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1875 Beachside Ct FNCE18-0127 Approved Submittal, Not Issued 01.Alt., City of Atlantic Beach APPLICATION NUMBER �s ,.A Building Department (To be assigned by the Building Department.) 800 Seminole RoadF � / -O 127 Atlantic Beach, Florida 32233-5445uTwor `i IUPhone (904)247-5826 • Fax(904)247-5845JA) E-mail: building-dept@coab.us Date routed: I ( 2-f City web-site: http://www.coab.us !!! APPLICATION REVIEW AND TRACKING FORM Property Address: 1 g- c 'Beach S iCle 1 D_epartment review required Yej No Buildi Applicant: POn. Vectra_ -v cc. arming &Zoni�cn = Tree Administrator Project: Fy\.C.e " ( �� L Public W9r ublic Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: proved. IDenied. ['Not applicable (Circle one.) Comments: IA idsn_s aRat /"lo yl n,rs UILDIN in spec , poo I ro44%, ov�� '�^ PLANNING &ZONING Reviewed by: / ! `n Date:kr) 9 /ac TREE ADMIN. Second Review: Approved as revised. ❑Denied! ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 rr1`I j j City of Atlantic Beach APPLICATION NUMBER � Building Department (To be assigned by the Building Department.) 800 Seminole Road F. -Mc 12 �' Atlantic Beach, Florida 32233-5445 ,v IQ Phone (904)247-5826 • Fax(904)247-5845 < ffI "-o;ill/ E-mail: building-dept@coab.us Date routed: t 1 2 I City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Ig--i 5 cEah s t((c- CT D artment review required Yes No Buildiuq Applicant: 'T00-e rcYc `P ace arming &Zon__i�n_g__. CC Tree Administrator Project: Fea.e. -C( TOO L Public wo ab.lic Utilities; Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept.of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: /VI/Approved. ❑Denied. Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: .0‘--� l< -- Date: Ii -Z ( — (Dp TREE ADMIN. Second Review: ['Approved as revised. ❑Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: Approved as revised. ❑Denied. ['Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 �S >,,ri., City of Atlantic Beach NUMBER �S L'� Building Department APPLICATIONIVE (To be assigned by the Building Department.) Y A Itli 800 Seminole Road \1 Z .-o 127 -67gir Atlantic Beach, Florida 32233-5445 NOV 26 f, v Phone(904)247-5826• Fax(904)247-5$ Z�t8 j Z ti �riii9`• E-mail: building-dept@coab.us BY: Date routed: I l City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM • Property Address: I 7 5 Er_ NetC 1 s' tile- CT D ment review required Yes No ` ' Buildi Applicant: Ti Ong Vf' YC& `P\Ce arming &Zonis -�j Tree Administrator Project: Pence kr ` OO L Pr blic Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept.of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: ❑Approved. ❑Denied. $•,:t applicable (Circle one.) Comments: .7 BUILDING PLANNING &ZONING Reviewed by: Date: // Z8 , B TREE ADMIN. Second Review: Approved as revised. ❑Denied. I 'Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: Approved as revised. ❑Denied. I Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 rjyl,`.jlr, City of Atlantic Beach APPLICATION NUMBER ,ipito Building Department • Etv be assigned by the Building Department.) 800 Seminole Road I">�A`CklS'r O fZ 7 :� Atlantic Beach, Florida 32233-5445jtVir Q' I Phone(904)247-5826 • Fax(904)247-5845 ii 2 6 2018 2 E-mail: buildin de t coab.us ate routed: l I fig' City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: I g-1 J .'etch s(Ck/ CT impartment review required Yes No CBuildir Applicant: Toftctra_ pCearming &Zonlg CC Tree Administrator Project: F(.Ce TOO L P 4bJic Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept.of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: Approved. Denied. Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by;1 Date: �/ .Z y%O TREE ADMIN. Second Review: I 'Approved as revised. I 'Denied. Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ['Denied. fNot applicable Comments: Reviewed by: Date: Revised 05/19/2017 4 ';4.. Building Permit Application Updated 10/9/18 .. City of Atlantic Beach Building Department "'AU.INFORMATION 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY 1111P402, Phone: (904) 247-5826 Fax: (904)247-5845 Email: Building-Dept@coab.us IS REQUIRED. Job Address: I 75 Permit Number: ` (v�-�.. I Ob— Li'2-7 Legal Description 17/{.77 Pi oq --u?s-071E- Lo-/ j, is I K.s. RE# I (0c19:-/,..??- 0 (-)Lit Valuation of Work(Replacement Cost)$ ioIvo(7k•Q`� Heated/Cooled SF Non-Heated/Cooled _ • Class of Work: ❑New ❑Addition DAlteration DRepair DMove [Memo ❑Pool ['Window/Door • Use of existing/proposed structure(s): ElCommercial ❑Residential • If an existing structure,is a fire sprinkler system installed?: ❑Yes ONo • 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: LD k'e move o(ct woad. ce,-)ce Afict reploce w',V (.-, tie w wood -reiAc e(pO0( cycle Florida Product Approval# for multiple products use product approval form Property Owner Information C� Name PO ff t-y Lk C Ke I y Address I l� / s 13e/9C.1n5 c�.e a.City R , (- , t State pC.- Zip 3 72 ? Phone *Q1/-`1S',`j -,215-7 E-Mail Jc,SI-It),ctc144Le o6 y;tAA-,\ ,r ofr-n Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company f)c)4A-e VC-J,fi,4 Cvt C e Qualifying Agent Cell A h 1 k 4.A,l'-\- Address <'Z Z ' /1(f 0 S I City 'Si. ' State CL-- Zip T2(:) ,), Office Phone goL'3'--o r7GR Job Site Contact Number State Certification/Registration# E-Mail / '7-/(-•I/edr j4 Feel6 e,rys„g;( i Architect Name&Phone# Engineer's Name& Phone# Workers Compensation Insurer OR Exempt VExpiration Date 7/h -ZO2 0 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 AN ATTORNEY BEFORE RECORD��3Yi NOTICE OF COMMENCEMENT. f/, • �I .xr. , Y4 Ai iii �. /�' , iI J (Signature of Owner or Agent) (Signature of Contractor) Signed to(or affirmed) before me this 21 da of Signed and sworn to(or affirmed) before me this 20day of by r/ —a, Ii ik)O nbC,/ 2 , � P.I ._ by ' A .arArsiwo .2 1- Y? (Signal 1;•+'rte' �'!�°. _�•` g_ MY COMMISSION#GG 255331 • JAMIE D.SMITH r,�Ili : EXPIRES:September 5,2022 *: '-' ;♦c MYPIRES:COMMISSION ' foiro 111 ,;��`rod: Bondod Thtu Notary Publk Underwriters [ I Personally Known OR :;FoFF oP; EXPIRES:September 5,2022 [ )Personally Known d'. ,,�,*' [ roduced Identification -==:- ° No�YPubricUnderwritors p [ roduced Identification // MAP SHOWING BOUNDARY SURVEY OF LOT 12, BLOCK 1, BEACHSIDE, AS RECORDED IN PLAT 800K 42, PAGES 14, 14A THROUGH 14C, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. . .,.i_ CERTIFIED T0: I/, ,() apc25 stz —„c3"4,1 —...,- RALPH H. ANDERSON AND MAUREEN E. ANDERSON W tp,IISpercu 1 1 (;TLtk2T3 1111t pfyy\fl ficl)Ale., BUSCHMAN, AHERN, PERSONS AND BANKSTON // I V 1�1"} TICOR TITLE INSURANCE COMPANY VjC1(� $ D aLLULL/ M0kciCrLig %/ COUNTRYWIDE HOME LOANS, INC. iq TO LOT 30 LOT 31 T Cam. IO Gt(Y)T(taE IN ppE BLOCK 1 BLOCK 1 60.07' (PLAT) (01/eltklE IVC0( 1)S• S 0319'00" E S03'12'08" E 59.:____68' (MEASURED) SET 1j2" RESAR STAMPm jCL LB 6702 FOUND 1/2� IRON PIP£ T t —�iT �-- NO O TIFlCATONr.p. T �� 4 ( t��//�� r- / r .cam pe0A�>S/ G /N,C C ..c,cc_ eL.`C O l� , Ait L et..//74 .S eel=c cm r/---s, 1",-"- II I 00 . ,._ , ;.:: , .... n n _ A 22.3' rS ' 16.5' V) • K , N. rtxv Aii,d,... d • W TWO STORY w o" MASONRY & FRAME h ^ /,JL,4,�-�S c...,--,/�J(( p, 2j ^o o POSTED 1875 - Ki 0 -4-iv I) Gs-,/-v Low."- CDim LOT 13 a LOT 11 ro Pc.a -9,e.4, t-rpF— BLOCK 1 BLOCK 1 4.6• 5.3' fo io 9.5' 0 7.1 1--- .7.3' $• p a N.` . •' , ' • • ;• •. Nf4 1:1, cr) - erO OSe _BLoi-k-IOIn fiOr Nv'3 O7 . " 2. i me toc. '0 r o1S .X`.5 t ,n�rre-AC.e- co C 5 S A e.9• 7.r zo• Z z —17 8.5.:-.11 .. i,' • . .''' 'FOU/I1Pj 2��5557. 0 • s�f�p,. A REVOCABLE ENCROACHMENT AGREEMENT REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida,a municipal corporation organized and existin under the laws of the State of Florida,hereinafter referred to as"CITY"and 1ekKe V 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 asbC.e. . 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 n°tt_ice to SER shall be given by certified mail, return receipt requested,to the following address 1$1 S leQO VIS f e Cr . • 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 I9-7(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 are hereby assumed by the USER. AO Date IIIZ1 !IU Property Owner/Ager signed in presence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL /I, I The foregoing instrument was acknowledged this 2I day of NUV ,20 I b , by t1/4-4J ela D" hit-t) ,who personally appeared before me and (printed name of Signer) acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. 0 a/Nti-. D .nature of Notary Public, Sta o Florida Department Approval: ersonally Known Produced Identification(Type) �---� ///�/,�/ . i • '`P JAMIE D.SMITH Scott Williams, Public Works l erector ;:,. + MY COMMISSION#GG 255331 it• r�n ;: O:\Public Works\ADMf4 '�•. �•{ncrbdtnRFAtWWRIACt5dNZ2 Revision Date:8/31/1 " • r;;:o Bonded Thu Notary Public Underwriters