Permit Folder 1177 Atlantic Blvd City of Atlantic Beach i
Building Department
APPLICATION NUMBER
�€_
800 Seminole Road 2`"10 (To be assigned by the Buildin epartment.)
Atlantic Beach, Florida 32233-5445 /d -
Phone(904)247-5826 - Fax(904)25
LrjD9a E-mail: building-dept@coab.us a� Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z/ -/ 7 k—Z B L sfJ D
epartment review uired
lding
Applicant: in &Zoning
Tree Administrator
Project: S fiii�—M
ie Safety
Fire Services
Review fee;$ - Dept Signature
Other Agency Review or Permit Required Rev w R Pew r Ice- B Date
Florida Dept.of Environmental Protection
Florida Dept of Transportation
SL Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacxo
Other.
APPLICATION STATUS
Reviewing Department First Review: Approved. ❑Denied,
(Circle one.) ments:
BUILDING T th o y �k wpw,, �Q- 0-ca,,'
PLANNING $ZONING
Reviewed by;X Da
to
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 05/14/09
CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
800 Seminole Road
Atlantic Beach,Florida 32233-5445 904-247-5800
Fax 904-247-5845
PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION.
Date �b
PERMIT#
Job Address I r T T , Q,yj G '0'04ISSUED BY THE CITY
Permitee: -er� Telephone#-- � `5� = ' J.
Permittee Address: .7 1 1k6<9�iG ��� -J
Requesting Permi,�sion to onstruct:
Location: (Reference to Cross-Street) i If#7 /7 9-- +� 1V4' er
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 (�' o ( ) 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 Dep rtm nt of Transportation Standards and be
performed under the supervision of (Contractor's Project
Superintendent) located at 4 1-71#1 Telephone* 7e ll
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 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 completion.
OWNER
Signed: Y f� Date:
Before me this day of in the County of Duval,
State Of Florida,has personally appeared
Notary Public at Large,State of Florida, County of Duval.
My commission expires: Personally Known:
Produced Identification:
R.O.W. Permit Attachment of for
R.O.W. Permit# issued 3200_ Atlantic Beach, FL 32233
Owner's Name: lkl'40,4, ;re;,*
Property Address: /177 1)05�114)5� /1' Z
Grr
Subdivision:
Lot#/Block#:
R.E. #:
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of
, 200_3 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-of-Way/Easement permit numbers noted above (copies attached).
This work is generally described as: �pt hr
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
USER shall be given by certified mail, repm receipt requested, to the following address:
41 Z 7 T4,i b & ofy J Gc 7c 4 �Z.. .,s:72 2 ?_3
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 USER shall 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 all 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 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."
Page 1 of 2
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
USER shall, at the discretion of the CITY, be requested to submit as-built drawings showing the change
within thirty(3 0) 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
public rights-of-way and other public land. USER further agrees that the CITY and its officers and
employees shall be saved han-iless 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 USER.
DATED and SIGNED this day of , 200_.
By:
Property Owner
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this day of 200_, personally appeared before me, a Notary
Public in and for said County and State, the property owner of
' Atlantic Beach, Florida, known 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.
Notary Public in for said County and State
CITY OF ATLANTIC BEACH, FLORIDA, a
municipal corporation:
Approved:
Ricky L. Carper, Public Works Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Jim Hanson, City Manager
Page 2 of 2
NOT ALL PAVERS ARE CREATE® EQUAL
100% IMPERVIOUS (COAB LDR 24-17... Solid surface pavers. (e.g., brick or brick
appearing pavers as opposed to open grid pavers) do not qualify for any reduction in impervious
area, regardless of type of base material used. )
r•
FF .,
dN�
1 11 K
50% IMPERVIOUS (COAB LDR 24-17... Surfaces using pervious concrete or other similar
open grid paving systems shall be calculated as fifty (50) percent impervious surface, provided
that no barrier to natural percolation of water shall be installed beneath such material.)
Products shown are examples, others may be eligible with Public Works Director approval.
77
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Tremron TurfBloc SF-Rima
f
Impervious Surface Calculations % Formula
Find square footage of the following:
House footprint
Driveway
All sidewalks/walkways
AIC pads
Detached garage/sheds
Pool.Decking
Patios, terraces and/or decks
Add the total square footage of the areas listed above then, divide the sum by
the total lot area of the property.
5114/2007
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NO CAP PE a 4 BO 3672E Q
S '02'00" W 63.50
(S88'58'46"W 63.52' FIELD) POINT OF POINT OF
EXHIBIT "A" - OFFICIAL831, PBEGINNING REFERENCE
RECORDS VOLUME 831, PAGE
815 N 01'16'00" W
160.00 S 89'02'00" W
PART OF BLOCK 10 _ _ 865.00
ATLANTIC BOULEVARD
THE PROPERTY SHOWN HEREON
APPEARS TO LIE IN FLOOD ZONE 'Y' THIS-SURVEY WAS MADE FOR THE BENEFIT OF:
AS WELL AS CAN BE DETERMINED SCOTT HULIHAN
FROM THE "FLOOD INSURANCE RATE
MAP" COMMUNITY—PANEL NUMBER
120075 0001 D, REVISED APRIL 17,
1989 FOR THE CITY OF ATLANTIC
BEACH, FLORIDA.
NOT VALID WITHOUT THE SIGNATURE AND THE
ORIGINAL RAISED SEAL OF A FLORIDA LICENSED STEPHEN W. CREWS, P.S.M.
SURVEYOR AND MAPPER." FLORIDA LIC. SURVEYOR and MAPPER No. LS 5996
_ FLORIDA LIC. SURVEYING & MAPPING BUSINESS No. LB 3672
CHECKED BY:
DRAWN BY: KGL A-��GH T LAND SURVEYORS,VEYO
RS, INC. DATE:
MAY 16
, 2006FILE: 2006-0775 [1:50!0:?R:OBERTS
DRIVE, JACKSONVILLE BEACH, FLORIDA 241-8550 SHEET 1 OF 1
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