Permit 316 7th Street row 2011 j /1 9:�fe'
City of Atlantic Beach v-0 I APPLICATION NUMBER
z (To be assigned by the Building Department.)
Building Department at
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
S7- Department review required Yes No
Property Address: �c5l & 7T;n
Building
Applicant: Planning &Zoning
Tree Administrator
Project: JQ4,eS ��ublic Wor!5�0
e la&—U fill i_f,6--s>
Public Safety
Fire Services
OWWOr"MU12 $11,16004222mamam
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
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.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN. Second Review: F]Approved as revised. F�Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: []Approved as revised. F�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 904-247-5800
-5445 -247-5845
'A" Atlantic Beach,Florida 32233 Fax 904
Date PERMIT#
ISSUED BY THE CITY
Job Address 41- 1
Permitee: cl(ZK-) 4—C-wlcvl S0-1 ie&S Telephone# V�?_ - 32 7!5-
Permittee Address: 31 � 3`4 &�ta�
Requesting Permission to Construct:
Location: (Reference to Cross-Street)
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 ) No ( 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 Permiftee 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 -ro(>o A i3dYca (Contractor's Project
Superintendent)located at C_,CAJL'05 f5LfjLDrfQ e ir ez(g Telephone#: 57 VY'—J 40 61b
4. All materials and equipment shall be subject to inspection by thd 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
Ri-ght 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 SE'
City's right, title and interest in the land to be entered upon and us(
times, assume all risk of and indemnify, defend, and save harm
against any and all loss, damage, and cost of expenses arising in
exercises by the holder of the aforesaid rights and privileges.
9. The Director of Public Works shall be notified twenty-four (24) -72-B
immediately upo ompletion.
0 completion.
Date.
v of—.'C—
'y U P&
OWNER (V 7�
Signed: Date:
Before me this y of tv I the County of Duva 4-C�i
State Of Florida,has—pWr-sonally appeared aijeni: -�,Vex-57
Notary Public at Large,State of Florida,County of'bdval. 556
My corrimi,5sjon expires:
,:tttaily=Kn n:
entification: WILLIAM L PePE
Notary Public, State of Florida 7 500
MY COMm. exp. Oct 19, 2011
Comm. No. DO 714216
R.O.W. Permit Attachment of for
R.O.W. Permit# issued 200_ Atlantic Beach, FL 32233
Owner's Name: T- ey(CA
Property Address: -7
Subdivision:
Lot#/Block#:
R.E. #:
REVOCABLE ENCROACHMENT PERMIT
T HIS REVOCABLE ENCROACHMENT PERMIT, issued on this -2-(e 41 day of
ju��Q" 201 by Atlantic Beach, Florida, a municipal corporation organized and existing
under the 4s-of t�e 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: ef n oe f r� 7? T& vi ec,
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, 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 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."
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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, 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 A(o dayof 2041.
By: i �
Pl%e�ner
(to in ce of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this ZZ �e day of 204 k personally appeared before me, a Notary
Public in and f r said County and' State, (�jr"c�, /&�� , the property owner of
I -)cx,� —
(.0 _7Z SA-r-P-0— Atlanti�BeaA,-�Florida, k4own 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.
416&� _�C�zc WILLIAM L POPE
NotE I County and State Notary Public, State of Florida
MY COMM. exP. Oct 19, 2011
CITY OF ATLANTIC BEACH, FLORIDA, a Comm. No. DO 714216
municipal corporation:
Approved:
Ricky L. Carper, Public Works Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Jim Hanson, City Manager
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