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1918 Oak Circle Paver Dway, Walkway Submittal 4 / r 4wieBuilding Permit Application updated 10/9A9 : City of Atlantic Beach Building Department •'ALL INFORMATION HIGHLIG 800 Seminole Road, Atlantic Beach, FL 32233 IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address I / ( G`' OCAZ. C IC L!1 e Pt Ft. .322J Permit Number: -' Legal Description ILI,. 11 c _ h.- , RLp_ _ - Valuation of Work(Replacement Cost)S 13e 12 E Heated/Cooled SF Non Hi. ECEIV • Class of Work: UNew UAddition UAlteration LYR`epalr //UMove CJDemo OPool D\" AUG 1 2 2021 • Use of existing/proposed structure(s): OCommercial i311Residential �[ BY: • If an existing structure,is a fire sprinkler system installed?: ❑Yes 11i o �Ye mus ubmit •arate ree Removal Permit_. • ill • •• em. -• 'na • i.tion ith •r+•.•seg •ro��, ( Describe in d tali the type of work to b perform d: IZC-1' G:«.- C C 4 S i I - t-i rl J un c.,.E . a ci v'e- c-yld, Lz. IA)i t(,1 �rt-V.615 Florida Product Approval# for multiple products use product approval form Prope a er Info .tion Name ,,ti.i- in E i 1 Address 6 * c 'E �r - City r C L L - State �''� , , ""?�' A_'i PF•jne )D' •O E-Mai OM J . .CU. __.) .1P_Iec&Se CC — wn o Agent(If Agent,Power of Att:liney or Agency Letter Required) — Contractor Information tom, Name of Company 4 f'tel!jcs� t' 5 Qualifying gent tU I l(,Ll G•...2.. �e, i Address [O it t1 r G-C City .j c.c.. Oi v ' State 1✓L Zip c. Office Phone - (� Job Site Co tact Number 3 . _ -- State Certification/Registration# L.LI'Goo is j3 Li. E-Mail fr i a p-r<t r , S crl'' &= 2'G„ Architect Name& Phone# iJJ A _ v — Engineers Name&Phone# I • • -" Workers Compensation Insurer T+u1 IFSIE ''r Go. OR Exempt a Expiration Date ' 22... Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work o.insta ation 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.f 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 coning. 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 RECORDIN. �A Vy *TICE OF COMMENCEMENT,4.,..t. /[1J --- ��Art atuce of Owner or Agenri gnature of Contractor) Signed . d worn to(or affirme• •efor me thi • day of Signed and sworn to(or affirmed)before me hi j day of AU5US1 , loll,by `. f /27 •4.v• a A,*�/)f , t L by ,(...:t\0 1-- 3( rat G //. ,4_• , - WA (Signature of Notary) TIP !'• 40 % , Commission#HH 102870 �-- i.. �1. Expires July 2,2025 !!•!! • CHRISTIAN Cl ''"'r)'•'M1°p'` Bonded Thru Troy Fain Laurance 600385.7019 [ )Personally Known OR f :y: MY COMMISSION 1P rwnaily Known OR " (4Produced Identification Y� °_;:�;` ;%;; EXPIRfiS: 1 aiSGced Identification'f Type of identification:fl-DL "�:fe:i,ew ,y of delineation: *"1(bale._ �i,v--1.{ )L, i•.z -y-- .,ii-Adi REVOCABLE ENCROACHMENT AGREEMENT S 'f 4 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.n�ierthe la 9f the State of Florida, hereinafter referred to as "CITY" and `/ „ 1 1®I c _ 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 WC-0t.-.L ex 11C.I etc_ klLNYC= cam.,. w,Q,k- -ti4y ,,% I `'tiles Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege gl(anted remains subject to relocation or removal on thirty(30)days' notice by CITY to U ER said otic11-11 [e to//US/ER shall be given by certified mail, return receipt requested, to the following address /9 /6 (2kci cc.k, /7f L . 8aA Gt4 FL_3 22= • 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 .rmless by the USER from any of the work herein under the terms of this permit and that all of said li..ilitia are hereby assumed by the USER. ,� Date(97�/� /2/2-O 2 Proper Owner/Agent (signed in presence of Notary Public) STATE OF FLORIDA, COUNTY OF DUVAL The foregoing instrument was acknowledged this i.th_day of _itivotiST _ _, 20 2 I , by_Kill gi... j1 k LIN , who personally appeared before me and (printed name of Signer) acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. �N" ` _ ,,, Department Approval: . +iiCHRISTIAN GILES Signature of Notary Public, State of Florida lib:,,,,..r"-: 6;v COMMISSION#HH 117153 [ I Personally Known • .z�.;a; EXPIRES:April 13,2025 _ i' ' c 0 Bonded TMu Notary Public Underwriters [ Produced Identification (Type) FL L_ I--`' -- Scott Williams, Public Works Director H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18 RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **AL1 INFORMATION City of Atlantic Beach HIGHUGHTED IN GRAY IS 800 Seminole Road, Atlantic Beach, FL 32233 REQUIRED. PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job Address I 915 Gik C rfG I�� � �• t'i L�1 �� .32L3.3 Permit Number _ Contractor Information l Company =Gi' � `��S Qualifying Agent intAcLQ. ( =2,(---1 Address .3232 OI i S City1 lie State L Zi -32 32.E c1 � .S �(Z©� ���-c,kso n v � � p �-- Phone . 01-1 -LZD--c,6-2.„ Email (1 1 ( 'Cc. S 2 . EMIL State Certification/Registration # L tivvc 1Z13Gg- Architect Phone Email Engineer Phone _ Email Workers Compensation Insurers I��S- OR ExemptnExpi ration Date Or74/2122. • 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 Oct R . An 1 Ett (Project Superintendent) with(Company Name) (4-11 `5 4,014 Phone Cyl 7 Z I SS • All materials and equipment shall be subject tc4 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 showing any increase in impervious area on owner's lot or in the City right-of-way are to be included with this application. • The permittee shall commence actual construction in good faith within 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 expenses - sin; in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. • is W. s Director shall be notified 24 hours prior to starting work and again� immediatelyC1� "upon� mpl ion.Date zea/ Permitt. si :I Bence of Notary Public) STATE OF FLORIDA, COUNTY OF DUVAL The foregoing instrument was acknowledged this 1-2_11-1 day of A v&V ST ,20 Z) by K.L1 N ,who ersonall a peared before me and (printed name of Permittee) CHRISTIANGILES . .ice acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it t . MY COMMISSION 1t HH 117153 EXPIRES.:April 13,2025 I ' P,ilut' ponded T Notary Public Underwrkers [ l Personally Known Signature of Votary Public, State of Florida [ produced Identification(Type) F(, DL H\Annlirations R Forms\Word Documents\101RM001 Rieht-of-Wav Fasement Permit Annliratinn.dorx Revision Date:10/1/1R — $ ilk SIOt4 MAP SHOWING SURVEY OF JT 10 , '-`:LVA MARINA, UNIT 12-A, AS RECURDLI IN PLAY BOOK 36 , :'AGL 64 , OF TI CURRENT PUBLIC RECORDS UP DUVAL COUNTY, FLORIDA. FQT : ALJ 7 ZUTN 0I C.4 EV / A 4y 114.. r' pq n ,�. .�. �... i .a,-z-,s g "s21. 222 g,9]sl e 1 A Y Y Y V� � f7 Lor 32 a. 5'Bv a o 1 9 R 4 ZV GO "`^0 8r.1' $ gt O ^ rv // ��^ asg cn � ea sa s Ce eQV ( ii .4 /_,.., _2 io p. o LIJ E— ^i Q �° '3 rte' 9_ • A O i W '; (lam, 3 d/ •o W N/ - N /1r2 /9/8 •` g ' < 4 ' a / m S ''+ � S1 x5 ^fAc, 3 � T+D .oma? �• `r g QI .„g'•ke.,... 6� /.q 77) II. 1 f o a .. u ,r IQ 978 at)O 0 •4 b 4 d 4. m W 4 Z A) a• h� n o t o a >.. • . . . .....,._. .7 . ED .i.. z. 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Ru F. / c o k ?/ oR. 9)> T `)o r9 2T �- o 4- 0 3 �‘ 4 / �.�. T F r` [ N � t ' J/ c` ti �1a i /0 /O b v., % /. / N/ 0ro / 1I' ° '9'8 !' . 2 S�'0 3°.(1•• I Cu /V •mow.;;�O ,. ? t�,i..1 Tro / f/ Q? vire.? ..e.," :� G' /9j'� ti �t.� \ ! QNI r sa'�, I 0, o. '-' •• •'• • 3Ds I � ' P - , - , 111 -.? / I .I 4' e ? — c- •.-.,:.?.. I ;Y. l : l o ' �c 4C43.8 9 o >' c . .,A '7 /9 // t a• s\ O, \\...,,.. zY --___' QUA i CERTIFIED TO: COIF }ONWFALTH `— 1°f� LAND TITLE COMPANY �i • 7 4//s /5 4 j 444 S, A 'I4.EY. (4G • A/o a4ZO4W/4 REZ-TR/C7 /t.W4- BY - 'z 4T. 4 • 77$.•/S .4'•QOPETTY LIES .W c<c op 2[1NE '›CI',"_'RPE.4 r