Hickory Lane 1872CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number 10-00000896 Date 7/29/10
Property Address 1872 HICKORY LN
Application type description RIGHT-OF-WAY PERMIT
Property Zoning TO BE UPDATED
Application valuation 0
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Application desc
additional drivway concrete
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Owner Contractor
------------------------ ------------------------
PIERSON OWNER
1872 HICKORY LANE
JAX BEACH FL 32250
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Permit
Additional desc .
Permit Fee .
Issue Date
Expiration Date .
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Special Notes and
Ensure all meter
are set to grade
A sewer cleanout
cleanout must be
metal lid. Clem
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DRIVEWAY PERMIT
35.00 Plan Check Fee .00
. Valuation 0
1/25/11
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Comments
boxes, sewer cleanouts and valve covers
and visible.
must be installed at the property line.
covered with an RT1 concrete box with
tout to be set to grade and visible.
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 35.00 35.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 35.00 35.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
,
rf~~~~ '~' CITY OF ATLANTIC BEACH
=~~ ~~ CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
~ ~r
°?~;' 800 Seminole Road 904-247-5800
:.~'1~?' Atlantic Beach, Florida 32233-5445 Fax 904-247-5845
PLEASE SUBMIT (3) COMPLETE SETS OF PLANS WITH APPLICATION.
Date D ! `~ I ~ `- ~ ~ PERMIT #
Job Address_ _~ ~ 7 ~_}--~ j C ~ p ~ oy (_ f ISSUED BY THE CITY
Permitee; ~ ~ N I EL ~ (~~~lu Telephone # .3 7 ~ ~j 9
Permittee Address: ) 8 70~ }--~ LC k ~r ~,~
Requesting Permission to Construct: E X T~~'' 17 ~~ I V ~ w~'`/
Location: (Reference to Cross-Street) 1 ~ ~ 7 I
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:
Bell South Telephone Company Yes ( ) No ( ) Date:
Ferrell Gas Yes ( ) No ( ) Date:
Comcast Yes ( ) No ( ) Date:
2. Whenever necessary far 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 Dep ment of Transportation Standards and be
performed under the supervision of ~~-~ ~ ~ (Contractor's Project
Superintendent) located, at Telephone #:
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 anv inccease in impervious area on owner's lot or in the city
Right of Way are to be included with this application.
7. This permiftee shall commence actual construction in good faith with days. If the beginning date is
more than 60 days from date of permit approval, then permiftee 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 completion.
O~dNtR
Signed: Ou~ ./~~'' te: 0 7 -f Q - / O _
Before m this day of in the County of v Y SHIRLEY L GRAHAM
p y ppeared ,r_ MY COMMISSION # DD 957760
State Of F{orida, has ersonall a ••~'"
Notary Public at Large, State of Florida, Gounty of uval. ~x•, ~a EXPfRES: Febroary 14, 2014
'1 ' •••' • ~' tary Public Underwrltero
My commission expo: s+~n~PQd~rT$4'~°. ____ _-
,~ ~s~~}~,,,, City of Atlantic Beach ~ ~ ~~~~~ " ~' ~~~~ ~ ~~'~~ ~~-~
~;~ ~ ~;~, Building Department IllL ~ ~ 2010
} 800 Seminole Road ~
~' ~ -~°~~ Atlantic Beach, Florida 32233-5445
Phone (904) 247-5826 Fax (904) 247 _
~84,a _ _._
,., „J;;~> E-mail: buildin ;_, _ _. _ _ ._ _._..~_..._ _. ____.._..
~-r F r g-dept@coab.us
City web-site: http://www.coab.us
~ APPLICATION NUMBER
(To be assigned by the Building Department.)
Date routed:
APPLICATION REVIEW AND TRACKING FORM
Property Address: ~~7Z /77 ~iCO,~'~/ ~~jy__
Applicant: ~/,y~j ~,~
Project: ~ ~ ~
~~.lt"
De artment review re uired Yes No
Building
Planning 8~ Zoning
Tree Administrator
ublic
' Utilities
Public afety
Fire Services
- _ _ __
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified B Date
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: QApproved. Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING
TREE ADMIN.
PUBLIC WORKS
PUBLIC UTILITIES
PUBLIC SAFETY
FIRE SERVICES
Reviewed by:
Second Review: Approved as revised. ^Denied.
Comments:
Date: ~ ~ /~
~_
Reviewed ~--- Date: ~ ~~' v
Third Review: QApproved as revised. ^Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
t-~~~r City of Atlantic Beach ~ . F
~' ~ '~"~~ Building Department h ~ ~ „
,' 800 Seminole Road ~ ~l ~ ~ ~' 2 i~ ' l~
j , - ~~ Atlantic Beach, Florida 32233-5445 ~ '
Phone (904) 247-5826 Fax (904) 24-T--:5845
~r ~ ~ E-mail: buildin de t coab.us ~ ~ y ~ "`"
City web-site: http://www.coab.us
APPLICATION NUMBER
(To be assigned by the Building Department.)
Date routed:
APPLICATION REVIEW AND TRACKING FORM
Pro a Address: ~. ~,~,
p ~ .~~z ~ ~ ~~~
Applicant: 6~~ ~ ~
Project: ~~~~~~ i £ ~iV~u~!-~~/
.~~-~'/
Review fee $
De artment review re uired Yes No
Building
Planning & Zoning
Tree Administrator
ublic k
Utilities
Public afety
Fire Services
Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified B Date
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: i
BUILDING
PLANNING & ZONING Reviewed by: Date: ~O
TREE ADMIN. Second Review: ^Approved as revised. ^Denied.
CifVO S
__. omments:
TIL IES
P LIC AFETY Reviewed by: Date:
FIRE SERVICES Third Review: ^Approved as revised. ^Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09