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460 Sailfish Dr DWAY17-0003 Submittal rS�L��r City of Atlantic Beach APPLICATION NUMBER sSe \ Building Department (To be assigned by the Building Department.) A,`�-� 800 Seminole Road -j e Atlantic Beach, Florida 32233-5445 '-\iV A — 00 0 Phone(904)247-5826 • Fax(904)247-5845 –7 '° on �r E-mail: building-dept@coab.us Date routed: 'S cl [ / City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 4 G O S Po LP(S H DIZE Department review required Yes No jj�� Building Applicant: iy Iv D F,SC© \ Iv -fanning &Zoning �� ree A ii . . Project: l..-� i\.vec.•0 R yc public Works Public tilities Public Safety Fire Services Review fee $ Dept Signature° , '4 r ,# Ft .,, 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. (Circle one.) Comments: BUILDING PLANNING &ZONING cj'�6 (I Reviewed by:_ ____ _____ Date: TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 t.APi , City of Atlantic Beach APPLICATION NUMBER JS S\ Building Department _ �. (To be assigned by the Building Department.) 800 Seminole Road i.1. :r Atlantic Beach, Florida 32233-5445 �� '-��i\J (A Lf 1 -7 —,0003 ''. � Phone(904)247-5826 • Fax(904)247-5845 .�9 2017 t /c� acj;t �� E-mail: building-dept@coab.us q Date routed: '5` i /i 7 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 4 G O S VA-ILP(S H {:)$2._6.., Department review required Yes No I Building Applicant: ly N- D F_SC_© 1 fanning oning ree ' •mr . • Project: l--J R.\ve"C.o k ublic Works Public tilities 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. (Circle one.) Comments: fee AVi'`•_ ii/Ne`'1 BUILDING PLANNING &ZONING Reviewed by: 5 47,4,�i(/y' . Dat 9 -L . TREE ADMIN. Second Review: ❑Approved as revised. ['Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 1- .?]-4- BUILDING PERMIT APPLICATION � ` CITY OF ATLANTIC BEACH DATE 2800 Seminole Road,Atlantic Beach FL 32233 � Dill % Office: (904)247-5826 • Fax: (904)247-5845 Job Address: L 0 L,6y - Pot 17- Permit Number: i- I b 3 -z s —2cie LoTg Blxio Legal Description a/p our VY o r Qo y n I Polv.,s U1 2n RE# 1 -7 I 4i'0 t7 — 0 C2€ Valuation of Work(Replacement Cost) $ Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s) (Circle one): Commercial Residential • If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No N/A • Submit a Tree Removal Permit Application if any trees are to be removed or AffidavitGE of No Tree Removal Describe in detail the type of work to be performed: c p 1 ce- F' 5� IVE 1.S t S CContc(2r& ) Florida Product Approval# for multiuleprodiats lroduct approval form Property Owner Information NffAAi Name: z C s plc 9 v)�57'-7� �r.3?/r Address: 177 �i(ljti S'B8t nt City o:74 A ` State f Zip 3 ZZZ.5" Phone rj' afitanCh, FL E-Mail Co..J A) l t G- f!? 4_7r. /J tom' Owner or Agent (If Agent,¢ower of Attorney or Agency Letter Required) 64 t..wl Ai (,d A) ,J t�1- 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 RECORDING YOUR NOTICE OF COMMENCEMENT. Contractor Information: •Name of Company: �1 eS C" ,L�, Qualifying Agent: �Q2c� kl�" �''e Address: —19 eci S Ca a-(c4t J.iS's 1 fate City "TA C J ei w State Zip FL- 32.2.c-C Office Phone 4104 Gl-ct BSO 1, Job Site/Contact Number 1 ,104 ) 8?74( State Certification/Registration# C& I 9..9s-6160 E-Mail art desJC,Gi vs-kI •.0•" Architect Name &Phone# Engineer's Name &Phone# Worker's Compensation /.,fr"S& i( ('i Exempt / Insurer / Lease Employees / Expiration Date 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 laws regulating construction in this jurisdelfton. This permit becomes null and void if work is not commenced within six(6 months, or if construction or work is sus.en' or aband' r a period six(6)months at any time after work is commenced. I understand that separate permits must be secured for.,I' ical Work Pl.imbing, Signs, WWells,Pools,Furnaces,Boilers,Heaters,Tank and Air Conditioners,etc. / (1&4fr Signature of Property O --- . Signature of Contractor: � l Before pe d this-3r Day of Wu./ Before me this 3rA Day of MP''( Notary Public: Ar., l SP. ' '•: MY JOAN EI BOM.Mary Pull ic: A — -— JOAN E.BOWMAN 0j�� COMMISSION#GG 077886 r►1 �n�P,o`; EXPIRES:February 28,2021 , to = MY COMMISSION#GG 0771 •:"p ...•O. R• rr, ••._ °;.; • Bonded Thru Notary Public Underwriters "%•.r5..•*;li EXPIRES:February 28,202 I hereby certO,that I have read and examine,ruts zippll ullo,'n„d A-,rer riw it---r be true and correct. `''A , •fo 7 0 u of whether governing this type work will be complied with specified herein or not. The grafi . presume to give authority to violate or cancel the provisions of any other federal, state, or local law regulating construction or the performance of construction. Rev.5/2/16 r? tnemttsqe.0 pf-11,)!1!;1 JR ,rizhaoil •oi:,;i:;.2.A 1,3 • BOUNDARY SURVEY Date Of Field Work-311912017 Drawn By-D.M Order#:1000006986 4 460 East Sailfish Dr, Atlantic Beach, FL 32233 I it iC ' - '11, BLOCK I 4. CORNER �� "- w AERIAL PHOTOGRAPH SCALE:1%10' CO--TG;C4_=' .v r LOT 10 ➢I BLOCK 10 FOUND 1'2' ' 30.0' FOUND 1;2" IRON PIPE m IRON PIPE 93.00' I FENCE N82` 43 58 E (n 0.7'S 7,:-; m \---I 0.9' 3.3' `I 6 EQUIPMENT . c G CD Zo 24.2' o co?.;) LOT 9 + 0BLOCK 10 i', p --4 it r- 0 1 0 o m 6� . �, n r-- wo o cS! G) _ LOT 18 N rn g.8' COVERED '�� o ➢o I Cl) BLOCK 10 rn ' 'O n? X3.6' o ` 26.0' r6 {< N 3.8'N 20.0' 0 �0 6.5RESIDENCE ' - i CONCRETE X) w =460 Q' DRIVEWAY ' — 54 3' 26.0' m 0 01 FENCE 0 6'N _ --30.1' 0.4'E s82° 43' 58'" 93.00' LOT 191 FOUND 1/2" FOUND 1,2" BLOCK 10 LOT 8 IRON PIPE IRON PIPE BLOCK 10 -ALL ANGLES AND DISTANCES SHOWN HEREON ARE BOTH RECORD AND MEASURED UNLESS OTHERWISE NOTED SHEET I OF 2(SKETCH OF SURVEY)-SEE SHEET 2 OF 2 FOR LEGAL DESCRIPTION,AND OTHER SURVEY RELATED DATA.SURVEY IS NOT COMPLETE WITHOUT AU.SHEETS EXG iPHONE: 561.508272 SWAS AU-I-CR,7FC Bs OCTFA : 561.508.609 LB 8111 CLYDE O. MCNEAL SURVEYING, LLC. PSM 2883 5601 CORPORATE WAY. SUITE 103 WEST PALM BEACH, FL 33407 4.- NexgenSurveying.com `-4 96f1.1LTdish Aie p�,(7 /7 - tt4ty ikci- 93 fC fid, b..r = 711'0x /710tti GZO K 4V,46 r--- .12 iTs 17 t,, ‘ ,.= Ivo_ _ig ou -(2ea-14eiqwe-Az k- V 4.' DP 0 -ha-441--S0 X -r t Yoc irse ? :5 _____xr Zb9C9z: /f0 Jo x .4. � 1/0 >1Ag/If —441447—fr—de r: :lc fr /G0 t•Zr t 3f),r 121,2 - /GP K9 -- 1 4$12. ------ -&1"70.-/7 "iva) 4efric 6,, 21--1 ' 1 . CiTY OF ATLANTIC BEACH r ' - n CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS 800 Seminole Road 904-247-5800 �;;, - Atlantic Beach,Florida 32233-5445 Fax 904-247-5845 PERMIT# PLEASE SUBMIT(2)COMPLETE SETS OF PLANS WITH APPLICATION. Date ISSUES BY THE CITY Job Address 767 �) itc.<Z.X6,5 l^- /4�14t E-mail 0-.ctc-9 55c 2 C,_rhe, ( • C Permitee: Telephone# 904 6 2 6. 8 7 3ci Permitee Address: L( 6 U Sc.- ( I�,. 5 Dr2,'--c- rT Requesting Permission to Construct: (2 =- (21 p CC- G x•;51 ,--75 Co•nc4c Vic— pQ;-mac= -7 AS _Ts Location: (Reference to Cross-Street) 1. Applicant declares that prior to filing this application he has ascertained the location of all existing utilities, both aerial and underground and the accurate locations are shown on the sketches. A Letter of Notification was mailed to the following Utilities/Municipalities: Jacksonville Electric Authority Yes ( ) No ( ) Date: Bell South Telephone Company Yes ( ) No ( ) Date: Ferrell Gas Yes( ) No( ) Date: Comcast Yes ( ) No ( ) Date: 2. 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 Director of Public Works, any or all of 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 Director of Public Works, and at the expense of the Permitee unless reimbursement is authorized. 3. All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the supervision of 7, ;0 5,-, T I. (Contractor's Project Superintendent) located at Telephone#: ( t)`-i 626 E3/3c( 4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee. 5. 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. 6. 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. 7. This permittee shall commence actual construction in good faith with days. If the beginning date is more than 60 days from date of permit approval, then permittee must review the permit with the Director of Public Works to make sure no changes have occurred in the area that would affect the permitted construction. 8. 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. 9. The Director of Public Works shall be notified twenty-four(24) hours prior to starting work and again immediately upon completion. OWNER ` Signed Y Date: 57,3// Before me this 3r day of AAA--/ in the County of buval, State Of Florida,, hips personally appeared • ,,, ''p�, JOAN ����„_ - „„d Notary Public at Large, State of Florida, County of Duval. My = '_ : ion exi res: 2 • 2-8- I-7 Personally Known: MY COMM! 10N#GG 077886 yrdProduced Identification: h.. .0 EXPIRES:Felxua,y 28,2021 F ;o•' Bonded T to Notary Publii,Underwriters Revised 7129115 R.O.W.Permit Attachment of for R.O.W.Permit# issued ,20 Atlantic Beach,FL 32233 Owner's Name: B ( J s�yz�yj —1-�u p LL- , Property Address: ��� 6 ���� £ 4//Vt Subdivision: R.E.#: REVOCABLE ENCROACHMENT PERMIT THIS REVOCABLE ENCROACHMENT PERMIT, issued on this 3 day of Oil. SCC.-) , 20/'7, by Atlantic Beach, Florida, a municipal corporation organized and existing under the'laws of the State of Florida,hereinafter referred to as "CITY"and 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 of the City of Atlantic Beach for the purpose as described in the City of Atlantic Beach Right-of-Way/Easement permit numbers noted above(copies attached). This work is generally described as: pCtp lc,c e- ?� Coh 'C�2�.��wr AS i S 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 the USER, said notice to USER shall be given by certified mail, return receipt requested, to the following address: The depositing of said notice of cancellation in the United States mail shall constitute the notice of cancellation and the burden is upon USER to keep the CITY informed of USER's proper address. The USER shall promptly make any and all necessary repairs to any facility erected or maintained in the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe condition. 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 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." Page 1 of 2 4 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. The USER shall, at the discretion of the CITY, be requested to submit as-built drawings showing the change within thirty(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 public rights-of-way 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. DATED and SIGNED this 3 day of i4' 20 / 7. B,�7 Property Owner 4111/ (to be signed in presence of the Notary) STATE OF FLORIDA COUNTY OF DUVAL On this 3rot day of May , 201 � , personally appeared before me, a Notary Public in and for said County and State, (=we, , the property owner of , Atlantic Beach, Florida, known to me to be the person(s) described in and who executed the foregoing instrument; who acknowledged to me that he or she executed the same freely and voluntarily and for the uses and purposes therein mentioned. V., y Public in for said County and State ry . JOAN E.BOWMAN ` Vi••t;: MY COMMISSION#GG 077886 EXPIRES:February 28,2021 ..c4a:°;•' Bonded Thru Notary Pubic Underwriters CITY OF ATLANTIC BEACH,FLORIDA, a municipal corporation: Approved: n. _ . rSfL: .IR�elK ��• 0,- 40,in Public Works Director File: 12/12/16 Page 2 of 2