Permit Driveway 371 Skate Rd 2012 , % j - 11
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00001344 Date 9/24/12
Property Address . . . . . . 371 SKATE RD
Application type description DRIVEWAY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0 ------
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Application desc
crushed stone driveway
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Owner Contractor
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NACCA, RICK V ET AL ATLANTIC SEAL & PAVE
456 SKATE ROAD 325 15TH AVE N
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
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Permit . . . . . . DRIVEWAY PERMIT
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 3/23/13
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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.
Full right-of-way restoration, including sod, is required.
Street/right-of-way must be swept clean following
installation.
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
ENG REV BLDG MOD OR ROW 125 . 00
STATE DBPR SURCHARGE 2 . 00
UTIL REV MODIF OR ROW 25 . 00
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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 154 . 00 154 . 00 . 00 . 00
Grand Total 189 . 00 189 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
mAp SHOWING BOUNDARY SURVEY OF
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As RECORDED IN PLA BOOK Jj pAGES 16-16D OF THE CURRENT PUBUC RECORDS OF DUVAL COUNTY, FLORIDA.
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CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
0
-247-5800
904
800 Seminole Road
Atlantic Beach,Florida 32233-5445 Fax 904-247-5845
PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION.
Date I- I ?-"Ix PERMIT#
JobAddress S ISSUED BY THE CITY
Permitee: Telephone#
Permittee Address:
CX_1\ _�A
Requesting,Permilsion to Construct:
a cla, 9—L-1 /I C
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 (i(), No Date: 4-19
N. Bell South Telephone Company Yes No Date: 3
Ferrell Gas AfI14 Yes No Date:
Comcast Yes (vi" 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 r Florida Dep�Artment of Transportation Standards and be
performed under the supervision of (Contractor's Project
Supedritendent) located at Telephone*. _'30?-
4. iklt 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 impmious area on owner's lot or in the citV
Right of Way are to bg included with this application.
7. This permiftee shall commence actual construction in good faith with -5 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 DI
shall be notified twenty-four (24) hours prior to starting work and again
im Piataely"tupon completion.
OWNER
Signed Date:
Before day of in the County of Duval,
State Of Florida-bas personally apR.eared
Notary pdl5li_4�[La g tatrlrFeda,County of -yl G HAM
CHIRI.t
My ca i ne ir
'M@Jly own:
C, u 4,2014
.1 z1pi
is \ /I - -
5onded.bru NotorY Pdb iC
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 lirnitations/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–.
�y: ��C-..—
AoKrty 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 d County jo-rj the property owner of
t)K01t_C_1 CC. Atlantic Beach, Florida, known to me to be the person(s)
described,Q and who executed the foregoing instrument; who acknowledged to me that he or she
C the sai ie freel oluntarily and for the uses and purposes therein mentioned.
johe Asai ie0free j un arSi d
exe9ut�t y k ly an 'or
0' t
MEE!
H
SHIRIP L GRAHAM
ON 4 DD 957760
'Ay Cowls&
No Pu lic '14 2014
r s y EXPIRLS-�:ebruary 14,2014
Unj
unt an
No ary Public in or said d Sta
"p, B.nded Th.N'otary Public Underwritem
t
CITY OF AT ANTIC B3 H,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
APPLICATION NUMBER
P (To be assigned by the Building Department.)
Building Department
800 Seminole Road
Atlantic Beach, Florida 32233-5445 12 -
Phone(904)247-5826 - Fax(904)247-5845-
E-mail: building-deptQcoab.us L Date routed: 911 z Zz Z_
City web-site: http://Vmm.coab.us 1 11
APPLICATION REVIEW AND TRACKING FORM
Property Address: Department review required Yes No
Building
Applicant: /7'11 Planning&Zoning
Tre tor
,e��i�tra I
Project: 00C It ")'A _P��_
Publi I
,UtiliC
Public Safety
Fire Services
Review fee Dept Signature A-<-
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: pproved. FIDenied.
(Circle one.) Comments-
BUILDING a,A�'Qj
PLANNING&ZONING Reviewed by Date:
TREEADMIN. Second Review: FlApproved as revised. nDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: FlApproved as revised. FIDenied.
Comments:
Reviewed by: Date:
Revised 07127110
City of Atlantic Beach
APPLICATION NUMBER
Building Department (To be assigned by the Building D artment.)
800 Seminole Road 72012
Atlantic Beach, Florida 322J3 12 -
�,5445
Phone(904)247-5826 - FaiJO64)247-5845
-.91ti" E-mail: building-dept(§coab.us Date routed: 911 z/Z z-
City web-site: http://vvww.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Department review required Yes No
Building
Applicant: Planning&Zoning
Pro'ect: Or-�"4 TrSp-4dfftkxLstrator
Public Safety
Fire Services
Review fee _ Dept Signature
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: �A pproved. E]Denied.
(Circle one.) Comments:
BUiLDkNG
PLANNING&ZONING Reviewed by:
TR��ADMIN. Second Review: nApproved as revised. ElDenied.
W Comments:
IC UTILITIES
Reviewed by: Date:
PUBLIC SAFETY
FIRE SERVICES Third Review: ElApproved as revised. E]Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10