701 JASMINE ST JEA POLE 2013 (2) City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road 13 - J12-81
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Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845 3
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E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND `RACKING FORM
Property Address: _�Q 67-77 Department review required Yes No
CC Building
Applicant: G Planning &Zoning
O T e-Ad ' trator
Project: d( ublic Work
lic Utilitie
u is afety
Fire Services
Review fee $ Dept SignafureT''
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
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. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
r` CITY OF ATLANTIC BEACH
r CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
800 Seminole Road 904-247-5800
Atlantic Beach,Florida 32233-5445 Fax 904-247-5845
PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION.
Date 07/23/2013 PERMI�BYTHE
ISSUE �CITY
JobAddress,6I_JASMINE ST
Permitee: JEA Telephone# (904) 665-4191
Permittee Address: 21 WEST CHURCH ST
Requesting Permission to Construct: (1) 35 FT WOOD CLEARANCE AND 60 LF OF SECONDARY CROSSING
Location: (Reference to Cross-Street) NORTH OF 6TH STREET WEST
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 (✓) Date: � J�i"f L L
Bell South Telephone Company Yes( I No (✓) Date:
Ferrell Gas
Yes( ) No (✓) Date:
Comcast Yes( ) No (✓) Date: n
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
Warks, 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 EDDIEGALES JEACOORDINATOR (Contractor's Project
Superintendent)located at SOUTHISDE SERVICE CENTER Telephone#: fW4}66a-6855
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 ate to be included with this application.
7. This permittee shall commence actual construction in good faith with s 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 co pletion.
OWNER 7
Signe Dat
Before is ay of n the Co my of Duv
State Of I 'da.has personally ap red
Notary ubli at Large.State of A ri .County o Du al.
My co fission expires Personally Known:
Produced I entification:
ENGINEERING DESIGN
ORACLE PERMIT MAXIMO DATE REL
PROJECT#: 13121001 N•0•: 2012/3069.910 WO#: 21755355 CONST:07.23-2013
CIR. TREE TRIMMING
SUB-STA: NEPTUNE N.O.: 561 J READ:NONE
CELL
ENGINEER: HGALE N,O.:904-219-9714 ZIP CODE: 32233
CUSTOMER] -701 Svc PHONE
LOCATION:X JASMINE ST.(X-ST 6TH ST.WEST) CENTER-. SOUTH N,O.:665-4191 OFC
THIS PROJECT PROPOSE TO INSTALL (1) 35FT WOOD CLEARANCE POLE FOR A NEW HOUSE
CONSTRUCTION ON JASMINE ST.ATLANTIC BEACH.
PLEASE CALL ONE CALL BEFORE DIGGING. USE CAUTION WHEN PLACING POLE, BURIED UTILTIES IN AREA,
PLEASE CONTACT THE CITY OF ATLANTIC BEACH AT 904-247-5834 AT LEAST 24 HOURS PRIOR TO
BEGINNING WORK.
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