Permit 1721 Beach AvenueCITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number
Property Address
Application type description
Property Zoning .
Application valuation .
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Application desc
core bore storm drain
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10-00000860 Date 7/13/10
1721 BEACH AVE
RIGHT-OF-WAY PERMIT
TO BE UPDATED
0
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Owner Contractor
------------------------ ------------------------
LANE, JR., E.W. OWNER
3790 ORTEGA BLVD.
JACKSONVILLE FL 32210
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Permit DRIVEWAY PERMIT
Additional desc .
Permit Fee 35.00 Plan Check Fee .00
Issue Date Valuation 0
Expiration Date 1/09/11
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Special Notes and Comments
Avoid damage to underground water/sewer utilities. Verify
vertical and horizontal location of utilities. Hand dig if
necessary. If field coordination and needed, call
247-5834.
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.
S s'~~~raro City of Atlantic Beach ~ ,. ~ ~ ~ -~- _ ._...~
_ s~ Building Department ~ •• ~ •
s ,; :+ 800 Seminole Road ~ ,~(~(, a ~; 2L +!~
~' , s> Atlantic Beach, Florida 32233-54 5
Phone (904) 247-5826 Fax (90:7 5845 y ___` -~ . ,
~-~~;~ .~%' E-mail: building-dept@coab.us 1---
City web-site: http://www.coab.us
~~~~~
APPLICATION REVIEW AND TRACKING FORM
Property Address: _ f'~~% 2-~ ~~/~- ~ ~ ~G
Applicant:
Project: ~~~~ ~~~ ~%~~~ ~,4-~~
Review fee $_
Department review required Yes No
Building
Planning & Zoning
Tr ' trator
Publi
u is Utilitie
afety
Fire Services
Dept=Signature';
Other Agency Review or Permit Required Review or Receipt
of Permit Verified B Date
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department ~ First Review:
(Circle one.) Comments:
BUILDING
PLANNING & ZONING
TREE ADMIN.
PUBLIC WORKS
~._
PUBLIC UTILITI ~
PUBLIC SAFETY
FIRE SERVICES
Approved.
Reviewed by:
Second Review: []Approved as revised.
Comments:
APPL{CATION NUMBER j
(To be assigned by the Buildin/g~Department.)
~O - ~~ip y
Date routed: ~~~ ! f~
Hied.
Date:. ~~ ~'~~~
Reviewed by: Date:
Third Review: QApproved as revised. ^Denied.
Comments:
Reviewed by: Date:
^Denied.
Revised 05/14/09
i c+~:I~ ~ ~1 ~g1 all
-t''a'~r,,~, City of Atlantic Beach
~Y Building Department
~- 'y 800 Seminole Road _ -.: ;_-
a Atlantic Beach, Florida 32233-5445
Phone (904) 247-5826 Fax (904) 247-5845
'$~!~f# L~' E-mail: building-dept@coab.us
City web-site: http://www.coab.us
APPLICATION NUMBER
(To be assigne/dnby the Bjlui/ldin~glDepartment.)
/U DOU/ ~/
Date routed: ~ D
APPLICATION REVIEW AND TRACKING FORM
Property Address: ~` ./ ~ ~ ~~ ~ ~ ~V fG
Applicant: 4 !.~-~(~ /~
Project: l'DL~~ ~~£ ~i~~~ ~~n
Review fee $
De artment review re uired Yes No
Building
Planning & Zoning
Tr ' trator
Publi
u is Utilitie
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:
~1PP1 I[:~TI[~N STATI IC
Reviewing Department First Review: [Approved. ^Denied.
(Circle one.)
BUILDING C~me~~tos:,~ c... ~~v S 1 e
/`
~""' ~~
~
~
~ ~6~.-k. c.~
~ v _
~~
I~-
-~
_0
~"'~
~ Cf~'~ ~`~-
PLANNING 8~ ZONING ~ /
Reviewed by: Date: ~ r'~ !o
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
R.O.W. Permit Attachment of
R.O.W. Permit # issued
for
Atlantic Beach, FL 32233
e,~~J ~-N
E ~1 ~.1- ~.~~-G~ ~`e-_
REVOCABLE ENCROACHMENT PERMIT
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, hereinafter referred to as "CITY" and
of Atlantic Beach, Florida, hereinafter referred to as "USER".
WITNE5SETH:
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:
-l
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 snail, 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 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 hereui granted and shall at all tomes 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 utilit<,~ provider.
The facilities allowed by the permit shall meet the current requirements of the City Code, Buildu1g
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 uz color so that it
matches the existing acid adjoining sidewalks."
200_
Owner's Name:
Property Address
Subdivision:
Lot # /Block #:
R.E. #:
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 (30) days after the day of completion.
This permit shall inure to the benefit of, acid be binding upon, the USER and their respective
successors and assigns.
USER shall meet the terms and conditions of this per)nit 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 , 20~Q
Property Owner
(tome signed ~in presence of the Notary)
STATE OF FLORIDA
COUNTY OF UVAL
.~"~r ~ a
_~~••! ~4~ TRACY SHE ~
.; ~ E LTO
~~ ~ e ~' COMMISSION # OD 879101
°'~,::`.Y~~ EXPIRES:
~Y 1, 2013
On this ~ day of ~ ` 1. 20(10, person lly appeared before me, a Notary
Public in and for said oun _ and State, ,~/~~ YUP ,the property owner of
1~~ /~ g ~ j~}{/,p 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 wine freely and voluntarily and for the uses and purposes therein mentioned.
Public ' sai ounty and State
CITY OF ATLANTIC BEACH, FLORIDA, a
municipal corporation:
Approved•
7 ~ U
Ricky L. C er, Public Wor cs Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Jim Hanson, City Manager
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