Permit 1173 Sandpiper LaneMar 28 06 01:58p
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CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY ANDS
80o Seminole Road
Atlantic Beach, Florida 32233-5445
PLEASE SUBMIT {3) COMPLETE SETS OF PLANS WITH APPLICATION.
Date 3. 2- g . 0 r!P
.lob Address ~~ 1.3 .1Rn/7~~%D~ -' LRnrF
Pennitee: ~~ ~ ~! S ~7 4 A
Permittee Address:
Requesting Permission to Construct:
Location: {Reference to Cross-Stn.et)
1. Applicant declares that prior to filing this application he has ascertained the location of aft existing ~^tiiities,
both aerial and underground and the accurate locations are shoviR? 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 ( ) iNo ( ) Date:
Ferrell Gas Yes ( ) No ( ) Date:
Comcast Yes ( ) No ( ) Date:
2. Whenever necessary for the ~nstn,ciion, repair, improvement, maintenance, safe and efficient operation,
alteration or relocation of all, or any portion of said street or easement as determined by the Dinectar of Public
Works, any or all of said poles, wires, pipes, cables or other facilit'ses and appurtenances authorized
hereunder, shall be immediately removed from said stmt 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 shat! meet City of Atlantic Beach ar Florida Department of Transportation St-a;ldards and be
performed under the supervision f ~N ~/A-r1 ~ (Contractor's Project
Superintendent) located at ~~'~ ! Telephone #:
4. A!! materials and equipment shall be subject to inspection by the D'vector 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 specifiic~ltions
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. a:atcallai~ions sc?o~rinc arQV naz~ease in irn-~lrfotse area ~;~n ~vrner's lot ~cr in t`r~: cif?
~gtt4 of 3fyaw are to tie =#1ci!uded with ttr;is acplicaiion.
7. This permittee shall commence actual construction in good faith with days. If the beginning date is
mare than 60 days from date of permit approval, then permittee must review the permit with the Director of
Public Works to make sure rto changes have occurred in the area that would affect the petmit#ed 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 tfre land to be entered upon and used by the holder, and tie 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 yJpon comple~rJh. /
siyn~:.~-~--'--- ~ `~ Date:~`~/°d -~: ~ y~'FICIAL SEAL
Befor~5 day of +f~cscti in the County of Duval, '~
State rich, has personally appeared (~, rid S l cam,, ~~,_ 7..,~. i~E~ll1a ~81'~
Notary Public at Large, Stale of Florida, County of Duval. t5__ {~ ~,# 3~5
My commission expirES: __~.~.-E~tx~ 1'~ ~t ~`~ ,` onat ~~_Iy~~cndv~vn. y ~ i~MY C si~^ E%p~25 OL10bCr 13, 20(18
- _ _ _ __ ProducEd Identifir~tifln -n
p.5
9D4-247-580D
904-247-5845
PERMIT# JJ ? •~
ISSUED BY THE CIT' ~ 1}, ' ) 2 ~0 ~~
Telephone # ~ ~1 - ~ ~~
Mar 28 06 01:57p Information Systems
R.O.W. Permit Attachment ~_ of /
R.O.W. Permit # ~ issued , 2005
~y'~~'~ Owner's Name:
Property Address:
Subdivision:
Lot # I Block #:
R.E. #:
904247-5845 p.1
for
Atlantic Beach, FL 32233
~bu~
// ~S aIO~D,./" L'E'I
X4.1 ~ () J"/1C,5 ~ ~ ~ .
REVOCABLE ENCROACHMENT PER~VIIT ~
S~
THIS REVOCAB ENCROACHMENT PERMIT, issued on this ~ day of
11~~~C-1~ , 200~by Atlantic Beach, Florida, a municipal corporation organised and existing
under the laws of the State of Florida, hereinafter referred to as "CITY" and _M/~- Cv. t 7 S!~ t~/ttG.
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: /~~5~~~- ~"yf-~- 1~/L)/`/w'~ `/
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, return receipt requested, #o the followin 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 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 ofthe C1TY 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.
The USER, prior to making any changes from the approved plans andlor method; must obtain
written approval from the City of Atlantic Beach, Public Works Department, for said change. The
Page 1 of 2
Mar 28 06 01:57p Information Systems
904247-5845 p.3
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 respectir•e
successors and assigns.
USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY
laws andfor specifications, to include utilities locate requirements and use limitations/requirements of
public rights-of--way and other public sand. 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 ~ nit-c.~~- , 200.`.~j ,
CITY OF ATLANTIC BEACH, FLORIDA, By:
a municipal corporation:
~~
By: ~/
Jim Han ,City onager
Attest: ___ _
Rick Carper, Public Works Director
STATE OF FLORIDA
COUNTY OF DUVAL
Property
^~r Public - smell a Ybride
~'tY Commission Expin3s Feb 1,, 201
Commission # DD St8533
Bonded By National Notary gsyn•
On this ~nl ~ day of ~~1. a h e ~-- , 2005, personally appeared before me> a Notar!r
Public in and for said County and State, the property owner of
,Atlantic Beach, Florida, known to me to be the person(sl
described in and who executed the foregoing instrument; who acknowledged to me that 6e or she:
executed the same freely and voluntarily and for the uses and purposes therein mentioned.
No • Pub ism ors 'd ounty and State
'~„~,~,~
,,`~."-+"~~'~,'~••. SHIRLEY GttAMAM
1.
`g~= ~Y Pubpc • Stele o/ Fbride
' • ~ commiaato-, Exphes Feb f4, 2010
~';FOF ;,,,~°' Commission # DD 5f8533
' ' Bonded By National Notary q~•
Page 2 of 2
Bv:
Pr perty Owner
(to be signed in presence o he Notary)
~~l X:rl ~+'~..
t ~.. ~Y ~~ A'Tg,AN'Tl[C ~~A~ D
1. =- U~
,.. F ; ~ PUlE~LIC W®I~S DEPAIt7CI4~dE1~I'Y' ' ~ 1
`= `~~~ ~~' 1200 Sandpiper Lane U`-'
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" % ' Atlantic Beach, Florida 32233
'-' ~.,, }/=.= ~ (904) 247-5834
`~'-~' (904) 247-1843 Fax
www.coab.us
PLA~ ~~.W ~~~~.~~-~
Permit Application # ~ ~ ' ~2 ~ Z 7
Property Address: ~~ 73 ~f!//D ~/D,Ei~ Gft"//~
Applicant:
Project:
~~ ~~~ Der Doo,e, ~9~ - ~~~ ~
if
Your application is approved as noted by the Public Works Department.
Fanal appHication approvaa must come from the Du~diing Department.
o Your permit application has been reviewed by the Public Works Department
anal the following items need attention:
Reviewed b er; P.l ., Public Works Director
Date .~ 3~
Signature
Contractor Notified Date
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.