1761 SEA OATS DR DWAY21-0009 fTh LoARR 1 - c CC cj
,;, E-c''''4,,.,;\ Building Permit Application Updated 10/9/18
/ City of Atlantic Beach Building Department s_____..r)
**ALL INFORMATIONO
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
",''/}rte IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us /
Job Address: /fit/ S 9 l&6-T.s l7R ,r /ce.-f 7JC BPa,rZ,/=� 322 Permit Number: ).-7Z(LIz -)`- 1.)4
Legal Description 407 Nal/s;5tkl�/he//I,4/A-r i' RE#
Valuation of Work(Replacement Cost)$ /,) eAr, Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration [2' pair ❑❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial IZResidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s)be removed in association with proposed oroiect? ❑Yes(must submit separate Tree Removal Permit) E l o
Describe in detail the type of work to be performed: VE/ZS' Pg.(V L(0,47'
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name 5-1 CIC c) 4 ,/J-ir' ,4 / Address 17 L I So -I C)ci1 f�`0,--, 3 ....52;2„.13City /}-f-/t h C a `�-) State /--L Zip 3��•3-3 Phone -7 7 0 '3f(( --- 74,&S-
E-MailJ---+ 111> [t(BC(In t L..%(1/ /C 2 ma /. /c ( Ot'-
Owner or Agent(If Agent,Power of Attorney or Agency Letteequired)
Contractor Information
Name of Company tti/,h/g/ /tet ps _ i2&sZ r !IC- Qualifying Agent /11/c,Ee C l ,f,ENr✓
Address 5' Y -;'TNR✓ 1'(4-� City .._f I X. j3cxf State 7 0 Zip 322r 5
Office Phone !G 6 Si- y2 y-9/.C/ Job Site Contact Number S-9�c
State Certification/Registration# 4' Ye)c'(9O 5"72-77 E-Mail /}1&wge-, -4,.177- NET
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt i1YExpiration Date 3-1 ` Z/
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 BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT. 4 zzl
//
($ignature of Owner or Agent) + I Signature of Contractor)
J
Si ned and sworn to(or affirmed)before me this 1 1 day of Signed and sworn to(or affirmed)before me this \1 day of
_iv a__ 1 t,by S�GLC - _ +h Fehr OA 1 , 10- ,by lie \�Jt (1
� I! � -"- 4
W.Ila ��
turd G'CONNOR • ignature of Notary)
:•1'.'1•\,,,::-,, Notary Public-Stale of Florida
••= Commission#GG 177533
v My Comm.Exires Jan 22,2022 .��,v��''.. KORI CAPUTO
„ ;� fPersonallyKnown OR $. 4
[ ]Personally Known OR '- ;,;1 � Borxtedu,rougnN;,IionalNolaryAssn [ I � a< Notary Public•State of Florida
[4firoduced Identification [.}tProduced Identification 3 Commission%HH 038234
Type of Identification: i-i, 1.�; `- `. OP"
Type of Identification: ���� YP My Comm.Expires Aug 31,2024
"l � REVOCABLE ENCROACHMENT AGREEMENT
r -',s_,,,,,i, "ALL INFORMATION
City of Atlantic Beach
rt I>� HIGHLIGHTED IN GRAY
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
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 r\ V ea,O OL f f? ,r` .
Any facility maintained, repaired, erected, and/or installed in the exercis of the privilege granted remains subject to
relocation or removal on thirty(30)days'notice by CITY to USER,said notic to USERshall be given by certified mail,return
receipt requested,to the following address (�(Z �.---(- .
• 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.
„f ,i t phi"t.t C._A _ Date 1 7 1 -J l
Property Owner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this ( \ day of J i l,vj , 20 c-\ ,
by .(---CA( 2 S Yr `l- ,who personally appeared before me and
(printed name ofSigner)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
i
/ ;;1Ni,"i.r''•... CHRISTIANA V O'CONNOR
/ 9 �,�'`� ::_ Notary Public-Stale of Florida I Department Approval:
_� ���JJJ 111 •. Commission#GG 177533 p
�'
-Signature of Notary Public,State of Florida °',,'Y°' x My Comm.Expires Jan 22,2022
:...; . Bonded through National Notary Assn
[ I P rsonally Known _
[A/Produced Identification(Type) , ()L._ Scott Williams, Public Works Director
H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
MAP SHOWING BOUNDARY SURVEY OF
LOT 7. BLOCK 15, SELVA MARINA, UNIT NO. 8, ACCORDING TO THE
PLAT THEREOF AS RECORDED IN PLAT BOOK 34, PAGE 85, OF THE
CURRENT PUBLIC RECORDS OF DUVAL COUNTY. FLORIDA.
CERTIFIED T0: _j
TRACT "C"
S 00'39'26• E 93.37' (CHORD) (PLAT)
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N 0011'28' E PT R.4644.38'-L. 72 73' •---- -
22.90' (MEASURED) N 0074'41' W 72.70' (CHORD) (MEASURED)
N 0008'20" E N 00'18'35" W 72.73' (CHORD) (PLAT)
LEGEND: 22.87' (PLAT)
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o `CE SEA OATS DRIVE
—N— . 'AC FENCE
O= CONCRETE (60'RIGHT OF WAr)
O-SET 1/Y REB.STAMPED PSM/61m
•=FOUND I/O WON PIPE 90 iDENTIFICADCN
(UNLESS OTNERMSE 80110)
•-4'.4"CONCRETE 80NUMENT
A/C AIR CONDITIONER PI
= POINT OF CURVATURE PRC . PONT OF REVERSE CURVATURE
Pl POINT CF T.GEJICY PCC . POINT OF COMPOUND CUR VA AIRE
NOTES:
1. BEARINGS ARE BASED ON THE PLAT _ BEARING OF _5_0:15.50- W ALONG THE REVISIONS
SOUTHERLY BOUNDARY UNE OF SUBJECT PARCEL DATE DESCRIPTION
2. BY GRAPHIC PLOTTING ONLY THE CAPTIONED LANDS LIE WITHIN FLOOD ZONE ___-__2(...7_ AS SHOWN ON THE
NATIONAL FLOOD INSURANCE MAP DATED NOVEMBER 2. 2018. COMMUNITY NUMBER 120075, PANEL 0407(_
3. THIS SURVEY REFLECTS ALL EASEMENTS & RIGHTS OF WAY AS PER RECORDED PLAT A/OR TITLE COMMITMENT OR
OTHER DOCUMENTS PROVIDED BY CLIENT. IF SUPPLIED. UNLESS OTHERWISE STATED. NO OTHER TITLE VERIFICATION
HAS BEEN PERFORMED BY THE UNDERSIGNED.
4. THIS SURVEY IS NOT VALID WITHOUT AN AUTHENTICATED ELECTRONIC SIGNATURE AND AUTHENTICATED ELECTRONIC
SEAL.
JOB # 39670 1 DATE OF FIELD SURVEY: 05-30-20 I SCALE: 1" = 20'
Ray Thompson CERTIFICATE
I HEREBY CERTIFY THAT TH15 �•A�' UNDER uv RESPONSBIE CN.Cf
SURVEYING, Inc. AND MEETS THE STANDARD 4 , T FORTH BY THE FLORIDA BOARD
CF PROFESSIONAL SURVE t;:, AP- 2 AP R 54-17,FLORIDA
_
'I. (Goldie the DISTANCE for You] AOYMSTRA neE /N••. .ANT TOw SelWON WON •�i, OR10A STATUTES.
i ' a 1 1825 University Boulevard West /
Jacksonville,Florida 32217 TAP
(Phone)904-448-5125 - RAYMOND THCMP ,,��II
REGIS TE'.? SURVEYOR:FAN() ' I 6146
(Fax) 904-448-5178 STATE OF 4+-IDA UCENS •r:?I ESS ESS No. 7469
LAND SURVEYS 0 CONSTRUCTION SURVEYS -." ': BDIVISIONS