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Permit Pavers 1647 W Park Ter 2011 s °I CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD '5 ,, ___.). ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number 11- 00001111 Date 6/15/11 Property Address 1647 W PARK TER Application type description RIGHT -OF -WAY PERMIT Property Zoning TO BE UPDATED Application valuation . . . 0 Application desc concrete to pavers Owner Contractor MILLER, CAPT. DONALD M OWNER 1647 PARK TERRACE WEST ATLANTIC BEACH FL 32233 Permit RIGHT OF WAY PERMIT Additional desc . Permit Fee . . . 35.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 12/12/11 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 is needed, call 247 -5834. 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. Roll off container company must be on City approved list and container cannot be placed on City right -of -way. Other Fees STATE DCA SURCHARGE 2.00 ENG REV BLDG MOD OR ROW 50.00 STATE DBPR SURCHARGE 2.00 UTIL REV MODIF OR ROW 25.00 Fee summary Charged Paid Credited Due Permit Fee Total 35.00 35.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1 79. p 00 7 . ( 0 �( 0 . 00 .00 � n PERMIT IS APP O IN ACCORDANCE Wi 1 ALL ° CITY OF AII NT IC EACH ORDINANC ° AND THE FLORIDA BUILDING CODES. , . , . 1 , • I • • ■ I .. S • ■ 1 1 c . ; r c , Donald M. Miller �� •�• • I647 Park Terrace W. O G. ' it ri • • . ` , ^ ' c = . t Atlantic Beach, Fla, 32233 ��� • t t I . ' n , I ,? No, 1209 l - L. / � — .' / / /.r .. / , t / I / /.C" / ' // a— ✓ l !y /- 0 " / // 7 /� �� •�' ..�.� ��1 • i J 1\ L N n Q n +� I ' S PY h , ......_ ,) , ...,, �; F , . I c.,... i, \ , , . ....„----.-„, , ,. , • , , u , .... , 1 \ , . i O T • I I I. 11 ! ar f . Ii i I • I ; i r —J . // . Le • - .) .. /" `- - r- ' ..`�.. - -_ _. ...... v.aw ? .. wrrrr - = pia... +.,•- ,.r�...r rww.�vau.erw.� .sue ....�... „...._. . . • 30 CITY OF ATLANTIC BEACH ' 3.A' A'' 0,0 : l.S ir, CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY ,'ND EASEMENTS l l 800 Seminole Road 904- 247 -5800 -cii ,.- Atlantic Beach, Florida 32233 -5445 / Fax 904 - 247 -5845 Date 5 3 / ;ail PERM! # Job Address /4 //TR T/1/K /1C(i l'Y ISSUE BY THE CITY Permitee: C inllieS W� / ,1 f5M/ M,f /vgy Thee Telephon ? d i 4 ' f 9371/ Permittee Address: o?402.5" f 't $'6 B /I4" ciA-,e, /=L 3.42/,6 Req esting Permission to Constr ct: gOrnOU' f ©/I# 1 'PG 0'A lite G 1.fta - 4 Location: (Reference to Cross - Street) /47 7 PARK leitqlcP fril 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 (11 No ( ) Date: Bell South Telephone Company Yes (Pr No ( ) Date: Ferrell Gas Yes (4' 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 Permittee 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 (Contractor's Project Superintendent) located at Telephone #: 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 showing any increase in impervious area on owner's lot or in the city Right 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 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: D31e: ��J ! l �j Before me this day of � in the County of Duval, State Of Florida, has personally appeared Notary Public at Large, State of Flori. -, County of Duval. My commission expires: , ,----'., "' ° "' SH Personally Known: /% W i► �A i '' . - . GRAHAM �{ SHIRIRLEE Y L L A DD 957760 ,� / Produced Ident'fi •- ion: ! R PIRES: February 14, 2014 •r ' C I !ll......___ , ' ' Bonded Thru Notary Public Underwriters C) R.O.W. Permit Attachment of for R.O.W. Permit # issued , 200_ Atlantic Beach, FL 32233 Owner' s Name: Property Address: /(p r 7 414 /Er" Subdivision: Lot # / Block #: R.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 ". 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: ? 6r 7A, V !_S 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." 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, 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 31 day of /ray , 204j. Property Owner (to be signed in presence of the Notary) STATE OF FLORIDA COUNTY OF DUVAL On this day of a , 200, personally appeared before me, a Notary Public in and for said County aiid 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 exxxx• a e same free d vol tarily and for the uses and purposes therein mentioned. Notary Public i , for sa County . es Y:4?-: SHIRLEY L. GRAHAM : *• i :,r MY COMMISSION # DD 957760 -i -? EXPIRES: February 14, 2014 CITY OF ATLANTIC BEACH, F c * y Bonded Thru Notary Public Underwriters 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 ril,:1.�1 � City of Atlantic Beach APPLICATION NUMBER jt ' Building Department � (To be assigned by the Building Department.) 800 Seminole Road ✓,(1� ' // - ; T : - Atlantic Beach, Florida 32233 -5445 .t' , " , _ Phone (904) 247 -5826 • Fax (904) 5845 � ?0j / _�,a >. E -mail: building- dept@coab.us Date routed: /.�//// City web -site: http: //www.coab.us 111 APPLICATION REVIEW AND - ACKING FORM Property Address: /6 / 7 It) Par ✓ l /' Department review required Yes No Building Applicant: £/t4i/- 11, 6-i3'an Planning & Zoning LL - trator Project: i Cr y TD s Public W • r. :Di. __ Utilities Public Safety Fire Services .. i $ . 7 � p : Review fee . _ .. ,�y .. ' ` ��e t'3 ieAtZ7 . Rev Other Agency Review or Permit Required of Pe rm it or Ve Receipt rified 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. VDenied. (Circle one.) Comments: I -C G- I"t .e BUILDING PLANNING & ZONING Reviewed by: '4 Date: 0--)// TREE ADMIN. Second Review: Approved as revised. ❑ Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES ?ALA° PUBLIC SAFETY Reviewed by: I . Date: 4 FIRE SERVICES Third Review: ['Approved as revised. ['Denied. Comments: Reviewed by: Date: Revised 07/27/10 t � a,y. City of Atlantic Beach APPLICATION NUMBER r �... � Buildin De 0- t ( To be V assigned by the Building Department.) r 8 00 Seminole Road ✓/4 //-7//1 , ,- s.. � Atlantic Beach, Florida 32233 -5445 1 , \ .. P hone (904) 247 -5826 • Fax (904)' •..w, -!: 5 I �// //� :2, �; : 1 9 p Cd3 9 > E -m ail: buildin -de t coab.us ,,�, Date routed : �/3/ / City web -site: http: //www.coab.us APPLICATION REVIEW AND - A CKING FORM Property Address: ili 7 lea Pa r/ V le Department review required Yes No Building Applicant: Oitfr /_s PI /1 Q rim 6-6 r Planning & Zoning LL y t rator Project: 1 rn erf / & Tb S Public W • Utiles Public Safety Fire Services Review fee $; i ilpSig :« 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: QApproved. [Denied. (Circle one.) Comments: es )& BUILDING PLANNING & ZONING Reviewed by: Date: 0).--)// 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 07;27/10 f" 11.:1Tdr� City of Atlantic Beach APPLICATION NUMBER '' i Building Department ( To be assigned by the Building Department.) v 800 Seminole Road /1— // / 1 j F > : -, P Atlantic Beach, Florida 32233 -5445 Phone (904) 247-5826 • Fax (904) 247 -5845 M.olti E -mail: building- dept @coab.us Date routed: 3/ // City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: /(7 / 7 10 Pa r/C V / Department review required Yes No Building Applicant: C)1-r/" P);/// Q- r � r Planning & Zoning . - -'•' trator Project: �b7') Lrf ! & -h ��-�- S Public Worms A 'c Utilitie Public Safety Fire Services Review fe $ . � , � , l l P 91�e � 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 k PLANNING & ZONING ( 4 4 i i Reviewed by by: Date: 6l/7/ TREE ADMIN. Second Review: Approved as revised. ['Denied. P 4 19 Comments: • 4 9, IL , f PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07/27/10