Permit 158 BelvedereCITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number 10-00000787 Date 6/25/10
Property Address 158 BELVEDERE ST
Application type description RIGHT-OF-WAY PERMIT
Property Zoning TO BE UPDATED
Application valuation 0
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Application desc
CONCRETE TO PAVERS
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Owner Contractor
PHILLIPS OWNER
158 BELVEDERE STREET
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 12/22/10
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Special Notes and Comments
Ensure all meter boxes, sewer cleanouts and valve covers
are set to grade and visible.
A sewer cleanout must be installed at the property line.
cleanout must be covered with an RT1 concrete box with
metal lid. cleanout to be set to grade and visible.
Roll off container company must be on City approved list
and container cannot be placed on City right-of-way.
Must use pervious base material.
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- -------
Permit Fee Total
Plan Check Total
Grand Total
35.00 35.00 .00 .00
.00 .00 .00 .00
35.00 35.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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1 S''~'~~;ys,,~ City of Atiarotic Beach
. i3caiidirog ®epartenerat ~~N ~ ~ ~~~~
-;~~rx:.;,~5;'a 80D Seminole Road
\~- '''~ rM Atlantic Beach, Florida 32233-5445 Y __
w ~ Phone (904) 247-5826 Fax (904) 247-5845 ~~.-~-"~'~
~ ''~sast ;r E-mail: building-dept@coab.us
City web-site: http:/lwww.coab.us
APPLICATION NUMBER
(To be assigned by the Building Department.)
Date routed:
°r®perty Address:
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project: ~~~ ~',~~~ --~ ~~~V ~,~5 ~
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®e artrraent reviev+o required Yes iVo
Building
Planning & Zoning
Tree Administrator
Publi
'litie
Public Safety
Fire Services
Other Agency Review or Permit Required Review or Receipt
of Permit Verified By ®ate
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.) Co ants: / )) ~pp
BUILDING ~` ~~`~~~ ~ ~ fi1G-~ r'/Y~r~d~'~v"C•
PLANNING &ZONING ~~
Reviewed by: ~ Date: ~ ~~ ~ ~1-
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 05114/D9
~`~~'~'r'~' C[TY OF ATLANT[C BEACH
}~. CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
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3:1,, °~`.: 904-247-5600
"~~ Vr 800 Seminole Road
~SJr~ia~ ~ Atlantic Beach, Florida 32233-5445 Fax 904-247-5645
PERMIT #
ISSUED SY THE CITY
Telephone # ~~`1 ' Z `~ ~' ~?`~q
Requesting Permission to Construct:
Location: (Reference to Cross-Street) 'J L/1~ c~Y~
2.
3.
4.
5.
6.
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: G • /S. / D
Bell South Telephone Company Yes ( No ( } Date: ~ . ~S. i o
Ferrell Gas Yes ( No ( ) Date: ! v . / •t v
Comcast Yes (y+~ No ( ) Date: ~. /S (o
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.
All work shall meet City of Atlantic Bea or// ~Flor' a Depa ant of Transportation Standards and be
performed under the supervision of ~ !G~ ri ~n (Contr ct is Project
Superintendent) located. at I S ~ c Telephone #: - 3~' /S~
All materials and equipment shall be subject to ins action by the Director of Public Works or his designee.
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 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 fat or in the city
Right of 1P1/ay are to be included with this application.
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.
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.
The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again
immediately upon completion.
®R
Signed: Date '~ ~~~
Befor ethis 9VntYof Q~~al~~~
St Of Florida, has .,zppear~ rI7GG!/
otary Public at Large o
My commission expire ` ~ :< EXPIgE9:M8y21, 019 Personally Known:
'•• .sdn„• ~°" ~ "'_ used Identification:
~L
l~~F/2 ~f23~~f?~
PLEASE SUBMIT (3) COMPLETE SETS OF PLANS WITH APPLICATION.
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R.O.W. Permit Attachment of
R.O.W. Permit # issued
200_
Owner's Name:
Property Address
Subdivision:
Lot # /Block #:
R.E. #:
for
Atlantic Beach, FL 32233
Jcr~
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REVOCABLE ENCROACHMENT PERMI'T'
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of
200_, by Atlantic Beach, Florida, a municipal corporation organized and existing
under the laws of the State of Florida, hereuzafter referred to as "CITY" and
of Atlantic Beach, Florida, hereinafter refei~ed 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 nunnbers noted above (copies attached).
This work is generally described as: _~~~~1~ ~i ~~~/ ~~
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 email, returi 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 flee CITY informed of USER's proper address.
The USER shall promptly inalce any and all necessary repairs to any facility erected or maintained in
the exercise of the privilege herein granted and shall at all tunes 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 flee 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 flee City Code, Building
Codes, Land Development Code, gild 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 i1 color so that it
matches tine 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 Deparhnent, for said change. The
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, aizd be binding upon, the USER and their respective
successors and assigns.
USER shall meet the terms aild 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. U5ER 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.
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DATED and SIGNED this /.~ day of , 209
~.
By:
roperty Owner
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DWAL
On this ~~day of 200, personally appeared before me, a Notary
Public in and for said unty and State, ~/GI~hC/~~ ~a~/zGt,r/'S , the property owner of
~.~ /.~~f/t.~e~- ,Atlantic Beach, Florida, known to me to be the person(s)
described in and who executed the foregoing instrument; who acknowled e Hat he or she
executed the same freely and voluntarily and for the uses quor~ed
~ o~~1,e~ MY COMMISSION # DD x,34126
21,2011
*~ ' = EXPIpES: M Pubic undeivrMe~s
• ~;+i~lp ~t BondetlThNNotaN
1•
Notary Public in for said County and State
CITY OF ATLANTIC BEACH, FLORIDA, a
municipal corporation:
Approved:
~~~~~
Ricky L. Carper, P lic Works Director
For Permits where city sidewalk is impacted,
City Manager approval required:
/-
Jim Hanson, City M Hager
Page 2 of 2
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