2215 Alicia Ln 2013 ROW �� zz CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
�JF3
Application Number . . . . . 13-00003770 Date 12/10/13
Property Address . . . . . . 2215 ALICIA LN
Application type description RIGHT-OF-WAY PERMIT
Property Zoning . . . . . . . RES GEN MF DISTRICT
Application valuation . . . . 0
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Application desc
NEW PAVERS, DRIVEWAY, WALKWAY, TRAVERTINE STEPS
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Owner Contractor
------------------------ ------------------------
LEWIS DENISE KLETT LIVING TRST OWNER
335 W 107TH STREET
CARMEL IN 460329587
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Permit . . . . . . DRIVEWAY PERMIT
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 6/08/14
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Special Notes and Comments
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.
No public right-of-way impacts, and no increase in existing
impervious surface area is permitted.
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 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 29 . 00 29 . 00 . 00 . 00
Grand Total 64 . 00 64 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
CITY OF ATLANTIC BEACH
M F� L'J
CONSTRUCTION PERMIT WITHIN CITY RIGHT W,Y,AN, E TS
800 Seminole Road 90 47-5800
Atlantic Beach,Florida 32233-5445 h
904 47-5845
By
PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION. copy
PERMIT# (�
Job Address L,Z A�/)CI'yti ISSUED BY THE CITY
Permitee: �� ') (�ew�' Telephone# ?b -/ -
Permittee Address: 2-2- K hl4n �_,l
Requesting Permission to Construct: /v P�qve/t I'lafrti WA IX"o et
Location: (Reference to Cross-Street) I , i i PG[✓ C
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 �Lll �-VPY Yes (.� No ( ) Date:
Bell South Telephone Company n Yes (t) No ( ) Date:
Ferrell Gas Yes (� No ( ) Date:
Comcast w '�j3 Yes (✓S 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 SHAW41 10414PIE2 (Contractor's Project
Superintendent) located at 65o:3 Si lvatj Glen nit- 7hX -FL 32Z5'T Telephone#: -33q- 128(o
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 ompletion.
OWNER � '
` �� /3
Signed: Date:
Before me this day of /��re"4w i�County of Duval,
State Of Florida, has personally appeared
Notary Public at Large,State of Florida,County o Duva 3.
My commission expires: Personally KnEn:entification: p� STEPHEN T.PUTNAM
°cam Notary Public,State of Florida
Commission#DD998148
My comm.expires July 20,2014
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: Gli�� Rti��/��} LAX, Permit Number:
Legal Description Parcel#
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ VII–L--� Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition e eration pair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residential
If an existing structtuure,is a fire sprm er system installed?(Circle one): Yes No N/A
Florida Product Approval#
For multiple products use product approva orm
est cn�e'm detail the type of work to be performed: &EW n/� �I�1zA,t.IW1 �l�L/i LI/la�s
di T12Aw2 ma STm• �t'�olrff
Prover r Information:
Name: RI 1Ly)S
2
_LIS
t City /i"i IQifI1�L lS�r StateP'1-Ziphone
E-Mail or Fax (Optional) �,
Contractor information: Q,tie P_#r,wit`s FM Lty
Company Name. QualiAing A ent:
Address: CS�'�S� ry l Ctry J XK 3"t ,11, State Zip t4
Office Phone Job ite/Contact Number Fax#
State CertificatiSnMgisha ton !�!�
Architect Name&Phone# #71 r;� /.7.
Engineer's Name&Phone# � _?W
Fee Simple Title Holder Name and-
Address
Bonding Company Name and
Address
Mortgage Lender Name and Address
Ahpplication is hereby made obtain a permit to do the work and ixstatlattoru as indicated Icethat no work or installation has commenced prior to
t e issuance of a permit an that all work will bepe dorm d to meet the tandards of all laws regulattn c nstructton in this jurisdiction This permit
becomes rmll and void if work is not commenced within six�6)months,or construction or work is suspengde�or abandoned(or a pperiod o�six(6)months
at any time after work rs commenced I understand that separate permits must be secured for Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,
Boilers,Healers,Tanks and Air Conditioners,etc
WARNING TO OWNER:YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY.IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing
this type ofwork will be complied with whether spec�ed herein or not. The grantin ofa permit does not resume to give authority to violate or cancel the
provisions of arty otherfederal,st local law re lating cynstruction or the performance ofconstructpon.
Signature of Owner Signature of Contra. rds
Print Name 4 644/1 S Print Name _ _.._..._._
Sworn tR and subscribed before me Sworn to and subscribed before me
this Day of /xltw' r .20/ this —Day of -20
Notary Public Notary Public
Revised 01.26.10
.� STEPliEN T.PUTNAM
Notary Public,State of Florida
IRScommission#OD998148
FAy comm.expires July 20, 2014
R.O.W. Permit Attachment of for
R.O.W. Permit# issued , 200_ Atlantic Beach, FL 32233
Owner's Name: G Rn 1 eU.i 5 i
Property Address: Z z i S &f664 Z4
Al',�;47jc f�e�c�, j'G 3L233
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: MOW PAVGIZ L0$4 W A t-kk.;A VS
Q �\Jo
1
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 insure 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.
DATEDand ED thia�._
day of
By:
Property Owner
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL S
On this 2=8 day of cem 20� , personally appeared before me, a Notary
Public in and for said County and State, . C• Le-,:s , the property owner of
t 21 S' A I.C,'5 L Sn f , Atlantic Aeach, 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 freely and voluntarily and for the uses and purposes therein mentioned.
/ �y p6� STEPHEN T.PUTNAM
Notary Public,State of Florida
Notary Public in for said County and State My comm.'expire July 20,2014
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
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A i PA` ED PRIVATE ROAD
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
. r
` Phone (904)247-5826 • Fax(904)247-5845
j ? E-mail: building-dept@coab.us Date routed: ^Z'
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z2) 5 Au D A U\) Department review required Yes No
' Q Building
Applicant: ��� w Is Planning &Zoning
Tree Administrator
Project: Pay L rSy V V t + Public Wor
f G11/ ` _ `Ck� 5� Pubic�ii
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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: F_
BUILDING _ ¢ � ���— � vC
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
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
• 800 Seminole Road 1-3-3 3��0
Atlantic Beach, Florida 32233-5445
* Phone(904)247-5826 • Fax(904)247-5845
��; �• E-mail: building-dept@coab.us L Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 2ZI 5 AW U A Uv Department review required Yes No
IN Building
Applicant: GI QkY_U Lf lJV1S Planning &Zoning
1/ Tree Administrator
Project: ublic Works
pp /� Public Utilities Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or ReceiptDate
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: 911pproved. ❑Denied.
Circle one.)) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied.
PRKS C ments:
UB U ILITIE
PUBL
BLOC r Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. [—]Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09