380 SEMINOLE RD DWAY21-0015 C **.1; Building Permit Application Updated 10/9/18
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City of Atlantic Beach Building Department
ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
rs�~ IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us k..__ lk.)A
Job Address: Up i' 11((e • HI Ik Iii C..€eet,i[k-. Permit Number: ► 9\ZJ" 6020
Legal Description 2-tp b Sit 1-f' Air S tror RE# 1,`101.75- 0170
Valuation of Work(Replacement Cost)$ I i 0 Ob Heated/Cooled SF Non-Heated/Cooled
• Class of Work: DNew ❑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 atNo
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed: N ci6ve. 'y `7
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Florida
Florida Product Approval# for multiple products use product approval form
Property Owner Information ,, II�
Name �i C- 1.- �II 2V +40,1SC11 Address 3 et s,/1U 1()le ed.
City 1` 1G L 6,-Ptit (1 State F-L Zip 3 L-L3 3 Phone 1j -j/7 —0023`)
E-Mail ah it 0,-Irm e, y4a400, .off
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Qualifying Agent
Address City „V"------. State Zip
Office Phone Job Site Contact Nurrrtier
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 rk and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that I work will be performed to meet the standards of all the laws regulating
construction in this jurisdiction. I understand that a eparate 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 YO R TICE OF COMMENCEMENT. ,"
1t -
(Signature of Owner or Agent) , l (Signature of Contractor)
• ned
an sworn
�t-,00((or affifmed)before me this IDday of Signed and sworn to(or affirmed)before me this day of
�\ ZOZ1_,by •J/ I'1 l/ls01\ b
at of • (Signature of Notary)
1,,';'4,PG ,, TONT GINDLE'�ERGER
[ ]Personally Known OR =_°' ,�, *: MY COMMISSION#GG 3b317�] rsonally Known OR
[ ]Produced Identification . _:W:',...a EXPIRES:October6,2023 [ ] .�educed Identification
Type of Identification: , rd',"••�P ;.,.:,.ThrUNotary Public Underwe.-rte of Identification:
0-w,, Owner Builder Affidavit **ALL INFORMATION
•. HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
VaPv 800 Seminole Rd, Atlantic Beach, FL 32233
Tf�'
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#DU:?I\1/417 t '"0015
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: 3O 5 1uY L)LQ, v o11(0-4 G Gua,k FL ?3 7 Z3 3
Owner Name: 6A C- 1 V '( V) _Phone Number: 1-10S--4/12- -(.02.x'7
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Mailing Address: 3Sett'.I S LIZ V-6.
, City:"N C C—A,\ State: FL Zip: 3 Z2 3J
Notarized Signature of Owner \ ^ � 7
The fc re�g 'ng ins rum nt was acknowledged before me this/CJ da 1I Q.r'c2J 202 (in the State of Florida, County
of �J(� tia.,
Signature of Notary Pub <) add,
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: r
Updated 10/24/18
k;
TO
TONE GINDLESP€
MY COMMISSION#GE 353178
EXPIRES:October 6,2023
°`°' Bonded
ria Thru Notary Public UnderwrMerc
t
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RIGHT-OF-WAY/EASEMENT PERMIT APPLICATION **ALL INFORMATION
:4(
1 City of Atlantic Beach HIGHLIGHTED IN GRAY IS
800 Seminole Road, Atlantic Beach,FL 32233 REQUIRED.
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES l -
Sem
n� a l 2 i -C.c,i
Job Address 3 Se,n no le 0-ek• k- IIa1rf Beath tL 32Z33 Permit Number 12- 1-0 -002°
Contractor Information
Company 'P'1 V /2e/Y -11'lSO")/ Qualifying Agent
?
Address o suns► lO(e mit• City 4fr1ttft'c &,664i State - Zip 322-3'3
Phone id CS - 14)Z-(97-3E2 Email /x111n5611 rl GI @ vii.cx)((L)V7
State Certification/Registration#
Architect V IGJi2O✓ Phone Email
Engineer 55ZA -0,0 Phone Email
Workers Compensation Insurers OR ExemptfExpiration Date
• Permittee declares that prior to filing this application they have ascertained the location of all existing utilities, both aerial
and underground and the accurate locations are shown on the sketches.
• Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation, alteration or
relocation of all, or any portion of said street or easement as determined by the Public Works Director,any or all said poles,
wires, pipes,cables or other facilities and appurtenances authorized hereunder, shall be immediately removed from said
street or easement or reset or relocated hereon as required by the Public Works Director and at the expense of the
Permittee unless reimbursement is authorized.
• All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the
supervision of O(..4/ ni litSCS\// (Project Superintendent)
with (Company Name) 19711,my 7)'•1,c')(.)--,'t Phone go-- 1-112_ , !1,'237
• All materials and equipment shall be subject to inspection by the Public Works Director.
• All city property shall be restored to its original condition as far as practical,in keeping with City specifications and the
manner satisfactory to the City.
• A sketch of plans covering details of this installation, as well as a copy of a recent survey shall be made a part of this permit.
Calculations showing any increase in impervious area on owner's lot or in the City right-of-way are to be included with
this application.
• The permittee shall commence actual construction in good faith within days. If the beginning date is more than 60
days from date of permit approval then permittee must review the permit with the Public Works Director to make sure no
changes have occurred in the area that would affect the permitted construction.
• It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right,
title and interest in the land to be entered upon and used by the holder,and the holder will, at all times,assume all risk of
and indemnify,defend and save harmless the City of Atlantic Beach from and against any and all loss,damage and cost of
expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges.
• Theublic Worksnirector shall be notified 24 hours prior to starting work and again immediately upon completion.
9- A 4-1/1/I-1 Date j.,�' % '
Permittee(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL f
The foregoing instrument was acknowledged this / 0 day of \ Q k. ,20 ( (
by 63111207
)i<_�L m ,who personally appeared before me and
(pr' ted name of Permittee)
ackno I ged that he/ he s• n d the instrument voluntarily for the purpose expressed in ;i'r°`av;'u TONT GINDLESPERGER
41 ;,. MY COMMISSION#GG 353178
;T�•.•:;` EXPIRES:October 5,2023
C\� .IC. F; F F°P Bonded Thru Notary Public Underxriters
[ ] Personally Known 0
Signature of Notary Public,State of Flori ) [ )Produced Identification (Type)
��. REVOCABLE ENCROACHMENT AGREEMENT
r. **ALL INFORMATION
j " : City of Atlantic Beach
Y '` 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED E GRAY
7 IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a mu icipal corporation organized and
existing under thellaws.of the State of Florida, hereinafter referred to as"CITY" and
0-010(2)7 )1 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 cf-VaUe.AOCA-'Li .
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 3S0 (.' yl10.t L V-L( t 60±fc ).Ll_C.61 1 mac. ":-;-7. 733
• 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
Iia 'Ries are hereby assumed by the USER.
� Il,eL Date - 1-t� l
Property ner/Agent (signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this day of 14_r"(`: _ , 20_Z__,‘
by 141,vi 0 i‘r-- k11\S0V1 , who personally appeared before me and
rinted name of Signer)
ack w edge t she sig d the instrument voluntarily for the purpose expressed in it.
C Department Approval:
Signature of Notary Public, State of Fl. —
' TONI GINDLESPERGER
[ ] Personally Known '..',A'NP ••`•'':. MY COMMISSION#GG 333178
[ ] Produced Identification (Type) i `;•�, o EXPIRES:October 6,2023 Scott Williams, Public Works Director
'%.For FS" Bonded Thru Notary Public Underwriters
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MAP OF BOUNDARY SURVEY/TOPOGRAPHIC SURVEY
DESCRIPTION:
LOT 260, SALTAIR SECTION 2, ACCORDING TO THE PLAT THEREOF AS N rj
RECORDED IN PLAT BOOK 10, PAGE(S) 15 OF THE CURRENT PUBLIC C
RECORDS OF DUVAL COUNTY, FLORIDA.
CC
F,ISP.M 2' ry
T %-
EL.8.30' �,����\� N 7�
4711/ ''''''"442 0
` §) '�_`-. ,� LOT 259 0�:
LOT 248 `. EL-B.;• .'",.....e
a' C- �-
t4„ EL-8.17' ^. •OJ, \
4,N EL-B..:' -�/b /,\ 0
\L} SCALE: 1 " = 30 '
EL..8.03'X t7 y 1L/ ay.,
. ti 1 STORY BLOCK.
L I 'N. F.I.P. 1/2' `.
•' /380
x•8.19' LOT 250 Na 10 Nr (r[
I f11/ 10 a-8.0 0 . 7.19' , ,Y
F.1.P. 1/2' o•7.71' ` i'." COVE)ED A, N.:1!... '7Y// \
NO TO
ii a- 7.A5 :':.: ..
- . : . _Fl- 7.76' ..' Q\..' .'..
/ • ."11 : a.7•..• ;.1p ..
LOT 261 X f b .;::. . ; X T6M '
y •111pf"4
O
LP. 1/2• `a-7 .• .'
TOPOGRAPHIC NOTES / M7 10 .. .• ....
THE SCOPE OF SEFYICES FOP THIS TOPOGRAPHIC 91MY IS LIMITED TO THE 1
SPJ
ECIFIC ITEMS RUBESTED BY THE CLIENT ONLY BEING ELEVATION SHOT5 ON 1 V\... ....
A 25 FOOT G91O IN SMELT PROPERTY, TO CFIITEFIINE OF SEMINOLE ROTO. 1 �1 .
•(GENGTES LOCATION SPOT ELEVATIONS i) EL•8.06'
a-7.89' DENOTES SPOT ELEVATION
P
-SURD:11016f11A1 GPS OOT SET NCD IN RIGHT OF NAY tO
IN FRONT rr rAFTTnu PPrwP Y Tuvrna F, YATInu m•
//SJ 0
/ \
SURVEY NOTES:
fl PLAT PROVIDES NO ANGLES OR BEARINGS THEREFORE THE
BEARING OF THE SOUTHWEST LINE OF LOT 260 WAS SCALED
FROM THE RECORD MAP AS BEING AS BEING N61 '00'00"W.
#2 UNDERGROUND UTILITIES, FOUNDATIONS OR OTHER CERTIFIED TO AND FOR THE
IMPROVEMENTS AND/OR OVERHEAD ELECTRIC LINES EXCLUSIVE BENEFIT OF:
IF ANY, WERE NOT LOCATED BY THIS SURVEY.
03 ACCORDING TO THE FEDERAL EMERGENCY MANAGEMENT AGENCY KIMBER HINSON
FIRM MAP PANEL NO. 12031C 0409 J, EFFECTIVE 11/02/2018, STREET ADDRESS:
THE PROPERTY DESCRIBED HEREON APPEARS TO LIE IN ZONE "X".
04 THIS SURVEY PERFORMED WITHOUT BENEFIT OF AN ABSTRACT, 380 SEMINOLE ROAD
TITLE SEARCH, TITLE OPINION OR TITLE INSURANCE. JACKSONVILLE,FLORIDA
15 DIMENSIONS ARE SHOWN IN FEET ANO DECIMALS THEREOF
AND ARE PLAT AND MEASURED UNLESS SHOWN OTHERWISE.
#6 ALL EASEMENTS ARE PER PLAT UNLESS SHOWN OTHERWISE.
#7 THERE MAY BE ADDITIONAL RESTRICTIONS THAT APPLY WHICH ARE
NOT SHOWN ON THIS SURVEY WHICH CAN BE FOUND IN PUBLIC
RECORDS OF SAID COUNTY.
08 THIS SURVEY DOES NOT GUARANTEE OWNERSHIP.
a #9 TEMPORARY, NON-PERMANENT IMPROVEMENTS AND/OR MAN-MADE ITEMS
a SUCH AS, BUT NOT LIMITED TO THE FOLLOWING: BUILDING MATERIAL,
STORAGE PODS, PAVER BLOCKS, RUBBERMAID OR PLASTIC UTILITY
0 BUILDINGS NOT ON FOUNDATIONS, VEHICLES ON BLOCKS MAY BE ON
m THIS PROPERTY BUT NOT LOCATED OR SHOWN.
i 010 LEGAL DESCRIPTION PROVIDED BY CLIENT.
m
m 011 - (IF SITE PLAN) PROPOSED ELEVATIONS AND LOCATION OF PROPOSED HOME
-, MAY HAVE BEEN SET BY SURVEYOR, THESE ARE SUBJECT TO CHANGE BY ARCHITECT,
M ENGINEER, AND/OR CLIENT. FCLS ASSUMES NO RESPONSIBILITY/LIABILITYcti
o FOR PROPOSED ELEVATIONS OR PROPOSED LOCATION OF HOME OR ANY
D PROPOSED IMPERVIOUS LOCATION
m V
Pri
m NOTICEEOF LIABILITY:F. THIS SURVEYSIS EFITIOIER TO THOSE INDIVIDUALSATESHOWNTON il �j
� THE FACE THEREOF. ANY OTHER USE, BENEFIT OR RELIANCE BY ANY OTHER PARTY IS
wSTRICTLY PROHIBITED AND RESTRICTED. SURVEYOR IS RESPONSIBLE ONLY TO THOSE
a CERTIFIED AND HEREBY DISCLAIMS ANY OTHER LIABILITY AND HEREBY RESTRICTS THE
RIGHTS OF ANY OTHER INDIVIDUAL OA FIRM TO USE THIS SURVEY, WITHOUT EXPRESS C /E O. V; KLEECK
o
WRITTEN CONSENT OF THE SURVEYOR. FLORIDA REGISTER'S SURVEYO• AND MAPPER NO. 2546
, NOT VALID WITHOUT T' SIGNATURE & THE ORIGINAL RAISED
m SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER.
o `
F
,, F.C.N. - FOUND CONCRETE MONUMENT C.N. - CONCRETE MONUMENT SEC - SECTION F/H - FIRE HYDRANT OHE -OVERHEAD ELECTRIC
C- F.I.R.C. - FOUND IRON ROD ANO CAP P.T. - POINT OF TANGENCY TNP - TOWNSHIP WV - NATER VALVE C.L.F.-CHAIN LINK FENCE \I
ENO - FOUND N.F. -WOOD FENCE
F.I.R. - FOUND IRON ROD P.C. - POINT OF CURVATURE RGE R�W�EC.B. -WOODD BEARING
i F.I.P. - FOUND IRON PIPE U.E. - UTITLITY EASEMENT P.I.- POINT OF INTERSECTION -MATER METER
I S.I.R.C. - SET IRON ROD AND CAP O.E. - DRAINAGE EASEMENT A/C - AIR CONDITION UNIT E) - ELECTRIC BOX WP -WOOD POLE
F.NOD - FOUND NAIL ANO DISK C 6 G - CURB 6 GUTTER NTS - NOT TO SCALE CONC. - CONCRETE
j, (M) - FIELD MEASUREMENT RIM - RIGHT OF WAY 1' C.L.F. - J( CB - CABLE BOX LP -LIGHT POLE
In (C) - CALCULATED MEASUREMENT C/L - CENTERLINE 6' M.F. -/—/—i—/- pB - PHONE BOX M/H -MANHOLE
MELD SURVEY DATE i FIRST COAST LAND \ ( PROJECT INFORMATION LL \
PLOT PLAN ORDER NO: 31850
BOUNDARY: 12/15/2020 SURVEYORS INC. DRAWN BY: KMP
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Li FORMBOARD 3161-4 ST JOHNS BLUFF ROAD S, JACKSONVILLE, FL.32246 REVIEWED BY: HF
J
i FOUNDATION J \ PHONEWW9 WWW.FIRSTCOASTLANDSURVEYING.COM EANO. LB 6225
(904) 779-2062 FAX (904) 779-7784 CHECKED BY: VAN
�INAL