1679 Atlantic Beach Dr voided driveway permit application Ira ATLANTIC BEACH
PERMIT RECEIPT
0"' October 10, 2016
PERMIT DESCRIPTION: new driveway
PERMIT NUMBER: 16-DWAY-1828
ADDRESS: 1679 ATLANTIC BEACH DR
OWNER:
Fence/ROW $35.00
UTIL REV MODIF OR ROW $50.00
Totals: $85.00
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�� CITY OF ATLANTIC BEACH
*� PUBLIC UTILITIES
1200 Sandpiper Lane
rt J Sl)� ATLANTIC BEACH,FL 32233
(904)270-2535 or(904)247-5874
NEW WATER/SEWER TAP REQUEST
Date: Project Address: /(o?} ,M14�-
No.of Units:�_Commercial_Residential Muki-Family
3 It
New Water Tap(s)&Meter(s) Meter Sizes)
New Irrigation Meter ✓ Upgrade Existing Meter from to (size)
I,
New Reclaim Water Meter✓Size!f New Connection to City Sewer
Name:
Applicant Address:
City: State: Zip
Phone Number: Cell Number:
Email Address Fax:
Signature:
(Applicant)
CITY STAFF USE ONLY
Application# 16-5F2 -/ 820
Water System Development Charge $ q 0. 00
Sewer System Development Charge $ OTO. 00
Water Meter Only $
Reclaim Meter Only $ /*dd
Water Meter Tap $ (notes)
Sewer Tap $
Cross Connection $_a01 ISD
Other $
TOTAL L� (�
APPROVED: Kavle Moore,PE R(,�
(Deputy PW Director or AwhorizedSignatwe)
ALL TAP REQUEST MUST BE APPROVED BY UTLI77ES DEPARTMENT BEFORE FEES
CANBEASSESSED
City of Atlantic Beach ECEIVE APPLICATION NUMBER
u Building Department AUG (To be assigned by the Building Department.)
800 Seminole Road Z��s `'_
Atlantic Beach, Florida 32233- Ih_pw 1 via%
Phone(904)247-5826 Fax(904 AZ-5845
E-mail: building-dept@wab.us Date routed: (D� II� I Ib
Cityweb-site: hdp://www.mab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I W TSL—1 A+I BQ,IL(,h.y(• De artment review required Yes No
n,,I,- r�` Building
Applicant: Coasketk Ugt-s Wzimi Planning&Zoning
,1 Tree Administrator
Project: 11 W & �4 QAW" ublic Works
u I
Public Safe y
Fire Services
Review fee $
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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 N/,a M6lN�
PLANNING &ZONING Reviewed by: Date:
TREEADMIN. Second Review:
❑Approved as revised. ❑Den ed.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05114109
CITY OF ATLANTIC BEACH
® CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
800 Seminole Road
Atlantic Beach,Florida 32233-5445 Fax 904-1475845
PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION,
Date Z- 10- 1U
PERMITN lt0' dW AY- 1$AS!
Job Address I(.;-l�j MfLooft( Ty- Issued BY THE CITY
Permitee: ILA544i4 J'%A37 Telephone#_`105�'Lz T�(a 1pJZ
Permittee Address: 30)0 � � f 4>< q 4 GZS�
Requesting Permission to Construct: New 7>ILI VEw2
Location: (Reference to Cross-Street) /4r14 Fit l3 Fra c.N 1z/ (DAA E-c QAAS
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 (AI Date:
Bell South Telephone Company Yes( ) No V , Date:
(F
Ferrell Gas Yes( ) No Date:
Comcast Yes( ) No (W Date:
2. Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation,
akeration 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 arc 4G 3nwIT'r (Contractor's Project
Superintendent)located at 3olu 5"� S, S s r 5< Telephone#: 5ir/-ccs lo4cz
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 wall as, a copy of a recent survey shall be made a
part of this permit Calculations showing any increase in impervious arca on owner's lot or in [he city
Right of Way are to be included with this apft is on
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 Ci of Atl
against any and all loss, damage, and cost of expenses arising in any m
exercises by the holder of the aforesaid rights and privileges. D
9. The Director of Public Works shall be notified twenty-four (24) hours a ng wort an a
immediately upon completion.
OWNER
Signed: J Date:
Before me is day ofthe cy of Duval.
State Of pride,he personalty appeared nor rC'
Notary Public at Large.State of Florida County of Duval
My commission expires: 4-1 i 7
Protlucetl Itlenli0ra9on., RENEE D.:FF012208
S
..�A. Notary Public- Florida
My Comm.Ecpire5,2017
r Cpmmiseion Crimise
caw„ City of Atlantic Beach P041�'l
APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road 4&01I�j� v� ee�`'
Atlantic Beach,Florida 322335445 p., f `� I�-1olyw4— vial
Phone(904)247-5826 - Fax(904)247= 45 /s
E-mail: building-dept@coab.us Date routed: CJ TC ALL
City web-site: http:/A~.wab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: )%o '9 A+k"C gQ r� \�(WSewices
ent review re wired Yes No
t� ` p`
Applicant: CMSAAk Oct -J eb N&A Zoning
A "_ nistrator
Project: � �.1..) t}t i� LW L 4 rks
y
es
Dept Signature,
['CM
gency Review or Permit Required Review or Receipt Date
of Permit Verified B
ept.of Environmental Protection
ept of Transportation
River Water Management Districtrps of Engineersf Hotels and Restaurantsf Alcoholic Beverages and Tobaccor:
APPLICATION STATUS
Reviewing Department First Review: I Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed by: 1/L. Date:
TREEADMIN. Second Review:
❑Approved as revised. ❑Denied.
VVORKV Co ments:
APUBLUTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05[14/09
4it
CITY OF ATLANTIC BEACH
�l CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
800 Se 1 le R d
"',q,_1 Atlantic BeaCh,Florida 32233-5445 9042475800
Fax 904247-5345
PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION.
Date_
RERMITN Ito-' OWAy— I�aS(
Job AddressJ.(o-t�j nfLaaftc �f p Issueo sv THE crY
Permitee: 7.j424t (,�ykf Pn sfr• to Telephone#_ 7j0`'/'ZZj�(o(p�7
Permittee Address: 3010 3 ' ''t
Requesting Permission to Construct:_A,,,e
Location: (Reference to CfOSS-Street)--Arl4dfII r3 J2 CN- /z� fTnssf c 04ks
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 (A r Date:
BellSouthTelephone Company
FerrellllGas Yes( ) No (. Date:
Ga
ComVI)
Comcast Yas( ) No ate: ,
Yes( ) No (t,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 mix sC, bnvlfr
Superintendent) located at 3oio 5 A S c x 6xH (Contractor's Project
4. All materials and p Telephone#: 9o'I-zz.S-6,r,
aqui ment shall ba suctem 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.
5. 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 Catcutations showin nv,aincrea$e in impervious oras on owner's Iot�r in the city
Right of Wagare to be ineludad v�riY�this application
7. This permittee shall commence actual construction in good faith withdays. If the beginning date is
rrrore 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 indemn'rfy, defend, and save harmless the Cit of Atla
against any and all loss, damage, and cost of expenses arising In any m p
exercises by the holder of the aforesaid rights and privileges. D
9. The Director of Public Works shall be nofifed twenty-four (24) hours a ng worn an a
immediately upon completion.
OWNER r® y
S�netl: J Date: g 14'/ 16
Befora me Is day of Y I the Cunt of Duval,
State Of oride,ha pensonallyappeared M n•
Notary Fubilc at Large,State of Fbrba County of Duval.
My commission expires' {�_SC
'7 a S' °W BE B "MD25,2017
Produced ltlenNficallon. . Naltry Public-StaMy Comm.Expires ACommissionM FBoiMetl 7hraeDA Natiom