358 Skate Rd Paver driveway Submittal � 1 Building Permit Application Updated10/9/18
r i City of Atlantic Beach Building Department **ALL INFORMATION
3rU�;- 800 Seminole Road, Atlantic Beach, FL 32233
HIGHLIGHTED IN GRAY
Az IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: ?SFr -5 k /ee )Pa( /9 ///r.c'Tic /i' C i-/ Permit Number:
Description / ?J-IL 1 7 a S _ E R/- of P/ cy,rAoY/zr//,,,#5 u.ter .2/1--
Legal �O(,
2 1,.; 7 ,3.... :
��l /3lv e.-t-< s ��� � fit::�;,,
Valuation of Work(Replacemmnt Cost)$ /D< ciA00, Heated/Cooled SF Non-Hea • Gooled6r.) r....,
• Class of Work: ❑New ❑Addition ❑Alteration XRepair ❑Move t4Demo ❑Pool ❑Wind DAIL 27 2021
• Use of existing/proposed structure(s): ❑Commercial N(,Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No ^�
• 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: /2p/7:O ''i. ' c lilt j2, , -P A 7 /7e i',/,, c e
W( f /4 i°,4?I/e i S'
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name 5/e✓E'er c/v/ePi9/v Address '5 Sr r 7e Rd
City /� T/l-A/77C 0e4 c/-f' State f" Zip 3'2 Z ? 5 Phone Ct 7C 775- 35 7 7
E-Mail Jo,p p A-/- 4 /V6 G%G7 6:',44/ii C
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company T-::: R/ {'f,C S' /3/l/'e/'5 Qualifying Agent _
Address /72,._R '7 s7(, 6/e/y /- City �j#Cf(So,vz/,./�c' /-
State L Zip 32-2 7
Office Phone yO' -,),94/ - / 7 / L Job Site Contact Number
State Certification/Registration# E-Mail
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer j OR Exempt D 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 beperformed 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 CPNDITIONERS,etc. NOTICE: In addition to the requirements of this
permit,there may be additional restrictions applicable to this pfoperty that may be found in the public records of this county,and
there may be additional permits required from other govern ental 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
REC ING YOU TICE OF COMMENCEMENT.
T
(Sig re of Owner or Agent) (Signature of ontractor)
igned and sworn to(or of irme.)before me thi 7 day of Signed and sworn to(or affir• ed)before me this day of
`y ,2c 7 (,b ' -.c' L 0/ , , .
_IalffillM11.1111
(S'#a r TTl (Signature of Notary)
[ ]Personally Known OR „��a”Zs',•., [Pi�(Ii�el TO LESnally known O'
[ ]Produced Identification .: a!s :,_ MY COMMISSION(i ipGrMad I: ntification
Type of Identification: (1 1 .'^�. - EXPIRES:OctoAi kienti'`ation:
--',• ??:'''�'`odF Bcnded Thru Notary Public Underwriters
:LANs i, REVOCABLE ENCROACHMENT AGREEMENT
,'• f" 4\ City of Atlantic Beach **ALL INFORMATION
•-,�
r HIGHLIGHTED IN GRAY 800 Seminole Road,Atlantic Beach, FL 32233 IS REQUIRED.
.4111111r)trial0'
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
> 'V 4'. ci: /"?P,4A/ 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 pAve Lt' ,y Re,P,,,i,P /p/4xS •
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 ?ss 3'4-47c /es( j¢T71,tTic ge-mccr/
• 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 are hereby assumed by the USER.
SrE've do(FP/M-' Date Jkly .2-7/of
Property Owner/Agent (signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this icz 4y day of rg 7 , 2o 2 ( ,
by SreV e ✓U,,e99w ,who personally appeared before me and
. 'tinted name of Signer)
al kno edg:4a',Q :t /she signed the instrument voluntarily for the purpose expressed in it.
' •tirA7P •,, TONI GINDLESPERGER
• '' .'.' 'c.- MY COMMISSION#GG 353178 Department Approval:
Signature of Notary Public,State of Flor :14,, ^op PIRES:October6,2023
of e�, Bonded Thru Notary Public Undenvdters
[ ] Personally Known """""'..-
[ ] Produced Identification(Type) (`•-- Scott Williams, Public Works Director
H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
�i\ Owner Builder Affidavit **ALL INFORMATION
rt �� HIGHLIGHTED IN
it-"J ikark
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
-,n9.-� 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: S S� .S7c4re. kat nr,,v//G %?e4Gi‘7
Owner Name: S7c;C9ti cJc' ,1i9'' Phone Number: 970 -7 7S - 3S7 7
Mailing Address: ..?S"g' •57,--47e Rol City: /g.vTG j?eAChgtate: F/- Zip: 3.73.1 3
Notarized Signature of Owner '��L� t }s". `----
Th egoingins ument was acknowledged before me this 7day o .)Ii.1 , 2c2.-(, in the State of Florida, County
of L -jkJ
Ir(..--_(.4..."
Signature of Notary Pu ' -( t-
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: L-
*.f,..u:;., TONT GINDLESPERGER Updated 10/24/18
'r .,,: MY COMMISSION#GG 353178
"`..n •o EXPIRES:October 6,2023
E•• o?• '',•;.r .Public Under/afters
nrr�,. BOnded t' �'
MAP SHOWING BOUNDARY SURVEY OF
LOT 19 BLOCK 23 ACCORDING TO THE PLAT OF
.1l_ P[LaLlf OF PQMY OF
ROYAL. PALMS UNLIT TWO A
AS RECORDED IN PLAT BOOK 31 , PAGE(S) 16,1 6A,1 6B,16C Sc 16D OF THE CURRENT
PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO: DEWAYNE B. ELMORE, LINDA M. ELMORE,
• STEWART TITLE GUARANTY COMPANY,
WACHOVIA MORTGAGE CORPORATION
1" AND RICHARD T. MOREHEAD, P.A.
20' SKATE ROAD
.H.,, , ( 60' RIGHT—OF—WAY
S 07"16'02" E 80.65' (R)
S 07'16'02" E 80.65' (M) 1/2 REBAR
3/4" BEARING REFERENCE LINE ASSOC.SUR.
t41 ) 'zS 'Q L.B.5488 — —
408.57' (R & M)
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B L 0 C K 2 3 x❑
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1/2"REBAR
ASSOC.SUR. 1/2"
L.B.5488 N 0734'18" W 80.65' (Al) B.L.S.
N 07'16'02" ll 80.65' (R) 3295
54' RIGHT—OF—WAY FOR DRAINAGE & UTILITIES.
R v EO GENERAL31,
1. BEARINGS ARE BASED ON PLAT 800K31, PAGE 168
• s 2.STRUCTURE NO. 358 SHOWN HEREON UES IMTHIN FLOOD ZONE X AS BEST
63
A SSOCIATED SURVEYORS INC. THIS IS
FROM F.E.M.A. FLOOD MAPS PANEL NO 1 DATED G4-17-1989
3.THIS SA SURFACE SURVEY ONLY. THE EXTENT OF UNDERGROUND FOOTINGS,
o PIPES AND UTILITIES, IF ANY, NOT DETERMINED.
A ) LAND & ENGINEERING SURVEYS AND/OR
, _5.446 CILd.4./Di[/G Qcol... �✓ACD 4 LOCAL BY MSS 9J Y. ENVIRONMENTALLY SENSITIVE AREAS IF ANY, NOT
j JACKSONVILLE, FLORIDA 32210 5.THIS SURVEY WAS BASED ON LEGAL DESCRIPTIONS FURNISHED AND NE
Q 904-771-6468 PUBLIC RECORDS WERE NOT SEARCHED BY THIS SURVEYOR FOR EASEMENTS, 1111E,
,3` COVENANTS OR RESTRICTIONS THAT MAY AFFECT THIS PARCEL
0 O S.
6.UNLESS OTHERWISE STATED ALL IRON PIPES FOUND HAVE NO IDENTIFICATION.
S S d CERTIFICATE OF AUTHORIZATION NO. LB 0005488 7.NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A
�.....
FLORIDA LICENSED SURVEYOR AND MAPPER.
i....
LEGEND/AUREVIAT1ONS
I HEREBY CERTIFY THIS SURVEY WAS DONE UNDER MY 0 SET IRON PIPE OR REBAR P.C. = POINT OF CURVE COVD = COVERT
DIRECT SUPERVISION AND MEETS THE MINIMUM TECHNICAL "ASSOC.SURVEY" OR LB.5488 P.T. = POINT OF TANGENCY CH = CHOf
STANDARDS F R LAND PURSUANT Ts CHAPTER • FOUND IRON PIN OR PIPE (IP P.R.C. = POINT OF REVERSE CURVE
61G17-. •:''IDA A� I SURVEYING R: APT � • FOUND CONCRETE MONUMENT (C.M.) P.C.C. = POINT OF COMPOUND CURVE
X CROSS CUT OR DRILL HOLE C/L - CENIIR UNE R/W-. RIGHT OF Wi
.4_•' , - . / ...
• r (R) - RECORDIUS (M)L - MEASURED CAOCC-AIR CONCRETE
CONDITIONERB(E.T.)BUI BUILDING T
' R -RADIUS L ARC LENGTH A\C
CHARLES 8. HATCHER O.R.B. =OFFICIAL RECORD BOOK ® =WATER METER vas= UTILITY POI
FLORIDA CERTIFICATE NO. 3771 O.R.V. -OFTTCIAL RECORD VOLUME P.EQ. =POOL EQUPMENT -1.-= GUY ANCHC
P.R.M.=PERMANENT REFERENCE MONUMENT -O.U.-=OVER HEAD UTILITIES
JOB NO. 24537,.50.`B‘.; DATE /4 Fe6., 2002 B.R.L. -BUILDING RESTRICTION UNE X—X CHMN LINK FENCE
SCALE: 1" = 20' DRAFTER /..9f�1 E.T. - � �ER & PAD W-W WIRE FENCE E.B. ELECTRIC BC
J.E.A. -JACI(SCIMJ.E ELECTRIC AUTHORITY 0--I] WOOD FENCE BTN. - BETWEE