.__v ~e_,, ______________ _
Contractor/Contact Name : --+B_b-6_-~l~a-~t)~e_;~Q_Q~b~~ ........ ~-----------------
Contact Phone : ·cZ Z-3 4 l O 9 Email: Qo
Description of Proposed Revision/ Corrections:
G>-evocabl-e____.
_____________ affirm the revision/correction to comments is inclusive of the proposed changes .
(printed name)
• Will proposed revision/corrections add additional square footage to original submittal?
D No D Yes (additional s.f . to be added: ____________ )
• Will proposed revi sion/corrections add addit ional in crea se in building value to original submittal ?
D No D *Ye s (additional incre as e in building value : $ ________ ) (Contractor must sign if in crease in valuation)
*Signature of Contractor/ Agent : ______________________ _
(Office Use Only)
~Approved D Denied D Not Applicable to Department Permit Fee Due$ _____ _
Revision/Plan Review Comments _____________________________ _
Department Review Required:
Building
Planning & Zoning
Tree Administrator
Public Works
Public Utilities
Public Safety
Fire Services
Reviewed By
Date
Updated 10/1 7/18
REVOCABLE ENCROACHMENT AGREEM ENT
Ci ty of Atl antic Beac h
800 Sem ino le Ro a d, Atlanti c Be ach , FL 32233
**ALL INFORMATION
HIGHLIGHTED IN GRAY
IS REQUIRED.
REVOCABL E EN CROA CHM EN T AG REE M ENT by the City of Atlantic Beach , Flor ida , a municipal corporation organized and
existing under the laws of the State of Florida, hereinafter referred to as "CITY" and 8 <,1 d fJd H,. ~ • f . .,+ £, tk , ,n-, ,; of Atlantic Beach , Florida, here i nafter
referred to as "USER".
W ITNE SSET H:
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 ___ .... c __ ._,_e.._1 ... t ..,l '--_s _t,_,_,;,.,;,l..,;:,(_1 __________________ _
Any facility maintained , repaired , erected, and/or i nstalled in the exercise of the privilege granted remains subject to
relocation or removal on thirty {30) days' notice by CITY to USER, said notice t USER shal l be given by certified mail, return
.,,,,,,tJ ' 1.z. receipt requested, to the following address ___ _,__ ,~'----'---=--'-'"-J'f"-!~~CLl'IL..:...-.L:!f-Ll-...._1-1.f,~.,µ..~,.-,...-------'::::..1~-
• 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 m ust
be replace d with smooth concrete left natural in co lor so that it matc hes the existing and adjoining sidewa l ks."
• 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 utiliti es locate requirements and use limitations/requirements of easements, public
right -of-ways and other pub l ic land . USER further agrees that the CITY and its officers and e m ployees sha ll be
saved harmless by the USER from any of the work herein under the terms of this permit and that all of said
liabil" . u ed by the USER .
Date / J../,f /2t1 -~-,--, .... ~----
w ner/Agent (signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this l StfR day of bee eWl k)::?B. I 20 do-0 I
, who personally appeared before me and
(printed name of Signer)
acknowledged that fi,she signed the in strument voluntarily for the purpose expressed in it.
~-~~~ /
S1g na~fuof Notary Publ ic, State of Flor ida
W ersonally Known
JOYCE MAR IE FREEMAN
Notary Public -State of Florida
Commiss ion I GG 07291 1
My Co mm. Expires Jun 1'.I, 2021
Bonded through National Notary Assn.
[ ] Produced Identification (Type) ______ , ... __ ,..,..~~------...,..,4,
Departme nt Approval :
Scott Williams , Public Works Director
H:\Ap pli cations & Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revisio n Date : 8/31/18
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