333 5TH Street
,, ,.
~' ^'" CJTY OF ATLANTIC BEACH
~. ,: ~
,'"" CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WA~AND EASEMENTS
,..~,
iiii~ .~~:-,
!~ 8D0 Seminole Road 904-247-5800
_1 ,/
;~~~, Atlantic Beach, Florida 32233-5445 Fax 904-247-5845
PERMIT # ('~ ~ +f ~ t
ISSUED BY TiiE CI7Y " l7t h 7
Telephone #
Applicant deGares that prior to filing this application he has ascertained the location of all existing utilities,
kxnri aerial and underground and the accurate locations are shown on the sketches_
A Letter of Notification was mailed to the following UtilttieslMunicipalities:
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 for the construction, repair, improvement, maintenance, safe and efficient operation,
alteration ar 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 Departrn nt of Transportation Standards and be
performed under the supervision of ~ {Contractor's Project
Superintendent) located at Telephone #: ~_~J 7 - ~7 G,~ ? Gf
4. All materials and equipment sha 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.
;:. A sketch of plans covering details of this installation, as weU as, a copy of a recent survey shall be made a
part of this permit Calculations showrina any increase in im~rvioats area an owner's lot or in ttse clt~,•
t'2iaht of 1NIav are to be included will: #his atsalication.
7. This permittee shall commence actual construction in good faith with days. If the beginning date is
more than tit) 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 aN 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 compleU~ ~ ~ t~ ~ ,
of /~ ~ ~
OWNER
Signed: Date:
Before me this day of in the County of Duval,
State Of Florida, has personally appeared
Notary Public ~ Large, State of Florida. Courtly of Duval.
M1rty cammiasion expires: Personally Known:
Produced Identification:
T 'd SIBS-Li,Z-b06 ~H 4~e~H ai~uet~d ~o Rq [~ eS0 ~[]i 9fl 9t] ~eW
Location: (Reference tia Cross-Street)
t
R.O.W. Permit Attachment ~_ of ~ for
R.O.W. Permit # CJ~ - issued , 2005 Atlantic Beach, FL 32233
~,~ ~S( Owner's Name: ~ ~( (~ ~ `t
Property Address: ~' -+~~ f --
Subdivision:
Lot # / $iock #:
R.E. #:
REVOCABLE ENCROACHMENT PERMIT
.. THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of
2005, by Atlantic Beach, Florida, a municipal corporation organized and existing
under the laws of the State of Florida, hereinafter referred to as "CITY" and
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 of the City of Atlantic Beach for the purpose as described in the City of
Atlantic Beach Right-ot=Way/Easement pecrnit numbers noted above {copies attached).
work is ge~r cral iy descr
n
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 the USER, said notice to
U5ER shall be given Abp certified mail, retur} receipt requested, to the following address:
The depositing of said notice of cancellation in the United States mail shall constitute the notice of
cancellation and the burden is upon USER to keep the CITY informed of USER's proper address.
The US1R shalt promptly make any and all necessary repairs to any facility erected or maintained in
the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe
condition.
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 property of the CITY, the USER shall replace at the USER's
sole expense, any and aff 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 shalt meet the current requirements of the City Code, Building
Codes, Land Development Code, and all other land u.se and code requirements of the CITY.
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. The
Page 1 of 2
Z'd SbRR-/.~~-irnF nR 4~eaq ~i~ueigd ~o R~t~ e~~:nt 9n 9n JeW
Mar D6 06 10:05a City of Rtlantic Heach Bu 904-247-5845 p.3
USER shalt, at the discretion of the CITY, be requested to submit as-bunt drawings showing- the change
within thirty (30) days after the day of completion.
This permit shall inure to the benefit of, and be binding upon, the USf:R and [heir respective
successors and assigns.
USER shaft 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
public rights-of--way and other public [and. 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 alt of said liabilities are hereby~assumed by the USCR.
DATED and SIGNED this ~ day of ~_~ia~~
CITY OF ATLANTIC BEACH, FLORIDA, By:
a municipal corporation:
~ ~~ ~
Tim H on, City Manager
Attest:
Rick Carper, Public Works Director
STATE OF FLORIDA
COUNTY OF DUVAL
Sr
On this ~~ day of ~~Q~'C ~ , 2005, personally appeared before me, a Notary
Public in and for atd County and State, the property owner of
3 ~_~~ ~_ , Atlantic Beach, Florida, knawn to me to be the person(s)
described in and who executed the foregoing instrument; who acknowledged to me that he or she
executed the same freely and voluntarily and for the uses and purposes therein mentioned.
By:
y Public in for sal unty and State Pro rty Uwne
(to signed in resence of the Notary)
y moan, Public - saa a Fblide
~ • • 3uty Conm~fon Expires Feb 14, 2010
~~,,~ ~P;° Commission N OD 518533
''°~~°~""~ Bonded By National Noary Assn.
Page 2 of 2
MAP SHOW/NG BOUN/DARY SURVEY OF.~
LOTS 74, >6 ,BLOCK 7 , SUBD/VlS/ON "A", ATLANT/C BEACH
AS RECORDED /N PLA T BOOK 5 ,PAGE 69 OF THE CURRENT PUBL/C RECORDS OF
DUVAL COUNTY, FLOR/DA
LEGEND/ABBREVIATIONS
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Ip = IRON PIPE BRL = 6UILDINGRESTRICTIONL/NE
RB = REBAR NO-/D = NOIDENTIF/CATION
pC = PO/NT OF CURVATURE d = CENTRAL ANGLE
pT = POINT OF TANGENC'i' R = RADIUS
R/IV = RIGIfTOFWAY' A = ARC LENGTH
POC = PO/NT ON CURVE N = NOT TO SCALE
(A) ACTUAL P = PLAT
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/~ ~ FIFTH STREET RECHECKED AND RECERTTFlEO 7-11-100J TO SNOW PDOC IMPROVEMENTS
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'' ~`~' CIT'Y ®~ ATLANTIC BIEACI~ ,O
'f~,. ' q ; ~'; PUBLIC W®RKS I)IEPAlL~.TMENT
., , : . ~-r~ 1200 Sandpiper Lane QSO ! I n
~;~ % Atlantic Beach, Florida 32233 ~ W
,;;. =~~; / (904} 247-5834
===-' (904) 247-5843 Fax
www.coab.us
~~A~ ~~~W C~~~~iN~.~
~'elrmit Application # U ~D - .~ Z _~ ~ fG'
Property Address: ~ ~ ~ ~~ ~'"
Applicant: 7l ~ 1 / ~ lc- ~/~
Project:
Your application is approved as noted by the Public Works Department,
Final application approval must come from the Building Departanent.
^ Your permit application has been reviewed by the Public Works Department
and the following items need attention:
/,
Please submit these requirements to the Public Works Department, 1200 Sandpiper Lane,
Atlantic Beach, FL 32233 in order that we can approve your application. If you have any
questions, please call (904) 247-5834.
Reviewe y arper; P.E., Public Works Director
Date
Signature
Contractor Notified Date