305 AHERN ST RESO21-0080 ,,,,,•''''''-",,,,,,, Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
::r Y' 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
4�, IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address:B pth-e,r(lSi- 4iC nc chi FL 2.233 Permit Number: R oZ I - to�
Legal Description L I O prhex-r\ To t.x.. n ho n1¢ s RE# 13 q a(cam-- I t 4E
Valuation of Work(Replacement Cost)$10/000 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New IS'Addition ❑Alteration ❑Repair ❑Move [Memo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): OCommercial [residential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No nl2--
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit)lyecribe in detail the type of work to be performed:
Rdc,k p ck+h ur ay-From 0 At, • lb 1-14.f2- 9 a on other sicca.. O -ya 2a4
n? _m ev-LC l2 CLIC_ TO 3.e 19-3011-124) 6 ate_K C 0 ten)Cm. ID F- P fLo p EPLT -4 •
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name /vtel lJ Ka/7105 k---(/ Address 305 /4-flci /1 SI-
City Fj—tig f 7C, &a CA, State pt. Zip 377 3 3 Phone 2O —FASO-.2.-7b S
E-Mail Ku,-r-)ins 4 y!n 42, m-e . C i ro
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company AD AooVE Priptrh , Qualifying Agent
Address 54 ?oa- �litrA Lb\Dri i Ur• CityPov*t VtdtX ?xi}, State .L Zip 32CWZ
Office Phone 40t) - $0"1 - d .SiS Job Site Contact Number
State Certification/Registration# E-Mail ttU t,A- Qr al ,r.c (9111641' 1-w' .
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR ExemptX 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 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
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) 4, (Signature of Contractor)
Signed a d sworn to(or of m:q)before me this 9 day of • ed and sworn to(or affi -d)befor9 me this day of
lU% ( ,bY \@ . Kr:mt,1a _ b k4- L_ ker�c�\
(it natur:r [Sign. . • .mal.
ter., .
,i•f,,, TONI GINDLESPER .�pii�`'',"gig ,, 'iOiil GNDLESPERGER
[ ] Personally Known OR f..) :,,=, MY COMMISSION#GG 353178 ] Personally Known OR . !•�i i.1 MY COMMISSION#GG 353178 i
[ ]Produced Identification °;;���iiiiii P; EXPIRES:October 6,2023 ]Produced Identification ;r,��.p,; EXPIRES:October 6,2023
Type of Identification: °`r�', Notary `ype of Identification: D:1'a°�!',f� . EBondedThruNotary Public Undewnters
9unded Thru Pubiic Underwriters
r BOUNDARY SURVEY
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4, _.5 SURVEYORS R-IFICA TARGET .
• I HEROD CERTFI T.µ.*«gDIA EIP‘5„f.: � ._._ ....-- 1
E A1%.4 AND CORRECT RF°::S_\'A1FaA'J A 5'../Ill/E1 '.A. LLCEI PRAREDDER IA'DIFECIIJA VV
NiOYAUUD 'y'.1.M AUIMFMICATEOELECTROM:.
�,A."1 - sly.. _--.'. NelirluTpE Fcla7lc A- os...._ - LB#7893
SERVING FLORIDA
L. �'.�C ' 62K N NILRFBY TRH!: SONE 102
WEST PALM BEACH F.354CT
��� °HDNE 1561,6:0-4800
S7A?=N,DE P-ICNE 18001726.483'
YL NNF TH J OSBORNE 1,,', ` .
-, .:ri i::'(rt , STATEWIDE rACSIV:LE 1800:X41-0576 .•
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.-s `irREVOCABLE ENCROACHMENT AGREEMENT
: ilk-.. \\ City of Atlantic Beach
**ALL INFORMATION
„ ?:s HIGHLIGHTED IN GRAY
800 Seminole Road,Atlantic Beach, FL 32233 IS REQUIRED.
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
d U}/1) eIZ, 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 R oC.K t bQCK .
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 3 05 P-hern Si- A I tKn+,C cin I FL_372.33
• 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.
60 Date 9 /9( 2,r
Property Owner/Agent(signed in presence of No ry Public)
STATE OF FLORIDA, COUNTY OF DUVAL )
The foregoing instrument was acknowledged this 9 day of _
e , 20 G..LJ�
by Q,r1V IN )ka Irl item k.y ,who personally appeared before me and
(printed name of Signer)
ac no ledge. at he/she s'gned the instrument voluntarily for the purpose expressed in it.
il
(� ",/„. ., TONI GINDLESPERGER
(A._ aft. AI - =.. _• MY COMMISSION#GG 353178 Department Approval:
i-*: iYIII :*;
Signature of Notary Public,`State of Flori•,':- r..n�.p EXPIRES:October 6,2023
[ ] Personally Known "`e9F, ° Bonded Thru Notary Public Underwriters
[ ]Produced Identification(Type) -L. Scott Williams, Public Works Director
H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18