Permit 705 Amberjack Lane• ~~~
~~ f ~ . , ss, CITY ®~ ATLANTIC BEACH
`~' 800 SEMINOLE ROAD
:_:.,
\~ - ' ` ~ ATLANTIC BEACH, ~'L 32233
.- ~ INSPECTION PHONE LINE 247-5826
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Application Number 07-00000123 Date 2/20/07
Property Address 705 AMBERJACK LN
Application type description RIGHT OF WAY PERMIT
Property Zoning TO BE UPDATED
Application valuation 0
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Application desc
REPLACE DRIVEWAY
Owner
------------------------
STILLWELL, ERNEST L.
705 AMBERJACK LANE
ATLANTIC BEACH FL 32233
Contractor
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OWNER
ATLANTIC BEACH FL 32233
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Permit DRIVEWAY PERMIT
Additional desc .
Permit Fee 35.00 Plan Check Fee .00
Issue Date Valuation 0
Expiration Date 8/19/07
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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
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CITY OF ATLANTIC BEACH
PLAN REVIEW SHEET
Building Department Public Works & Public Utilities Departments
800 Seminole Road 1200 Sandpiper Lane
Atlantic Beach, Florida 32233 Atlantic Beach, Florida 32233
(904)247-5800 (904)247-5834
(904)247-5845 Fax (904)247-5843 Fax
Rauted to:
D.Hufstetler
S. Doerr
arper
a uzniak
Public Safety
PLAN REVIEW COMMENTS ~ FEB 1 3 2007
Permit Application # ~ - OD /Z3 I
Property Address fJ/ ~ ~,~ ,~C _.ti.~___.a
Applicant: L ,Q '7') ~ 5 T ~ ~-3 T/ ~~ I,tJ ~ /
Project: /~~,fJ~,aCf. ~~VF GJR ~l
This permit application has been:
Approved as noted by the ~~ Department.
Final application approval must come from the Building Department.
~ Reviewed and the following items need attention:
Please re-submit 2-copies of all revisions. Please re-submit your
revisions to the De artment re uestin them.
Building Dept, Public Works and Utility information at top of page,
failure to notify the correct department may delay your permit from
bein issued.
Reviewed By: Date:
Date Contractor Notified:
,~5~`''~'r ~' CITY OF ATLANTIC BEACH
JS r ~~ ~ `~ CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
_ s, -
?J
800 Seminole Road 904-247-5800
"!.~;s>>~ Atlantic Beach, Florida 32233-5445 Fax 904-247-5845
PLEASE SAUBMIT (3) COM/P~LETE SETS OF PLANS WITH APPLICATION.
Date /X ` /~`~ y ~ PERMIT #
Job Address 7D.~" /`~' `//~/~ ~~~ ~~~~ ISSUED BY THE CITY
Permiee: ~-~~~//Sr- ~(• ~ ~fLtJf.~' l/ Telephone # ~ (~ ' Q ~ Z
Permittee Address: ~r/S-• ~~//l ~~ ~~~3'~ - ~/
Requesting Permission to Construct: ~y~ ~ N ~_.i1/•iLtk~ G 8~ ~~ `I~~ `Y~'(
Location: (Reference to Cross-Street)
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 o ( ) Date:
Bell South Telephone Company Yes ( ) Date:
Ferrell Gas Yes o ( ) 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 Department of Transportation Standards and be
performed under the supervision,, of ~' £ / (Contractor's Project
Superintendent) located at Q Telephone #: 312 - d / Z
4. All materials and equipment shall be subject to ins ection 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: 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
R.O.W. Permit # issued , 2005
Owner's Name:
Property Address:
for
Atlantic Beach,
32233
Subdivision:
Lot # /Block #:
R.E. #:
REVOCABLE
THIS REVOCABLE ENCRO
2005, by
under the laws of the State of
of Atlantic Beach, Florida, her
ENT PERMIT, issued on this day of
Florida, a m icipal corporation organized and existing
ter referred t i as "CITY" and
to as "USER". ~
WITNESSETH:
able basis as described herein the
purpose as described in the City of
(copies attached).
That the CITY does hereby grant the USER permiss
right to enter upon the property of the City of Atlantic E
Atlantic Beach Right-of-Way/Easement permit numbers
This work is generally described as:
Any facility maintained, rel
remains subject to relocation or
USER shall be given by c~
,c~ erected, and/or installed in the exercise of the privilege granted
6va1 on thirty (30) days notice by CITY to the USER, said notice to
led mail, return receipt requested, to the following address:
The depositing of said noti a ,of cancellation in the United States mail shall constitute the notice of
cancellation and the burden is pon USER to keep the CITY informed of USER's proper address.
The USER shall promptl 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 Cade, and all other land use 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
r
Page 1 of 2
USER shall, at the discretion of the CITY, be requested to submit as-built 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 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 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 USER.
DATED and SIGNED this ~_ day of fp~ ,a2p~:.~LOa7
CITY OF ATLANTIC BEACH, FLORIDA, By:
a municipal corporation: roperty Owner
By:
Jim Hanson, City Manager
Attest:
Rick Carper, Public Works Director
STATE OF FLORIDA
COUNTY OF DUVAL
On this day of , 2005, 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
Page 2 of 2
By:
Property Owner
(to be signed in presence of the Notary)
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