1359 Beach Ave RESO23-0118 Revision Corrections 12-22-23Revision Request/Correction to Comments(
1
ALL INFORMATION
t,HIGHLIGHTED INCityofAtlanticBeachBuildingDepartmentGRAYISREQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
s"~Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: ( SD2 OtlS 1
Revision to Issued Permit OR 2Corrections to Comments Date: /7 /4 Z3
Project Address: 5'? -TO-A-6,4 f
Contractor/Contact Name: 141/6' X, '1 t' ,./ 6.24/4.1)0744, -# 4... ---7TIic r7,c/i
Contact Phone: ‘764.-- 1_5-47 741 Email: Ail U, L(''..? TOA-14;041)44 6i711
Description ofProposed Revision/Corrections:
f I 'P v) nJ5 CA-6C.V -3-7043' .r,2r. ox/ S /rte f 4-r' - 1-173/41/77-4,
2 , -pg_tiryA/y.-ilb /-,/T Or l,`( Gr(A-1'70g/ 4.7-746W,),
14v/- gz. - -:)1'•4c-i, -W.4-1.0,01.1 tzK T .,,04, tJ 1c1- 5!41-i-i, &5 QP-- 1W1=--
affirm the revision/correction to comments is inclusive of the proposed changes.Printed name)
Wil osed revision/corrections add additional square footage to original submittal?
No Yes (additional s.f. to be added:
W.illps.aposed revision/corrections add additional increase in building value to original submittal?N Yes (additional increase in building value: $ Contractor must sign if increase in valuation)
Signature of Contractor/Agent: 71 Z--
Mt 61-14-12,:_ 1., 1Krf
Office Use Only)
Approved Denied LTNot Applicable to Department Permit Fee Due $
Revision/Plan Review Comments
Department Review Required:
Building
Planning & Zoning Reviewed ByTreeAdministrator
Public Works
Public Utilities
Public Safety Date
Fire Services
Updated 10/17/18
By Vangers at 10:53 am, Dec 22, 2023
RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION ALL INFORMATION
City of Atlantic Beach HIGHLIGHTED IN GRAY IS
I 800 Seminole Road, Atlantic Beach, FL 32233 REQUIRED.
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address ( =-'7 1 *..,4,'}4 Permit Number -i" 0 Z3-fir ,
Contractor Information
1- P I, H,i Le,41 L77/z. LCompany14164,¢4O/' ' ./ 4/ Qualifying Agent VIIU,)4 i.t. IV0A/n1
Address 2-72,Z)-5- ,(4.4429,(powl. (2A4-) City,f tv,J# 8r'L4 ,c/ State '. Zip 3ZZ
Phone 704--je>C- -74/ Email /./1) c=,./1. L
State Certification/Registration# &8 t c,-4-) )1
Architect -r ' -2-Y 304440/6 Phone Email
Engineer Phone Email
Workers Compensation Insurer ` 0A/ - OR Exempt Expiration Date rr'''f' 2Y-
Permittee declares that prior to filing thisapplication they haveascertained the location of all existing utilities, both aerialandundergroundandtheaccuratelocationsareshownonthesketches.
Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation,alteration or
relocation of all,orany portion ofsaid street or easement as determined bythe 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 ofthe
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 (611 Ct//i-' _ aU,Vj J Project Superintendent)
with(Company Name) 0 I (44-c..-k... ,111L/tlJ 4O1477,a1 J - (L7,6427_ Phone' '-!,30, • ,7µ/
All materials and equipment shall besubjectto inspection bythe PublicWorks Director.
All city property shall berestored toits originalcondition asfar as practical, in keeping with Cityspecifications and the
manner satisfactory to the City.
A sketch of plans covering details of this installation,as well asa copy ofa 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 ismore 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 setout aregranted onlyto the extentofthe 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 mannerofthe exercise or attempted exercises by theholderofthe aforesaid rights and privileges.
ThPu orks Director sh II-be notified 24 hours prior to starting work and again immediately upon completion.
I/ C Date Z /S Z 'SPermite(signed in presenceofNo ry Publi f
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this 61-1-N day of AbVtavt,)er 20 ' 3 ,
by X ^"1 401oc_iZ' who personally appeared before me andprintednameofPermittee)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. AMY GORMAN
Notary Public,State of FloridaA,,; " Commission#HH 273537
u I' Mycomm.expires June 8,2026
I I Personally Known . t
Sig ature ofIry Public,State o lorida NrProduced Identification (Type) DL
H:\Applications&Forms\Word&Excel Document Originals\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
REVOCABLE ENCROACHMENT AGREEMENT
City of Atlantic Beach ALLINFORMATION
r1800 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 under the laws ofthe State of Florida, hereinafter referred to as "CITY" and
uors04, t7V6-1 9-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 17?-1V2/47
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 r3g R4 .4 v 1 iikkti t2 Z2i3
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 ofthe 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 ER.
e //j Date /2//S /2 _3
Proper y Owner/Agent (sig d in Pres n ofNotary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this (S-tt day of /Jove,,,1-27 20 0 3
by -3-01-‘.1.1 oc.P 12- printed name of Signer), who personally appeared
before me and ac nowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
AMY GORMAN
o t Notary Public,Statenf Florida
Commission#Hk;'13537
Mycomm.expires June 6.2026
22-W-Ovi(\ Department Approval:
Si atureof Notary Public, State of Florida
Personally Known
Produced Identification (Type) c(, T)c.Public Works Department Date
Revision Date:05/09/2023