Permit Voided 580 Sherry 2011 ;_ "��`° CITY OF ATLANTIC BEACH
7-: , ` CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
,` 800 Seminole Road
.1
904- 247 -5800
,'t 'le Atlantic Beach, Florida 32233 -5445 Fax 904 - 247 -5845
Date : "! (w 4 t 0) 'Z,° if.
PERMIT #
Job Address n > 4 t r3 \3 1 r \ +` .?;213 ISSUED BY THE CITY
Permitee: I a OA, „ Pew._, Telephone #
Permittee Address: r \1
Requesting Permission to Construct: QA.,,tn., (.6 `(-k; -..) (O Lt )(AL t
Location: (Reference to Cross - Street) / \.
k.
1. Applicant declares that prior to fill this application h- has - 1 ertained the location \ isting utilities,
both aerial and undergr d as he accurate locations : e s • on the sketches.
A Letter of Notification a Mailed to the f owing Utilitie nicipalities: \
Jacksonville Electric Authority Ye • ) o ( ) 1- : .
Bell South Telephone Company \ es ) o ( ) - e:
Ferrell Gas - o ( I -te:
Comcast o ( 1 ate:
2. Whenever necessary for the construction, rep , improve - mai en- \ -, safe and efficient operation,
alteration or relocation of all, or any portion of said street or : - - - ment - - d '. ined by the Director of Public
Works, any or all of said poles, wires, pipes, cables or other face i. and appurtenances authorized
hereunder, shall be immediately removed from said street or easem- 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 De artment of Transportation Standards and be
performed under the supervision of of .rit Vc..ue__, (Contractor's Project
Superintendent) located at 3%45 \'6‘%• ,,.Q. IV 4 Q L 2 . 25 3elephone #:Q'oc s _ 533 -O`- II
4. All materials and equipment shall be subject to inspection by the Direc or 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: .
Before me this day of in the County of Duval,
State Of Florida, has per onally appeared
Notary Public at Larg- of F orida, of Duv I 1. ■
My commis ' • ex. " "'� P�'- SHIRLEY L. GRAHAM
Personally nown: �� A� -1 I ? A a MY COMMISSION N DD 9577
Produced Id-'tificati lip
�• - 1 ' 0 , Bonded hru N a ry Pub Under writers _ ...
ebruary
R.O.W. Permit Attachment of for
R.O.W. Permit # issued , 200_ Atlantic Beach, FL 32233
Owner's Name: re,. 3 C \��--
Property Address: c7 J1, -e t f I OC
(Ns- \ 1._
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: w ay .� kotA,V(. 6-LX 'cx,'u
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 hereb assumed by the USER. l)
DATED and SIGNED this / day of , 2001
By:
Property 0 er
(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)
d ribed • ' , d who executed the foregoing instrument; who acknowledged to me that he or she
executef, . /- freel . Id vo A tarily -___ -- — eN .,;41!r• • - therein mentioned.
'� '
; ;n ;6., SHI'
2.*,.:. �' ,�� Y MY COMMISSION # DD 957760
' , � EXPIRES: February 14, 2014
i ' 0
; , y d4 Bonded Thru Notary Public Underwriters
Notary Public in or sai a, unty and Sta
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
" City of Atlantic Beach 1 C, APPLICATION NUMBER
rf l f".., Building Department y (To be assigned b the Buil / ding D partment.)
= 800 Seminole Road - N # , a // / / /
,J
'• ; r Atlantic Beach, Florida 32233-5445 « ��
J
Phone (904) 247 -5826 Fax (904) 2 5
'.� u jf' E -mail: building- dept @coab.us `• . Date routed: /�
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: X0) SM rr Department review required Yes No
Building
Applicant:' DC42 d a) 4 Planning & Zoning
Treg.Administrator
Project: -7_)>9-v--e_ ' u .:,) rksJ
(Mimi
Public Safety
Fire Services
Review fee ${ • - :, l _> ;QeP `'Stg tte
tiA .4., "k4=;;
k ;
Review or Receipt Date
Other Agency Review or Permit Required 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:
APP !CATION STATUS
Reviewing Department First Review: pproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by: Date: (0•-13 -1(
TREE ADMIN. Second Review: nApproved as revised. ❑Denied.
P 4 - ORKS C mments:
P :L UTIL IE
4J?
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: (Approved as revised. (Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
!.J,-1 f, . ,. City of Atlantic Beach
'' APPLICATION NUMBER
� r B ui ld ing Department (To be assigned by the Building Dgpartment )
'� 800 Seminole Road JON 7 Vii► - // / — /, ,_ 2. . ^-k ; -' -r Atlantic Beach, Florida 32233 -5445 J Ph (904) 247 -5826 • Fax (904 '' ' , 6845 lig 7!: � one . Date routed: (1 /
<.. 0ri1 j.• E -mail: building- dept @coab.us \„,__�
w
City web -site: http: //ww.coab.us ��\\
APPLICATION REVIEW AND TRACKING FORM
�jl_
Property Address: o ` / rr Department review required 1 Yes No
Building
Applicant: 7 k - - c:. d ed Planning & Zoning
Tr- - : • it' istrator
Project: e - -ub 'r•. Wn s
i)frii
errflralli'
Public Safety
Fire Services
Reyievu fee ${ : k ' t ° , - , l ket € tti .x., ZA` " ° . 4
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.) Commen
p— d , .
BUILDING L a-3e • , • .
.. 1.4.4_
PLANNING & ZONING
Reviewed by: Date:
TREE ADMIN. Second Review: DApproved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
PREPARED 6/15/11, 14:31:48 PAYMENTS DUE RECEIPT
CITY OF ATLANTIC BEACH PROGRAM BP820L
APPLICATION NUMBER: 11- 00001114 580 SHERRY DR
FEE DESCRIPTION AMOUNT DUE
STATE DCA SURCHARGE 2.00
ENG REV BLDG MOD OR ROW 50.00
RIGHT OF WAY PERMIT 35.00
STATE DBPR SURCHARGE 2.00
UTIL REV MODIF OR ROW 25.00
TOTAL DUE 114.00
Please present this receipt to the cashier with full payment.
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