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1355 Ocean Blvd Right of Way Application 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 I,t' ( Th O Job Address /35-5ci`•"mr_ 00/Po e, /�ZZ' Permit Number c ' 6 P /{w 1 /10' ��©A C i o /` /i r c j.e(� T• l^ ContractorInformatiioon/ /C n�,/�,�� 1T Lf t'-n1. AJ �{(f/V (/', 'V !` /�)/� l�J '�_ tF Company // e'L� . Quual}iffyyiinng Agent�Sf/ AiG 7 17•/7r w• t ( .AV V TC 1 Tl O 2 0W/ " ts+�— •wb ( AAL Address(• 0JC�Cillr/�" ✓,� City/Q'rzlrWrrG. State Zip 3`1.1! .�, g e_ C Jc�i „r , y s�/ F Phone !17 T Zr7 Z 5f 72 Email ,r ��Qrns5N4 pE cs�c0.74 -Tb �o nit r°LC� 1 (� 'V` Gr State Certification/Registration u N/ y TO f J C/J r /I us FleD CO (I/ �U Architect ^/ Phone Email /1/4.)//4 F N-r� lit J�C 1/ (� I Rr�C / O Q Engineer ,Y 1� d Phone N/�'I Email ^ 2,,- ^ e j/•i/ �f V�5 /b Co l e e {1 e /4' y ee6J`L7 Workers Compensation Insurer Ai//7 OR Exempt o Expiration Date N/AT _..---- I2,/�/ll 1 l..i L • Permittee declares that prior to filing this application they have ascertained the location of all existing utilities,both aerial gi �f ,( l ,.-F�, Q �l p /�/and underground and the accurate locations are shown on the sketches. �//��//� eOr�!� 1�'VNOI }C�///�/�i+/ �� f/�"C�C- �r7(/• Whenever necessary for the construction,repair,improvement,maintenance,safe and efficient operation,alteration or 1 V-O t7Jy '7 ,`-'lam v/ relocation of all,or any portion of said street or easement as determined by the Public Works Director,any or all said poles, 6/2(O n / n n �f-/' wires,pipes,cables or other facilities and appurtenances authorized hereunder,shall be immediately removed from said /�V S u S �� C O Tl/7'�� ./� ��C �,/�/ street or easement or reset or relocated hereon as required by the Public Works Director and at the expense of the I,1 y) 71/ AV Permittee unless reimbursement is authorized. • All work shall meet City of Atlantic Beach or.�Florida ADepartment of Transportation Standards and be performed under the kr /�//.)Q(I e/�/-/• supervision of ,r05/-1 �Nq /��7.e.04(.I�- • nt(POWN (Proj3ct Superintendent) 7 ALV" l� Y`-' with(Company Name) !Y!rJ Phone N(/A \ • 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 \ mannerketcsatisfactoryopo the Cita. I • 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 1 this application. ] VL • The permitter shall commence actual construction in good faith within 7 days. If the beginning date is more than 60 /�,•,J (�_ kiiN days from date of permit approval then permittee must review the permit with the Public Works Director to make sure no Tt �'V 0 changes have occurred in the area that would affect the permitted construction. ',. \� Z ^N^ • It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right, G _�— \ ,`\ 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 ' X ��., expenses. _ - ny man, of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. W _f\ • T. •ublic W. I -ct• sh. be notified 24 hours prior to starting work and again immediatelylyupon completion.p • w _... Date(/?/i C7/ ZC� Permittee(sign •.esence. otary Public) ((( STATE OF(LORI•• COUN • AL -� 7;t. \ fit- The fo egoing instrument was acknowledged this I �/ day of J (-1-e,_. 20 (-7,-( > N p�( ` by III 4.•�'l U CI- vJ_ k) t/SsfD C.k(...)/• -‘ who personally appeared before me and O 'V , •ri ed na e of Permittee) W — h \ ... ` ` ackno e•:ed that he/sh igne• - i strumentfo'untarily for the purpose expressed in it. c z v f` • [J Personally Known Q _'•r'•re of Notary Public, .e of Florida [J Produced Identification(Type) ` W ' •.�U /1 HAApplications&Forms\Word Documents\2018011b1 Right-of-Wdy Easement Permit Application.dacz Revision Dale:10/1/18 ` t";"' ; ON)GiNDLESPERGER,r*. ec; °V : -,: ilii. •; MY COMMISSION#GG 353178 W � 41 • ;;;,, .o ,- EXPIRES:October 6,2023 °F ,,, Bonded Thru Notary Pubic Underwriters Owner Builder Affidavit **ALL INFORMATION s ' HIGHLIGHTED IN A4 r City of Atlantic Beach Building Department GRAY IS REQUIRED. "y 800 Seminole Rd, Atlantic Beach, FL 32233 --ono- v Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 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: ('3S5 oc e, ,J g -vo Owner Name: \7OS�P 1ticc5cgAitiVt Phone Number: 47/7 it2-r lig/-7 j. Mailing Address: 13S5- DC�,47u n/1.-V/) City: /417,-4TiTfC- geataState: FL Zip: 5-2-2 3 3 Notarized Signature of Own- -----.. 01 7 The ,qr-:oi g inns_tru ent was ackn. , -•:ed •-• .., me this/U day 4, O n Q__, 20 G-(in the State of Florida, County C/ Signature of Notary Pu•Iic ak I A. A 111)1 .} �. [ ] Personally Known OR [ ] Produced Identification Type of Identificati . .. , •,•44‘..'••.�,c TONI GINDLESPERGER (fit . MY COMMISSION#GG 353178 Updated 10/24/18 "moi - =-.::-;;.674.-*::,-' EXPIRES:October 6,2023 ''°•,r`,1" Bonded Thru Notary Public Underwriters 4 MAP SHOWING BOUNDARY SURVEY OF LOT 8 BLOCK 53 ACCORDING TO THE PLAT OF PitANDALAY AS RECORDED IN PLAT BOOK 10, PAGE 11 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. CERTIFIED TO: CHASE S. MCKEAGUE AND LYNN E. MCKEAGUE, FIDELITY NATIONAL TITLE INSURANCE COMPANY AND GIBRALTAR TITLE SERVICES, LLC L07 9 LOT 6 BLOCK 53 BLOCK 53 50' (R) 50.26'(M) 1/2• 5/8'(RB)a/0.6' P.EO. OP) LB 3624 "Kf ON UNE `? 0.2' 0.2' , 4 . LOT • BLOCKI 25 3 0 S'— _'8_. 8.'4-.5..7— E'45'1 1 DMrg..,0D24. S.o UNE �g Poai. .: DED1 yp 15.3' 4Rly•gD.DEnc —3't CONE . i -�— W:QECK cr u.,0.3' 5.0'"-SVD !pop y 0.2 i W LOT 13 H . 13.9'1.t`� "- . 9.8'! n 44 LOT 7 BLOCK 53 .4 19.3. ( 1. BLOCK 53 IA n 72 V) 44 PADS�� IN) osI-o0 . . -A /MA 0.2' .-1n D W cD • r�~► \ n Z WLOT 14 z ,9.4' 9.9' O' +,, BLOCK 53 , N `V1 b tv WYO TV• 3.5 3.6' M000 OEda 3 1 ,.5�$9 1., °' -a - PAVERS-,L a o LOT 6 .ilk3 100'(9 A 4) 3 p" BLOCK 53 • 9' SEVER O 98.92' (1P)70(BP)(4) ON UNE'p ?i• 89 43'08' CLE -OUT 4 • \�( `_ 7E... I2 ON UNE 1� t 9 0.3' �72 I' (,P) QP) 03 F EAST. 1.08' t20,1c4;71),6>(' CO NC 'GENE OCEAN BOULEVARD EDGE OE PAVEMENT (50' R/W) f;.O07 24N[`OC.•ARENS OEIE/11MIm TO IN OUT90C THE 02x ANNUAL 01ANCS ROW PURR/FLOOD ZONE'x(*ADEUS)"..AREAS cr n2*ANNUAL C,l/NaE FLOOD, AREAS C:Ix AWw1AL ONAMQ MTh MENACE 110,1145 cc LESS DON 1 1301 OR 404 ORMNAOE AREAS LESS THAN 1 SgWARE ME. AMO AREAS PROTECTED 9Y LEVEES CROP Ix.ANNUAL 0014LE FLOOD. 1.....+ V E Y L ',tons, ststRAos, 51 4"`n moss Es AMgrow.LCA ARS SIRKY. 2.STRUChORE Nn ma.s:0110HCREcti u s W AW ROOD 201E AS TEST OE1ERw•ct, H 04% •.E hi A P1E100 4AP5 PANES.NO.NK OATEU I I-OP-S.O s ,, A SSOCIATED SURVEYORS INC. MA '7T; �T ,E1v(TfM 17,:"*"'„,„„,„: OAK Y i TTA e Y nos'RANEY LAND & ENGINEERING SURVEYS s.nos LRAMs'SATED ON LEGAL DESCRIPTIONS VLRMSHED. ANE PI,RAc UEttVpT 4ERE �/. NOT•J.JRONED IA ITS SINEW*FOR EASEITENT'S,ARE,CYONNANIS.eAL's jI�� 3846 BLANDINC BOULEVARD AR NEAvY Le SHOW4 RECINtAinNOA ms. u e. t+�raAvr Leaf sLurwa Ia1aEo1.rA.Nnt RacA ncr0u ipANe7ess 4 /� JACKSONVILLE. FLORIDA 32210 T.uNESS OTHERrsE STATED M.1 MDP Pas MONO HAVE AO CONTx1GT1OP i 904-771-6468 1 AC AIR CONDI TIDIER PSM •aaartISIOW.SIRYEYOR A P.P.C. RRL RUlL9p1K RESTRICTION LINE 70 S, S V CERTIFICATE OF AUTHORIZADON NO. LB 0005488 ITN YEiLiCEix nE R .*ADM cR, •EEM* E C> LDIiN1NE0 l811 RECORD RL5 ••REGISTERED LARD SURVEYOR N CVA COVENANTS 4 RESTRTCT115 R/R •910111'DE NAY 1 HEREBY CERTIFY THIS SURVEY WAS DONE UNDER MY 0 ti,�, . ,Dnr aAD ITIP) .E,PItAL O DIRECT SUPERVISION AND MEETS THE MINIMUM TECHNICAL CUNC CONCRETE ><T MN Pa(IP)C17 '(RR) STANDARDS FOR LAND SURVE 11NG PURSUANT TO CHAPTER 5J-17.050 r co'D K CURFD Ass9N PO oR EC S ER EtECTR 1L RDx • MAO IRON POCR kilo)) PIP THROUGH 17.052, FLORIDA ADMINISTRATIVE CODE, CHAPTER 472, F.S A A ELECTRIC 1111 11 'a c`AunTA 114 ; 1aRnCROSS WT OR '("N 9 L LEN4114 OF ARC MK A dHG ` � LR LICENSED RUSI,C1* —t—:SA—R—i—Y—Nt•^•CHAIN UM(rust ` R LI LICENSED SUIEVEMR `"1—1—i—N— NC'ra FENCE 4 Y N R 4 n R 'ARF PUKE BY: �.c�,`�� � • /�S..r E MI1R NA1La n/SC 6 a• a .•. a n RDNO 40155 CHARLES B. HATCHER FLORIDA CER El E NO. 3771 • R MEtclu RECORDS RED w.l Naha 1 MY IVT IC IAL RECORD(VOLUME -Yr ur-ar-or-ar-sr Yr-OVEAYAO UAllh CHARLES L STARUNG FLORIDA CERTIFIA TE NO. 4579 A PL: POINT OF CiNvE 1X Nx1z Ni011"'T RAYMOND J. SCHAEFER FLORIDA CERTI .TE NO. 6132 T PCC MAT U'CONKAAND CURVE 0 IPSO i PEP POLL.MIPME PAR 6� WE*WEAR POINT 6 1MIT_*at1xON u11ph PaF JOB NO. 75238 DATE 10-04-2019 REVOISC CUM N Poi PU'�NT T CY ICI4A NT .6- 7. COMMA 3 PT POINT OF 1MIEE7IC,SUTKflR '01TRK u4E OLA A.CCPOR SCALE. t` ,' DRAFTER S AXTELL _- pt.'" „mEErs1 R NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISE)) SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER