Right of Way Permit 11-1112 2009 Selva Marina 2011 ri I,Aliy City of Atlantic Beach APPLICATION NUMBER
� i S� Building Department (To be assigned by the Building Department.)
800 Seminole Road //_ �! 1Z
v • = =`, Atlantic Beach, Florida 32233 -5445
C Phone (904) 247 -5826 • Fax (904) 247 -5845
' 4p il � s• E -mail: building- dept @coab.us Date routed: /(Z
City web -site: http: //www.coab.us
APPLICATION REVIEW AND TRACKING FORM
(` Department required Yes No review re
Property Address: ZOO 9 mi=l va 4,7/74., Z p p
/ Building
Applicant: Ale.2,6..e S ¢ � y Planning & Zoning
,r� Tree Administrator
Project: L{ ( J" / / � 4 u / � � � 7 � 1 t � - ub ' :. _ J.---- a- - ubli
Public Safety
Fire Services
Review fee $. } r. a Apt Sigi ature " .
Review or Receipt
Other Agency Review or Permit Required of Permit Verified By 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: ❑Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by: Date:
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. EDenied.
Comments:
Reviewed by: Date: l
Revised 07/27/10
Jun. 1. 2011 4:57PM No. 2251 P. 1
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BILLING ADDRESS: 1179 ELLIS ROAD SOCJIB
JACKSONVILLE, FLORIDA 32205 -6359
DATE;_ ( r 11
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TO:
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FROM: PHONE #: 904-783-6697
` 11 �. l 0 ', -� -- FAX #' d 904- 783-6679
FAX aft:
Performance has built our business...
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Message: I
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IF YOU DID NOT RECEIVE ALL __ PAGES, INCLUDING THE COVER SHEET,
PLEASE CALL OUR OFFICE, (904) 783 -6697
Jun. 1. 2011 4:57PM No. 2251 P. 2
•
• CiTY OE ATLANTIC BEACH
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aina
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EA S EMENTS
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' 800 Seminole Road
- gyp' Atlantic Beach, Florida 12233-5445 904-247-5800
Fax 904-247-5845
PLEASE SUBMIT (3) COMPLETE SETS OF PLANS WITH APPLICATION,
Date( c:
- - ll
PERMIT B
Job Address CEO ELL 1 I; 111 i r'1 F1 Dl 1SSUEb YTHE CITY — Z
Permitee: 41 t1 V 13 �- n e Li Telephone # q 3-( (0 [
Permittee Address: 111 ` OtaCI
4
Requesting Permission to Construct: Q a ul
.,S, t 4 - � r f' b �~ � ` i? D IZ y t f i o V��► �R 19 ri 5 TG R6
Location: (Reference to Cross - Street) Se L1� Li a r sa �; r1 r1 J 1? -t H •
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 (.-1' N ( ) Date: 5 - ° - - 3 - /
Bell South Telephone Company Yes (,--)' No ( ) Date: 5- D.- 3 - / I
Ferrmcastas Yes (4 No ( ) Date: S 113 i
Yes (✓f 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. Ali work shall meet City of Atlantic Bea or P prida Department of Transportation Standards and be
performed under the supervision of KALI (° caope • (Contractor's Pro ct
Superintendent) located at _11:1 9 r1 LL s Rd S Telephone*. 7 ' 3_ L
4. All materials and equipment shall be subject to inspection 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 showi'ngi anv Increase in impervious area on owner's lot or In the oily
Ri ht of Wa 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 personalty appeared
Notary Public at Large, State of Florida, County of Duval,
My commission expires: Personally Known:
Produced Identification
Jun, 1, 2011 4:58PM No. 2251 P, 3
•
•
R.O.W. Permit Attachment " of for
R.O.W. Permit # issued , 200_ Atlantic Beach, FL 32233
Owner's Name:
Property Address:
Subdivision,
Lot # / Block #;
R.E. #:
REVOCABLE ENCROACBMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERT, issued on this day of
, 200_, by Atlantic Beach, Florida, a municipal corporation organized and e
under the laws of the State of Florida, hereinafter referred to as "CITY" and
of Atlantic Beach, Florida, hereinafter referred to as "USER ".
`V4 TNESSETH:
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 - Way/Easement permit nurnbers noted above (copies attached).
This work is generally described as:
•
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
conditi
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 anust be replaced with smooth concrete left natural in color so that it
matches the existing and adjoining sidewalks."
Page 1 of 2
Jun. 1. 2011 4:58PM No. 2251 P. 4
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 teens and conditions of this permit and to all of the applicable State and CITY
laws and/or specifications, to include utilities Iocate 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 , 200_.
By:
Property Owner
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this day of , 200_, 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
CITY OF ATLANTIC BEACH, FLORIDA, a
municipal corporation:
Approved:
Ricky L. Carper, Public Works Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Jim Hanson, City Manager
Page 2 of 2
Jun. 1. 2011 4:58PM No.2251 P. 5
,
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Impervious Surface Calculations % Formula.
Find sated footage of the following:
mouse footprint
Driveway
. All sidewalks/walkways .
.A/C pads
Detached garage /sheds
Pool Decking
Patios, terraces and/or decks
Add the total square footage of the areas listed above then, divide the sum by
the total lot area of - the property.
5/t4a007
Jun. 1. 2011 4:58PM _ No. 2251 P. 6
ENGINEERING DESIGN
ORACLE PERMIT MAXIMO b n (J( DATE PEL
PROJECT #:11121006 , N,O _ WO #: 2C 7 F ! CONST: 13 MAY 2911
CIR. TREE TRIMMING
SUS -STA: NEPTUNE BEACH N.O.: 565 REQ'D: NONE
ENGINEER: B H TRULL CELL
N.O. 591 5428 ZIP CODE:
CUSTOMER/
LOCATION: 2005 SELVA MARINA DR SVC PHONE
CENTER: CONTR ADM. N O :
TROUBLE TICKET: 20110506 - 000109 i j _� I N ;�' i '� ,
BORE 1" CONDUIT & PULL 12d •• <;
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