381 4TH St DWAY21-0017 Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
'`r 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
rase a'' IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 3 81 i tL c-f A-4414k �ecick RLQ gi.2 3 J Permit Number: t ) .1.)QL( Z(—CA-11 7
4, Legal Description '} 3b ) 11::(1( 1p M+C klCii RE#
Valuation of Work(Replacement Cost)$ c 000 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑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 ❑No
• Will tree(s) be removed in association with proposed project? EYes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed: Orl ve t'✓cq re plc ce ieh yl + W ft" p g1/c1(5
Florida Product Approval# for multiple products use product approval form
Property Owner Information ,/
Name g.oSS toe.. ✓,," Address 35/ 11I'h .S4- _
City 4fl,y�►�f,r- 1'ie4GI'1 State (=L Zip 313 Phone is (n c
V '/ },&?o
E-Mail -:,5.5_ t✓4 S-q1 d .1c4
Owner or Agent(If Agent, Pow r of Attorney or Agency Letter Required)
Contractor Information
Name of Compan Q&- Q4v&y S =hL Qualifying Agent
Address &Qq .)jc0,q (,c;- ii- City 74X Rita(L State �'L _Zip 3 ,,,13-43Office Phone 90/ t/7/ Q'S7 Job Site Contact Number c1�-/ �27 OS'7
4,p j
State Certification/Registration#, 3175 E-Mail"'rye ycs j; j 1 one S q[� WIC.,;I , telt/'7
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer T-f- -{,Q 0.( p OR Exempt o Expiration Date S'/f
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work ori stallation 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 R •RD A \ OTICE •F a MMENCEMENT MAY
'
RESULT IN YOUR PAYING TWICE FOR IMPRO 1 E • Y � R PROPE' Y. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOU ' ' ' A P :RN • BEFORE
RE,')RDIN . Y•UR 0-11cE OF COMM NCEME
k ialb !Ii If , /' `._ _�
(Signature of 0 --r or Agent) EP
(Signa . 1 ractor)
C
ed and worn to or aff(r )before e this ((day of ands orn or affir . .- ore m is 4 .ay of
ZO_Iby ha_r �lOne.s � t , b ���M A
im
( � ,_I 11 �
�� urr.T�, is ure. ,
.4.}F:;*;,-,, TONI GINDLES' GER
g..!4 MY COMMISSION#GG 353178
[ ]Personally Known OR ......:(.;.,, TONI siNni ^PEPGER [ Personally Known OR - '*` EXPIRES:October 6,2023
[ I Produced Identification : ply t;OM) : : -' G- '78 [ Produced Identification -,Fo ••o?:
1 + _. Tl .e of Identification: :ended Thru Notary Public Undeiwrlters
Type of Identification: ;4 ,,� EXPIRED.•.GIOb2(J,_�L:; —
it ;,I-;' Bonded Thru Notary Public Underwriters
- t 1 b. REVOCABLE ENCROACHMENT AGREEMENT
,,
m.
" =
' \ City of Atlantic Beach **ALL INFORMATION
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
itOS5 GBedit/ 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 j%Vf QylVtW4 y •
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 '35/ 1/1-11 5-1+ c,.,,1-.`c_ RQ q(,(,7 a 3,.7.07T-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
liabilities_ieare hereby assumed by the USER.
RbSS Lek,/ Date 31 14021
Property Owner/Agent (signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL _ /
The foregoing instrument was ack owledged this day of " f , 20 ,
by e('5,5 JG who personally appeared before me and
' (printed name of Signer)
ack .wledged th.h- •• e signed the instrument voluntarily for the purpose expressed in it.
y� 0 , Department Approval:
.?G TONI GINDLESPERGER p pp
Signature of Notary Public, State of '�da S.,.5-...'".'`r�-' MY COMMISSION#GG 353178
[ ] Personally Known i`;;. EXPIRES:October 6,2023
rPa.
•:>,or•c W. Bonded ThN Notary Public Underwriters
[ ] 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
'5410414 RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION
r City of Atlantic Beach HIGHLIGHTED IN GRAY IS
,7' 800 Seminole Road,Atlantic Beach, FL 32233 REQUIRED.
)if
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address ;II 1-1+1/1 5...1. Pi414144-L cu t, ICL 3)d- Permit Number
Contractor Information
Company Reek 04-ie,-5 .(,(„ Qualifying Agent
Address (.%;.b Li i2gy.q t4-01.-- City ix' �24C to State i'L. Zip W,i7
Phone 104/ q7/ 0-,51 Email ✓eyc 5 i.'j owe S .9 wtc,`I. ( 44i
State Certification/Registration# r
Architect Phone Email
Engineer Phone Email
Workers Compensation Insurer OR Exempt ❑ Expiration 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 Alla • Beach or Florid ftment of Transportation Standards and be performed under the
supervision of ‘,...e...4_ l 64 (er ect pe:07 dent)
with(Company Name) ctir-MS Phone ( y
• All materials and equipment shall be subject to insp on 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.
• The Public Works Director�j all be no'fled 24 hours prior to starting work and again immediately upon ompletion.
!' /s -!
—.L.4/...,/ `� %' // Date
Pe ittee(signed in presence o .may Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this /5 f L day of /f�
'l kvCI„ ,20
by 5) !, /V 1 ,who personally appeared before me and
(printed name of Permittee)
aclsnowl •g:d that he/ e sign:d the instr ment voluntarily for the'.,u "c, press ikgiNDLESPERGER
:, ';,_ MY COMMISSION#GG 333178
" 3 EXPIRES:October 6,2023
',Z•
o °p' Bended fire Notary Public Underwriters
Signature of Notary Pub at-of Florid, [ ]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 SURVEY OF
LOT 30, BLOCK 6, ATLANTIC BEACH, AS RECORDED IN PLAT BOCK 5, PAGE 69 OF THE CURRENT
PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
LESS AND EXCEPT:
A PART OF LOT 30, BLOCK 6, ATLANTIC BEACH, AS RECORDED IN PLAT BOOK 5, PAGE 69 OF
THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA MORE PARTICULARLY DESCRIBED AS
FOLLWS: . '
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 25.10 FEET; THENCE
NORTHERLY, PARALLEL WITH THE EAST LNE OF SAID LOT AND ALONG THE WEST FACE OF AN
EXISTING BUILDING AND ITS SOUTHERLY PROJECTION, A DISTANCE OF 55.90 FEET; THENCE
EASTERLY 0.10 FEET TO THE CENTER OF A COMMON WALL DIVIDING TWO DWELLING UNITS WITHIN
SAID BULDING;THENCE NORTHERLY ALONG THE CENTER OF SAID COMMON WALL, A DISTANCE OF
33.20 FEET; THENCE EASTERLY 0.10 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 60.90 FEET, MORE OR LESS, TO THE NORTH LINE OF SAID LOT;
THENCE EASTERLY ALONG SAID NORTH LINE, A DISTANCE OF 24.90 FEET TO THE NORTHEAST
CORNER OF SAID LOT; THENCE SOUTHERLY, ALONG THE EAST LINE OF SAID LOT, A DISTANCE OF
150.00 FEET TO THE POINT OF BEGINNING.
• 1 co
LOT 31 1 LOT 29 LOT 27
II I
( 25.20' FIELD ) FOUND 1/2"
PIPUE.NO CAP IRON ,82'
25.10' . IRONCAP ILLEGIBLE
0,y _24.90
FOUND 1/2' .n i $.5j0'U 0.1' I
IRON PIPE. I
CAP Iu.EDBI£ 8' WOCO FENCES
( 1.0.SE'I).) O G
FRAME
SHED
0
Ic
0 I
R 1 0 204'
SCALE: 1" = 20' 7.6' p
0 ' j 1,!{o 17.30.2''
NOTES o
1. THIS IS A BOUNDARY SURVEY. i E a
2. NO BUILDING RESTRICTION LINES PER PLAT. I A/C BUILDING I
3. INTERIOR ANGLES PER FIELD SURVEY AS FOLLOWS: PAD WALL TO UNE I
I W
A = 89.55'18" W000Q \
B = 89'58'30" j STOOPIz -i
C = 89'52'16"
0 0 0.10'
0 - 9013'54"
4. NORTH PROTRACTED FROM PLAT. o g� z �U LZ,.I o - '� g
- d rU NCVq —' " I o
c,;,'1 Z I l
Ulf w
; —0 MgW ° 1 �1
°� N� J : I
LOT 32 l LOT 28
I lo 1
zl17.0' v V) v. I' I
I 7.7' W000 DECK WITH I ""OJ C' =
Y 2,d FLOOR Q V I
ji 'BALCONY \-0.10' 1.
4, o ti
\ u I GHQ oo R ¢
1
• t 1 STUCCO C _. __V._;
yy t WALLS AND '�
\ COLUMNS 0 L.
0.8' 4'
''r L� I '\41 w �
M 14 IC75
4Q \ r �' POINT OF BEGINNING
9L� 1 I Co '^ EXCEPTION
G \ - -- i
0 T I ( 25.03'FIELD) II
169.39' 1ls +'� Ce __25.10' 0
ND I/2'IRON 24.91J'1 FOUND 1/2' _- FOUND 1/2'IRON ---
PPE, NO CAP r IRON PIPE. PIPE. NO CAP
( '4.93,_Et it CAP ILLEGIBLE
FOURTH'"• /
STREET
40' RIGHT OF WAY PAVED
THE PROPERTY SHOWN HEREON APPEARS TO LIE IN
FLOOD ZONE "X" (AREA OUTSIDE THE 500 YEAR THIS SURVEY WAS MADE FOR THE BENEFIT OF PATRICIA H.
FLOOD PLAIN) AS WELL AS CAN BE DETERMINED
FROM THE FLOOD INSURANCE RATE MAP COMMUNITY BARTLESON; BANK OF AMERICA; BEACHES TITLE SERVICES,
PANEL No. 120075 0001 D, REVISED APRIL 17, 1989 LLC; and COMMONWEALTH LAND TITLE INSURANCE COMPANY
FOR THE CITY OF ATLANTIC BEACH, DUVAL COUNTY, A
FLORIDA. 1\
Revision Request/Correction to Comments **ALL INFORMATION
HIGHLIGHTED IN
I City of Atlantic Beach Building Department GRAY IS REQUIRED.
Off 800 Seminole Rd, Atlantic Beach, FL 32233
ti 91-
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
Revision to Issued Permit OR ❑ Corrections to Comments Date:
Project Address: 5-el -1 ‘1
Contractor/Contact Name: 3le_q___ o
Contact Phone: e?'a(-1- ecd3 I (Lr Email: C 15 ., eo 447
Description of Proposed Revision/Corrections:
qt:41,(Ail A S Tc, g( l F/1 ( A ziGti ECS
I 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?
❑No (es (additional s.f.to be added: (O 16 0,// ,reeel ) oZSa sloe-ea
• Will propose revision/corrections add additional increase ' building value to original submittal?
❑No Yes (additional increase in building value: $ / 0,9 ) (Contractor must sign if increase in valuation)
*Signature of Contractor/Agent: _a
ii
(Office Use Only)
❑ Approved ❑ Denied ❑ Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments
Department Review Required:
Building
Planning&Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services Updated 10/17/18
MAP SHOWING SURVEY OF
LOT 30, BLOCK 6, ATLANTIC BEACH, AS RECORDED IN PLAT BOCK 5, PAGE 69 OF THE CURRENT
PUBLIC RECORDS OF DUVAL COUNTY. FLORIDA.
LESS AND EXCEPT:
A PART OF LOT 30, BLOCK 6, ATLANTIC BEACH, AS RECORDED IN PLAT BOOK 5, PAGE 69 OF
THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA MORE PARTICULARLY DESCRIBED AS
FOLLWS: ' '
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 25.10 FEET; THENCE
NORTHERLY, PARALLEL WITH THE EAST LNE OF SAID LOT AND ALONG THE WEST FACE OF AN
EXISTING BUILDING AND ITS SOUTHERLY PROJECTION, A DISTANCE OF 55.90 FEET; THENCE
EASTERLY 0.10 FEET TO THE CENTER OF A COMMON WALL DIVIDING TWO DWELLING UNITS WITHIN
SAID BULDING;THENCE NORTHERLY ALONG THE CENTER OF SAID COMMON WALL, A DISTANCE OF
33.20 FEET; THENCE EASTERLY 0.10 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 60.90 FEET, MORE OR LESS, TO THE NORTH LINE OF SAID LOT;
THENCE EASTERLY ALONG SAID NORTH LINE, A DISTANCE OF 24.90 FEET TO THE NORTHEAST
CORNER OF SAID LOT; THENCE SOUTHERLY, ALONG THE EAST LINE OF SAID LOT, A DISTANCE OF
150.00 FEET TO THE POINT OF BEGINNING.
b
LOT 31 LOT 29 LOT 27
I 1
• ( 25.20' FIELD ) FOUND 1/2"
FOUND 1/2'IRON•
°2.25.10 0,6. IRON PIPE.
PIPE, NO CAP , /4°'.- CAP_•=t1EdBLE
6 24.90
FOUND 1/2' - ,.sl.o'0 0.1'
IRON PIPE,
CAP ILLEGIBLE 6' WOCO FENCES
( 1.0'SE'Iy) 0 Cl
SRAME
SNED
e J Q
o
0)
BRICK
4 10 20 40 PAT10
1
SCALE: 1" = 20' 0 7.6'
0 17.3'
0.8' I 1.9 + 0.2' I
NOTES I
1. THIS IS A BOUNDARY SURVEY. I 0 o
2. NO BUILDING RESTRICTION LINES PER PLAT. 1 A/G BUILDING
3. INTERIOR ANGLES PER FIELD SURVEY AS FOLLOWS: I PAD WALL TO LINE
A = 89'55'18' WOM
8 = 89'58'30" 1 sTODP z — I
C = 89'52'18" I I g
D - 90'13'54" o_ c7 o 0.10' i
4. NORTH PROTRACTED FROM PLAT. g Y 0 Z o^ a
OI }U b T- t I $I
- f W N 1 o I In
v A 5Q 1� zW ° I -1
IS (�)to M ce _ ,� I 1
LOT 32 - N -' I LOT 28
I z -co ;')1
U U _,
�! 17.0' aN vi '
�I 7'7' W000 DECK WITH OJ fi '=
x 2nd FLOOR U I
ji •RAI CONY \.,-0.1 Cr A.o A,
n t 1' 47
- \ 1 I STUCCO ;-.. .__V
1;1‘ 1 WALLS AND ,.,
` COLUUNS
';Tl 0.8')T —.).0 • • ■NM k/ 1
X13 I co
s,, ` I v of I
\ i tS+ N■
O &
Q I 6 POINT OF BEGINNING
9 �1 I ,' EXCEPTION
G \
c
o T i u ( 26.03'FIELD)
00 -
169.39' 1 % C 25_10' ________
DUND 1/2'IRON 24.93' FOUND 1/2' FOUND 1/2"IRON
PIPE, NO CAP ( 24.93' F ELD ) ICAP ILLEGIBLE PIPE.NO CAP
FOURTH STREET
40' RIGHT OF WAY PAVED
THE PROPERTY SHOWN HEREON APPEARS TO LIE IN
FLOOD ZONE "X" (AREA OUTSIDE THE 500 YEAR THIS SURVEY WAS MADE FOR THE BENEFIT OF PATRICIA H.
FLOOD PLAIN) AS WELL AS CAN BE DETERMINED
FROM THE FLOOD INSURANCE RATE MAP COMMUNITY BARTLESON; BANK OF AMERICA; BEACHES TITLE SERVICES,
PANEL No. 120075 0001 D. REVISED APRIL 17, 1989 LLC; and COMMONWEALTH LAND TITLE INSURANCE COMPANY.
FOR THE CITY OF ATLANTIC BEACH, DUVAL COUNTY, A
FLORIDA. 1\ ',