Permit Pavers R/W 376 4th 2011 . v :> CITY OF ATLANTIC BEACH
Wit I 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233 sl
„ , , ° o INSPECTION PHONE LINE 247 -5814
-.011. S
Application Number 11- 00002725 Date 10/11/11
Property Address 376 4TH ST
Application type description RIGHT -OF -WAY PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
Install Brick Pavers
Owner Contractor
WEISS OWNER
376 4TH STREET
ATLANTIC BEACH FL 32233
Permit DRIVEWAY PERMIT
Additional desc . .00
Permit Fee . . . 35.00 Plan Check Fee . .
Issue Date . . . Valuation . . . . 0
Expiration Date . 4/08/12
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 at RT1 concrete box with
metal lid. Cleanout to be set to grade and visible.
Driveway widening only.
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 79.00 79.00 .00 .00
Grand Total 114.00 114.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
i f
CITY OF ATLANTIC BEACH
A :i CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
—
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,, . 800 Seminole Road 904-247-5800
I Atlantic Beach, Florida 32233 -5445 Fax 904247 -5845
PLEASE SUBMIT (3) COMPLETE SETTS OF PLANS WITH APPLICATION.
Date /3Z /11 PERMIT #
' - ISSUED BY THE CITY
Job Address / 1 �1/ 1 0- 170
t IS Telephone # ° J/)y - =' '
Permitee: � 1,�t�lr � �
Permittee Address: 3 '7(' / j, -rif Sr � 4
7-1.A vr7L k'- 3,2 3 / Requesting Permission to Construct: ,r I
Location: (Reference to Cross - Street) )1iY-`7
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 (J) Date:
Bell South Telephone Company Yes ( ) No (4 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 Permittee unless reimbursement is
authorized.
3. All work shall meet City of Atlantic Beach or Florid Department of Transportation Standards and be
performed under the supervision of 4,01 -L4 ) r (Contractor's Project
Superintendent) located at 1 1,1w6‘..rt" t vOScA -off S&' & Telephone #: /or -543- ?015
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 _ ,.
�� !�►• te: ,, Signed: L da of 1 � ( i the C ►unt • ' _ I,,, c fl _ ®�,! MY q ,
Before � Y � / S6rpry NN'1E
State Of F 'da, has personally appeared ,k,4 `c-� t .tl�C GVI s S +,' 1RES . �RST, g
Notary Public at Large, State of Florida, County of Duval. "` nr nr Not,;; r 2 015
My mmissio n� mr�i Personally Known:
f � 0 L. - �t'd c u yc , S 'S - V C J Produced Identification:
1 71U - i4-7---4— 6 _._. -._.-_._._. —Z,1 �. -1- 4. Wiz .__..
R.O.W. Permit Attachment of for
R.O.W. Permit # issued , 200_ Atlantic Beach, FL 32233
Owner's Name:
Property Address: th /
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: i 6 ' Ay
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 pen 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.
DA'Z'ED and SIGNED this ` day of 6,f ,/..-t , 20f t.
B '�/� . -f.I'
L---Pi • erty Owner
(tt .e signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF ,DUVAL
On this da of ��� , 2Q 2 personally appeared before me, a Notary
Public in and for said County and State, J( '-I C /Z'i , u � `' ' , 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 freel and voluntarily and for the uses and purposes therein mentioned. 7
/l -6
elk DEBORAH AMANDA WHITE
otary Public in for said County and State : , , `' ' My COMMISSION # EE 057349
.:y EXPIRES: May 21, 2015
•• • Bonded ThN Nagy Pubhc UndenMrders
CITY OF ATLANTIC BEACH, FLORIDA, a l
m. .
municipal corporation:
Approved:
Ricky L. Carper, Public Works Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Jim Hanson, City Manager
Page2of2
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S't/'r City of Atlantic Beach APPLICATION NUMBER
` z" t Building Department
i (To be assigned by the Building Department.)
800 Seminole Road
247 -5845 //_ z 72 5
�� Atlantic Phone (904) 2 Beach, 7 F
-5826 32233 -5445 Fax (904)
'.. r_ort q r E -mail: building- dept @coab.us Date routed: / �
City web -site: http: //www.coab.us
APPLICATION REVIEW AND TRACKING FORM
i 4 //, Department review required Yes No
�
Property Address: / � "�"` -
Building
Applicant: (I-h4 --di nin_.g_& Zoning ----- t--'
Tree Administrator
Project: h blic Work) ✓
Public Utilitie s
Public Safety
Fire Services
Review fee S : x, s y'1a��` 4 z 544 ,
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:
e- I-0 Iwo/up-14A i4treaMOLLS Surtmex., lin/Lambe/
BUILDING
• NING . c /1 /6/44/26//
Reviewed by: % ate:
REE ADMIN. Second Review: ['Approved as revised. ['Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ODenied.
Comments:
Reviewed by: Date:
Revised 05/14/09
SL trry City of Atlantic Beach R ;C :V`!D APPLICATION NUMBER
s Building Department (To be assigned by the Building Department.)
r 800 Seminole Road ® 2011 //_ 2 2 2 5
j Atlantic Beach, F 32233- 4 / G Phone (904) 2 - 5826 Fax 247 - 5845 E -mail: building- dept @coab.0 � � =�� Date routed: �� - ---//
City web -site: http: //www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3 7( 4/
` Department review required Yes No
Building
Applicant: G- -e. wing & Zoning L/
Tree Administrator
Project: ?g--1-14-6.1---- �F•- bl ►c. w or s iv
C Public Utilities
Public Safety
Fire Services
ReVlle }X fee $ * .:, 0 " ,, c'`#i,,�^'" }. P. 3..„
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: gkpproved. ['Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by: Date: /6Cc — i/
l
TREE ADMIN. econd Review: QApproved as revised. ❑Denied.
P;1. OR S o ments:
■ PIB IC IL TIES
()—
PUBLIC SAFE Reviewed by: Date:
FIRE SERVICES Third Review: QApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
r S v- City of Atlantic Beach APPLICATION NUMBER
z „ Building Department RECEIVE L ) (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233 -5445 OCT 0 4 2011 g- Z Z 5
Phone (904) 247 -5826 • Fax (904) 247 -5845
y'r E -mail: building- dept @coab.us BS Date routed: / - -/
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property 4/
Address: 3 7(o - - 97 Department review required Yes No
P
Building
Applicant: C:Planning & Zoning ✓
Tree Administrator
Project: cblic Works �
Public Utilities h ✓
Public Safety
Fire Services
pp
6a �w. � .. `� � �� ,�a ' �u r° "
s Vi lla r��
NmT, ,4 > �Y' ,.., t •j ✓`^"1} 'A a �• Lr +—�;L $ .. r 0. Y + ,
�
f '��
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: 7
APPLICATION STATUS '
Reviewing Department First Review: ❑Approved. [gDenieed. c „ 0`' ) i h
(Circle one.) Comments: Fit ® p 1 � , r s „ I ` y^ tf - C�✓
BUILDING CoR_ /` -7 et ?V; 4-5 ,z,, o4k
frit4.
PLANNING & ZONING b
Reviewed by: Date: /
TREE ADMIN. Second Review: ►OP, pproved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES p_ DR) ,toy `D t A` QNL
PUBLIC SAFETY Reviewed by: Date: /9
FIRE SERVICES Third Review: ['Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09