JEA R/W 35' Pole2013 City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
r s 800 Seminole Road /3, Baa 7
�r Atlantic Beach, Florida 32233-5445
d Phone(904)247-5826 • Fax(904)247-5845
x_01119 E-mail: building-dept@coab.us Date routed: �%3
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /01100 ;��� Department review required Yes No
Building
Applicant: Planning &Zoning
Tree Administrator
Project: .,r/ Public Works
Public Utilities
`7n%otn4 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:
BUILDING
PLANNING &ZONING 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 07/27/10
CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
%0°°4 800 Seminole Road 904-247-5800
Atlantic Beach,Florida 32233-5445 Fax 904-247-5845
PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION.
Date 02/26/2013 PERMIT# /3 a-23`7
Job Address 30 Ardella Rd.. ATL B.C�H ISSUED BY THE CITY L FL_
Permitee: JEA Telephone# (904) 665-4191
Permittee Address: 21 WEST CHURCH ST
Requesting Permission to Construct: INSTALL(1)35 FT.CL-4 WOOD POLE FOR ELECTRIC SRVC TO HABITAT HOUSE
Location. (Reference to Cross-Street)_QX-STR_MAYPORT ROAD)
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: Ot�.�. CAIUL
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 Permittee 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 EDDiE GALES (Contractor's Project
Superintendent)located at JEA SOUITHSIDF SRVC CENTER Telephone#: 665.6855
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 6o 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 c mpletion.
OWNER
1
Si ( �--, Date. '
Before m his,.,,,,,_., _da /'J he County of Duval,
State O -Igrida,has perso ally appeared
Notary ublic at Large,St a of lorida,County of Duval.
My co n ission expires:_ _ Personally Known:
Produce Identification:
ENGINEERING DESIGN
ORACLE PERMIT MAXIMO DATE REL
PROJECT* 13121001 N.O.: 2013101501.910 WO#: Number CONST 2-26-2013
CIR. TREE TRIMMING
SUB-STA: NEPTUNE N,O,: 565 REQ'D:NONE
CELL
ENGINEER:HGALE N�O�: 219-9714 ZIP CODE: 32233
CUSTOMER/ Svc PHONE
LOCATION: 30 ARDELLA RD,(X-ST.MAYPORT RD) CENTERSOUTH N.O,:904-665-4191 OFC
THIS PROJECT PROPOSES TO INSTALL A NEW 35 FT WOOD CLEARANCE POLE TO SERVE A NEW
RESIDENTIAL CUSTOMER.
PROPOSED POLE STAKED ON 2-28-13.
CAUTION NARROW RIGHT OF WAY, COORDINATION WITH LOCAT TRAFFIC IS REQUIRED.
PLEASE USE ONE-CALL SYSTEM AND NOTIFY THE CITY OF ATLANTIC BCH (904)247-5837 - 24 HOURS PRIOR
TO BEGINNING WORK
PLEASE SEE COAB RIGHT OF WAY PERMIT FOR ADDITIONAL INSTRUCTIONS.
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Hart, Melissa
From: Gale, Harold T. [GaleHT@jea.com]
Sent: Tuesday, February 26, 2013 3:38 PM
To: Carper, Rick
Cc: Hart, Melissa
Subject: Right of Way Permit Request for 30 Ardella Rd
Attachments: R-W PERMIT ARDELLA RD 30.pdf
Dear Rick-
Please find a fully executed right of way permit application for replacing an existing JEA wood distribution pole for 30
Ardella Rd.to serve a new residential Habitat property.
The job has been staked in the field and ready for review.
Should you have any questions or require additional info, please let me know.
Harry
HAROLD T. GALE
GENERAL SERVICE ENGINEER
J EA-ELECTRIC
P.904-665.4191
E.GALEHT@JEA.COM
-----Original Message-----
From: twr04seshrpli@iea.com [mailto:twr04seshrpli@iea.com] On Behalf Of twr04seshrplj@
Sent:Tuesday, February 26, 2013 3:33 PM
To: Gale, Harold T.
Subject: Scanned image from MX-4501N
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