379 4th ST DWAY21-0016 Building Permit Application Updated 10/9/18
.:.,.,. City of Atlantic Beach Building Department **ALL INFORMATION
.:____,' 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
"`ring), IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us��
Job Address: 9 [ -, r / / (.4A/%/G Sfrf[�Jfh.-V " ermit Number: 0II
— _
Legal Description /\'�`�1 ®�(� /O;/ L�/4j/stn%✓J/oit% RE# 1�� c', 4 (, -oo i C
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Valuation of Work(Replacement Cost)$;" , Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition MAlteration ❑Repair ❑Movepemo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial l [Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• 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: pf4112✓E t7C�17(//6- Cdn)CITE �j,v t!F
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Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name �(,((>C 1/� � Address Y'e /
City /t/r/LState aZip - . Phone Jv�, ,C'f3 G'S ?
E-Mail
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alk j2t f kG1/, (Vf1
Owner or Agent(If Agent, Power of Attorl'fey or Agency Letter Required)
Contractor Information
Name of Co pany ai,40' , f/ Qualifying Agent
Address WV ,-A- Tr ' Pr. City /4LOO/JI/j1k 81-0--- State / t o Zip r ,>>.,o
Office Phone log. 0-/, OZ' ? Job Site Con ct Number p
State Certification/Registration# 123 4 -3 E-Mail f5 g_rbe C- e_i5 . itG46
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer sfirf. OF •FL"LIDIt OR Exempt 0 Expiration Date 5"`S '21
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. I
WARNING TO OWNER: YOUR FAILURE TO RECORD /I NOTICE OF Cg MME CEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEM iS TO YOU' /' OPE' . IF YOU INTEND
TO OBTAIN INANCING, CONSULT WITH YOUR L R • ' : / ORN : :EFORE
RECO itye * R NOTICE OF COMMENCEMEN r
(•,:nature of Owner or Agent)
.„---
, (Signature of Con or)
Signed and sworn to(or affirm-•)before me this J day of Sig ed an sworn to(or affirm-• .efore me this Is day of
A ZO ,b 1/e ,7bZ/ , b '� M
Y,L=- S
J , ROSS LOEH 3 (Signature of Notary) ignature of Not ry)
( ' `�;State of Florida-Norar Pub' y)
-. = Commission a GG 226087 •
-„,7,.,#'a� My Commission Expires Y c
%` p r�1IR7Nr iai�OR [Personally Known OR r,-i” TONI GINDLESPERGER I
���[ ]Pro enti ica io [ ]Produced Identification *! 1•• MY COMMISSION#GG 353178
Type of Identification: Type of Identification: I ,:`,,'+ EXPIRES:October 6,2023
4o• ,•n.ed Thru Notary Public Underwriters
1rREVOCABLE ENCROACHMENT AGREEMENT
,6 **ALL INFORMATION
City of Atlantic Beach 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 law of the State of Florida, hereinafter referred to as "CITY" and
OACLi ,4/t 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 le eri9ciCt Fx%'T1A16- ,OR11,6-144- witN Maeryletf / i,
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' noti a by CITY to USER,said notice to USER shall be given by certified mail,return
receipt requested,to the following address41ttil- .$7 ATC./ZltlMMM gEAct 6 .3 ?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
save. - .rmless by the USER from any of the work herein under the terms of this permit and that all of said
1.ili i:. are hereby assumed by the USER. t
n � K
/ �� ' Date 4,41!�a!, y7.0",?�
Property Own r,Agent (signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL ..- y��
The foregoing instrument was acknowledged this /S day of /V1 1)Or , 20 2/ ,
by gYU(e 4,efro 4'Yl ,who personally appeared before me and
(printed name of Signer)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
rzee.(4,...., l :ti .. ROSSL' HRDepartment Approval:
Notary Public,State of Florida ` :Sts,te • Fiortd. +pry r'�bt�kL •= Cu .ssion w 22087
Known =:•'1► ��S
,,,?a,,„ ,, rr. •�,mi(esi:�^n Expire!
X11111'' ;,..e 0/� 7022
[ ] 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
RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION
pl4r
k City of Atlantic Beach HIGHLIGHTED IN GRAY IS
800 Seminole Road, Atlantic Beach, FL 32233 REQUIRED.
jv
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
� l
T r' 1n (�
Job Address Permit Number��1t1 ( a 1 - 00( l0
Contractor Information I�
Company REQ P/ °� Qualifying Agent
Address 17 /$4'064- City rti(fc;,S JfI//I/ KE-,414tState ri Zip 3,20?)0
a
Phone %vy 7 �. 0.c$/ Email lifiLEScileee /Q 5 , cam
State Certification/Registration#
Architect Phone Email
Engineer Phone Email
Workers Compensation Insurer btitre Or- FOR/D-4 OR Exempt n Expiration Date 9-1>-21
• 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 Atlan ' Beach Fl • Department of Transportation Standards and be performed under the
supervision of (Pro act Superint n ant)
with(Company Name) P, fr Phone ! I"
• 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 in Aemnify,defend and save harmless the City of Atlantic Beach from and against any and all loss,damage and cost of
•�` arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges.
NrAThh P.lic W. • Director shall be notified 24 hours prior to starting work and again immediately upon completion.
YYY Date 1/ -2.1
P ttee(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this (S day of 0-48-
,20 Z( ,
by BN(ipQ /IRC1/0l'l/1 ,who personally appeared before me and
(printed name of Permittee) –
,,'pr"w',,,,, ROSS LOEHR
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. +° 1 ter•-State of Florida-Notary Public,
`• � Commission # GG 226087
re: My Commission Expires
June 07, 2022
Personally Known
ignature of Notary 'ublic,State of Florida [ ]Produced Identification(Type) _—
H:\Applications&forms\Word&Excel Document Originals\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
• MAP SHOWING BOUNDARY SURVEY OF
A PART OF LOT 30, BLOCK 6, PLAT NO. 1, SUBDIVISION A, ATLANTIC BEACH, AS RECORDED IN PLAT BOOK 5, PAGE 69,
OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, MORE PARTICULARLY DESCRIBED AS FOLLOWS: FOR A POINT
OF BEGINNING COMMENCE AT THE SOUTHEAST CORNER OF SAID LOT 30; THENCE WESTERLY ALONG THE SOUTH LINE OF
SAID LOT, A DISTANCE OF 25.1 FEET; THENCE NORTHERLY PARALLEL WITH THE EAST LINE OF SAID LOT AND ALONG THE
WEST FACE OF AN EXISTING BUILDING AND ITS SOUTHERLY PROJECTION, A DISTANCE OF 55.9 FEET; THENCE EASTERLY
0.1 FEET TO THE CENTER OF A COMMON WALL DIVIDING TWO DWELLING UNITS WITHIN SAID BUILDING; THENCE NORTHERLY
ALONG THE CENTER OF SAID COMMON WALL, A DISTANCE OF 33.2 FEET; THENCE EASTERLY 0.1 FEET; THENCE NORTHERLY
ALONG AN EAST FACE OF SAID BUILDING AND ITS NORTHERLY PROJECTION THE SAME BEING PARALLEL WITH THE EAST LINE
OF SAID LOT 30, A DISTANCE OF 60.9 FEET MORE OR LESS TO THE NORTH LINE OF SAID LOT; THENCE EASTERLY ALONG
SAID NORTH LINE, A DISTANCE OF 24.9 FEET TO THE NORTHEAST CORNER OF SAID LOT; THENCE SOUTHERLY ALONG THE
EAST LINE OF SAID LOT, A DISTANCE OF 150 FEET TO THE POINT OF BEGINNING.
CERTIFIED T'0: BONITA CARTER PATTESON, ATTORNEYS' TITLE INSURANCE FUND,
B B & T AND MILLER & WILLIAMS, PLC.
LOT 29 I LOT 27
BLOCK 6 EASTERLY BLOCK 6 _ _
1/2- 24.9' (R) -J - � �
DURDEN 23.82' (M) /
LB 1048 I.P. TO 1.P. ( 1/2" /
1.0' OFFSET 0.5'- 1.3' • / z I \
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3 LOT 30
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oN UNIT *! ' 17.0' 0.10' (R)
17.3'
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POOAT OF "---
_____:
175.00' (R) ti U100.00'0-0' (R) 1/7"
1/2" }74.76' (M) 1�2. 1/2" 100.29' (M) LB 1704
(UNDER ROOT) 25.08' (Al) k
EDGE OF
25.10' (R) PAVEMENT
WES1BRLY
FOURTH STREET
(40" R/W)
FL 000 ZONE"A" - AREAS DETERMINED TO 8E OUTSIDE THE 0.2%ANNUAL CHANCE F1000 PLAIN /FLOOD ZONE "X(SHADED).. • AREAS CF 0.2*ANNUAL CHANCE FLOOD; AREAS Of t%ANNUAL
CHANCE VAIN AVERAGE DEPTHS OF LESS THAN 1 FOOT OR MTH DRAINAGE AREAS LESS THAN 1 SQUARE MILE: AND AREAS PROTECTED 13Y LEVEES FROM 1%ANNUAL CHANCE FL000.
v E Y o GEI4E AL NOTES:i R 1. ANGLES AS SHOWN ON THIS SURVEY.
c, 2.STRUCTURE NO. 379 SHOWN HEREON UES WITHIN FLOOD ZONE X AS
BEST A SSOCIATED SURVEYORS INC. 3.THIS IS DETERMINED SURFACE SURVEY OM AONLY.THEEXTENT1OF UNDERGROUNDRFOOTINGS,
A I LAND & ENGINEERING SURVEYS PIPES AND UTILITIES, IF ANY, NOT DETERMINED.
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