379 7th St Pavers Submittal of•ri- Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department
j **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
4;1IJ~ IS REQUIRED.
Phone:- n (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 31q Seventh h S*Ce e T-- Permit Number:
Legal Description 0t05 Sherr`{ Te(`t'Q`C-e R/P RE# tGq.g45-0000
Valuation of Work(Replacement Cost) $ 41500.45° Heated/Cooled SF d Non-He. ' .,ua.
• Class of Work: ❑New ❑Addition XAlteration ❑Repair ❑Move ❑Demo ❑Pool ❑Win•': /DPR 0 2 2021
• Use of existing/proposed structure(s): ❑Commercial aResidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes OQlo BY:
• Will tree(s)be removed in association with proposed proiect? ❑Yes(must submit separate Tree Removal Permit) Vo
Describe in detail the type of work to be performed: Ierf\eUe -thy e>4.1S-\it 0.sph0.*ic di'i'Ve' `' Qad VOA back
(\eW ljr',ck ?6.V2rs +o 'Or\'- Same Stow('Q coo+0.g2 ai\8 -coo-1-pr-,n-i- as *'fie Ono.l -
c-iVe Wo-‘1 .
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name HOU.)O' tvtar shQ,U Address 3 7 q Se verb�h S4-Q2,4-
City +(0.r1C €Q 1 State E- Zip 32233 Phone ctO4 - g23-(c)832.
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information L
Name of Company t't1eS Cons 'oc--1- or' LLC Qualifying Agent �ObeC{- F Bore 's
Address 34(0(0 -6Un icC.. ZO City SO.L\cscov i Cc State FL Zip 3 2.2O
Office Phone 90-4 - 33 q - 3G-72- Job Site Contact Number C(04 - 3 3 9- 3 '1 2-
State
State Certification/Registration# CSC 12(03151 E-Mail L.8gA2n1 ES82.(0090-tCki 1 . Coe\
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer OR Exempt K Expiration Date OS/17., /7D 2.1
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 4N ATTORNEY BEFORE
RECO NG Y RI IOTICE OFc �MENCEMENT. ,/ ' i
z -lir ?l ,U-/��- -411W'�
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this g day of Signed and sworn to(or affirmed)before me this `4 day of
UMUAM + f7l,�S jhw 11 M�\1 ,L6 1 , by eA'. N�.,:
pr'ft JACK SCABAROZI �./✓ - . : Arris :.cam
:,= Commission#GG 24712 (Si nature of Notary) (".gnats re,o `o arY ABAROZI
-A9; P4:= Expires August 9,2022 ` ;.s:•'' "`��;
••4F...., Bonded Thru Troy Fain Insurance 800-385-7019, ;., ,Lx 1,,,, Commission#GG 247125
`-,•w . : Expires August 9,2022
[ ]Personally Known OR [ ]] Personally Known OR Bonded Thru Troy Fain Insurance 800-385-7019
N-1Produced Identification_ [`'Produced Identification
Type of Identification: \ � V v Type of Identification: \C-1/ ii l----
. „
A t:
,
RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION
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
Job Address 3ict Sevenk\A SA-Ce,Q,k- Permit Number
Contractor Information
L
Company 1f(\e,S COnS 1-CUC. i C.)I1 L L-C... Qualifying Agent }}Ot)ef---
t
- E. Vc -neg
Address 34(0 Fu( ice C.D• City ' aXe_J .G(-1 State F^ L- Zip 322_F; )
Phone 404- 33Q - 3072 Email t-- BQ4ZKIES8 2G@ 9 irnai L. COM
State Certification/Registration # C BC. ' 1203 1 5
Architect Phone Email
Engineer Phone Email
Workers Compensation Insurers OR Exempt piration Date 05V11420 12
• 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 1 QS 0,-c l—S (Project Superintendent)
with (Company Name) ( {\eS CiacY—O C O(l LLC. Phone QO4 " 33q " 3 b 1 Z
• 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 snowing any increase in impervious area on owner's lot or in the t.ity right-or-way are to De incivaed with
this application.
• The permittee shall commence actual construction in good faith within \0 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
expen s arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges.
• The e ks D. - or shall be notified 24 hours prior to starting work and again immediately upon completion.
/ Date 3/8/Z
Permitte (signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing ,
instrument was acknowledged this S '`-- day of i .Ltl'VI ,20 Z/ ,
by RY r-cA r R .{j ,who person•:14t•appear-, . .. .�
(printed name of Permittee) s. JACK SCABAROZI
�' ;; Commission#GG 247125
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. :
9;• 3.F Expires August 9,2022
�'••°•``,�'• Bonded Thru Troy Fain Insurance 800-3857019
�E�=c--- — [ I Personally Known
Signature of Notary Public,State of Florida [1jProduced Identification(Type) L DI--
H:\Applications&Forms\Word Documents\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
•
.- } .._..• .: ; e �t. A't�N$1 14110' Mi A3\`!IA -:0-T1'101
iiw '631 ,1000ifA;F►uti"+
JI
to , ifa iyx. fof" r!1s# `
•
11:1•,:/c1 { .� i t. fi' .� ...y! • •
-, J
•
-- :IY•i+.� :0}••
•
... 1•' •o . :'l9;,,:ti.- )?E ='t-i. ;i 'C,•r, 't',i;.t, !, 10:15. -i 9Pr0;nC'
',•t9 r:+''E f(y„‘.."10:1. i�+`!.--.,ta3'�) '}`6,ii,f.5-.: v-tr ; , ,,-,+lt .}- 5-;-
, 'E91? :'i�-3 ��,t'1 c.°iac "P' i.1}' J• dri'rf � ;t•• ,i E:`"-0T 7 ..;!� ,,:! :%i,"� !+i'..._.. ' t'ir.-•. -t•`',
`l .&• tr.3 "'io r 101.i1J : .�It {C'}',...i7':i ii }. it?its` 't+s 'i})X91: t.iri Cr r.. ';.i`: '4T6 ?i1 !#i` {i_
,. . •. c -� +•3, i. .. C:., . ... a:i'1 •..�E£i[?•.a'•,.•[i ;`IST :U;.t:r.:ar,-E+af"li.'�{Z k.i; lh . ..! ?fi' `taC¢iCi'41"4 t9t<jc•', ,2'$r;rC3 '.4-4444y
Jw rbi' • a,;,j its 'IF °-. _. eA.r:. _ ,l- _ -' ie. 119'''.;;."5 ?b b. a, ,;i s-,a� •n-'tr
?;<iC'e1'Ifli 5.'.11 J 11 i2I1.:jK4,a ,'.:.' 10"9: c•5!1 -r'64`..
"(}. .. .. r !7',:: •. '47� :..;lis - ... ,r',o''-'i':Tt"-i t {•9 T 'E,: .i'Ti1' 5014;; -i.•;j-;i=7�2 ,lJCSS'�r1 +:3 _ 3?!('f?'t6(iz ":i�,
tit''li ):i,ii :._ Qi 7:1 ttl i3i?'_tL�}i6 ..,.i q:-T_i,'.''�-.` .E,
_ ;�::- ; her ej '!. : s)ii • t-`,.:}f, :� iT; '';44C4i.;:' :S ! :C sG F.1 `i;.3 if:' •
. ._ �: - :iU•.r •+:: .j•;••If?':�aY,4�: ;;�,:: s.2r. �t'3:!%Ef -;..)11c;14,1- , 'ii-S3 +- E�iF;r,_:: 'ny..'�i'a' ;i'i't: '.,+::
i _ . ... 9 . . K• tt,f � ..,�;r:ggY>; ;s' ,. 41i.,zs_. .:#^i sr-' _ ,: .. l `•r- . ._ '
fu
.. s, .'f n: :F�f?:? �,:'. •...�.t- ,_... ` �j+t,-;tji+r-.}'"11 'a .r•:Q1i:.l4S74,-4t-.44`fEt _ f.'.71:4.: 41,J _-:j. 9(i
n_. ,.A ]�: iil !, .. ii.', '.:"fl.Hv:3; �4�.. i. i'tJ ft,}.., 1 aa.: "{�fl. :t'C:)C )!:_ •
Cr;i ?.:3T'r.1)1'10V.;Sti{'"h'r :f1';i: ` , •
!i ‘)` !` •i:�yTi tit; ".> I;' ��. l..Z ri :'✓ 7T i3 oi'I i- if ,;:..
4 � ,.;7Si .:I,b ig _ t Y i.)JJ'.i5{ "!9i •U,!i'.
1c. i`l!1'?.. ,t�q_ ;,i6 "1.,�.:,4f it ,OUai'4 h;._ is •;�!J.l',t Jim t.:' f7h: i'. ,.. �.'+ ,i .::
6 ?. .+_ i7;ft i +t1: ! .i?l:'i:-;all '. ,i kr:'t°� r c„ _ :, .
Y. L .w cif l?F "c �^_ _ 12,
. -il};3iif 7t} vl�Isi17`-r!!'�i.l=tt?n5 )9fQfTT!9:. '4..1:,:J/'. }Y 1 =r,.i, VI" f aryi,i-:
ry@'` _-, • :,.- +ili i!IfiStli }3,1 hiO4i. 16/.2 01t 7rt t } ii';,• 144', 'ici, • _t h
,.ai •
ii: i rt'`. a
fit?.+.`:«_- ,J pb3i' /SSI' ; KL't r7. .
._
.. .-b9?e�1yl•'S.._,1T;i(.4 :1},sr' :! fi7rujb\' ttt_. ;,. . ,. • :,n'sr'j1
•i
iibilCll 'O irSle
• ... ;i'. >wa?i,,.QT;:,.n.;, it s:.,t'7 it; •'-4 .$)OtOd O Jiii i 3��' ,•,:.,1!Y,r +�ci;�k tT{ :r�,iti:' •
REVOCABLE ENCROACHMENT AGREEMENT
City of Atlantic Beach **ALL INFORMATION
800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and
existing under the laws of the State of Florida, hereinafter referred to as"CITY" and
- ,00.)0..c a MarSha<< of Atlantic Beach, Florida, hereinafter
referred to as "USER".
WITNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon
the property for the purpose as described in the City of Atlantic Beach.
This work is generally described as ?0.Q$ (0cvC 3O-L(
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 3-16: S2Vexn-\"h a1.*' 1 L 3ZL33
• 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
li. silities are-'freby assumed by t R.
5-i- '��ti ``//a/ArDate I/0/
Property Owner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this day of n'', h , 20 - /
by \-'ci,rr-c- N1,IA ,Wit. l , who personally appeared before me and
(printed name of Signer)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
I ComJACKmSCABnAR0221ission�JGG247125 Department Approval:
Florida ' ,r` Expires August 9,2022
Signature of Notary Public, State of °fl";s$ Bonded ThroTroy Fain Insurance 800-385-7019
[ ] Personally Known
[,..oroduced Identification (Type) P(, 1)'- 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
Z or 4,(x) 7/� "" Eias7 /0.(x)' cam= 4_0T 3 AS SHOWN ON MAP OF
5 14 E IZR ( -T i R A...C..�
AS RECORDED IN PLAT BOOK ZU PAGES 4S OF THE PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA
CERTIFIED FOR: 1.--IOtk)AZ17) Mgt)SI-I44LL.; /J4TIUA.J,:275Avc_ MOo€:7 A1a(= CO/QP.., C/- !(4C- Q
IJ. 83° 42 'CX. "E. o l3,
i0.co' c-•�°- .U. s"3° 4.2' Com"E. 70.00•
L\ x .�� fr( e( k x
0.3 \.1' o"'
X
A
8
m
...
h� w ,c,f sNc-7
f FLvv/Z N
//
4 G U 7" ,....,..0,\)\ 0 O�
V wc�oD
32. ' ;1.1 �N
3 o) t S-r",Y �. ' — a
M s/.SEs7 s si-I.
N N
# 379 ,Iv
;
x e•'1: rQ
.-, I 3(.s' • Io�.5'
L__ k G i
� i
`
55 Lon 5
i
(n��t�cm. 18 wick
(h Lc,'2,.-7,4,,,,,,,4
WALL
),-, ci)
O�
�Aoma
7
M
ic
O
12Z.77' TO, c.Nt72E_i' 02o '
--'7. 83° 42' o " lx-/ e0oc, °'L
EVEIL) TF--1 ST122ET
(o' R/ )
£G•t/. LEr.7gL /--7-'j F,
THE PROPERTY SHOV1V HEREON APPEARS TO LIE t+7 Milt/ FLOOD HAZARD ZONE X AS SCALED FROM FLOOD
INSURANCE RATE MAP I FOR THE CITY OF /i7`�ait-N+,jiga FLORIDA, DATED (7-81 . AND
gr
IS SHOWN AS A COURTESY ONLY AND DOES NOT CONSTITUTE A CERT7FCAT70N OF SAME.
TRI-STATE LAND SURVEYORS, INC.
8411 BA MEADOWS WAY SUITE #Z JACKSONVILLE, FLORIDA 32256 (904) 731-7255
LEGEND BEARINGS BASED ON E/A.J LINE AS SHOWN.
• CONC. MON
• IRON COR. THIS SURVEY DOES NOT REFLECT OR DETERMINE OWNERSHIP.
(SST Mf7H CAP/LS 4144) -
NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL1"11 ,
-x-FENCE OF A FLORIDA LICENSED SURVEYOR AND MAPPER.
O IRON COR.(FOUND)
® CROSS CUT
B.R.L BUILDING RESTRICTION UNE
Esu? EASEMENT LARRY G. EDDY, P.L.S. No. 4144
R/W RIGHT-OF-WAY
COY. CONSRED AREA SCALE: / 2U if .0"//
i CEN7ERUNE
A/C AIR CONDITIONING PAD ' IS " 124'VEYOR D MAPPER,
(R) RADIAL DISTANCE DAT. //- 05-97 STATE 0. OR1DA (L t /49.1)
r''':1 CONCRETE
0F.B._4L PG. Z ORDER NO. 97-4770