1768 W PARK tER 2014 dRVEWY CITY OF ATLANTIC BEACH
1 s) 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00000146 Date 2/11/14
Property Address . . . . . . 1768 W PARK TER
Application type description RIGHT-OF-WAY PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
PAVER WALKWAY AND DRIVEWAY
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Owner Contractor
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LANIER MICHAEL W OWNER
1768 PARK TER W
ATLANTIC BEACH FL 322335612
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Permit . . . . . . DRIVEWAY PERMIT
Additional desc . . 00
Permit Fee . . . . 35 . 00 Plan Check Fee
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 8/10/14
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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.
Roll off container company must be on City approved list
and container cannot be placed on City Right-of-Way.
(Approved: Advanced Disposal, Realco, Shappelle ' s and Waste
Management . )
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Other Fees
_ STATE DCA SURCHARGE 2 . 0
ENG REV BLDG MOD OR ROW 25 . 00
STATE DBPR SURCHARGE 2 . 00
UTIL REV MODIF OR ROW 25 . 00
Fee summary Charged Paid Credited Due
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Permit Fee Total 35 . 00 35 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 54 . 00 54 . 00 . 00 . 00
Grand Total 89 . 00 89 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
' r 'I' ilJC
CITY OF ATLANTIC BEACH
J %`I 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_ I�3 I by
PERMIT#
Job Address 7 6y eoti ls Y ria tt A,*e!S f ISSUED BY THE CITY
Permitee: /'ldwdntaol 6Pnc,r ti`(e- c?�•� Telephone# 90`r 2*`/ �1K
Permittee Address: 14 /(/. AP X-c ale- 9/v,4 �i...�.c �/�.l�s >F'G .3Z o,r 2-
Requesting
Requesting Permission to Construct: _ Ve a ejo v ei- 6✓�1k&40VX X /41!04.•v e 44^01
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/Municipalitie
Jacksonville Electric Authority Yes( No ( ) Date:
Bell South Telephone Company CO Yes(. No ( ). Date:, . i
Ferrell Gas 1L Yes ( :No ( ) Date: � r
Comcast Yes (,.Y No ( ) Date: f AiriV.
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 S2i or easement or reset or relocated hereon as
required by the Director of Public d al p se of the Permittee unless reimbursement is
authorized.
3. All work shall meet Cit of AtlantBeach or Florida Department epartment of Transportation Standards and be
performed under the supervision of er (Contractor's Project
Superintendent) located at ✓."n Telephone#:(4�y) a?If::I/
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;-/6f 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.
I
OWNER '
xSigne /l _ Date:
Before a this day of in the County of Duval,
State f i a, s s ally appeared 1q ; SHIRLEY L GRAHAM
ublic at L e, to of Floridaof Duval I
AMMN#DD 157760
y co r m sio ,Co tyn ire Perso rh S•t•^hruary 14,2014
PFedmftd Identification: ! 4RThroNMaryPublicOdderwrflers
Permit Attachment of for
Permit# issued , 20_Atlantic Beach,FL 32233
Owner's Name: Property Address:
R.E. #:
Subdivision: Lot#/Block#:
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of , 20_,
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: 1 Lljitlk"[
rl r(,
`04�
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 requesied:..to submit as-built drawings showing the change within thirty (30) days
after the day of completion.
This permit shall insure to the be.-ae it'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.
DATED and SIGNED this day of J , 20/Y
Xy: 4M
operty Ownuo
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this day of , 20_, personally appeared before me, a Notary Public in
and for said ounty , and State, , the property owner of
j f ,Atlantic Beach,Florida, known tome 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 1 n y a for the d purpo s therein mentioned.
SHIRLEY L.GRAHAM
L
4'�Y PY�i
Nota Public in f said Coun and State A,. Y Av COMMISSION#DD 9577760
�' m•.� ;, EXPIRES:February 14, _
141
',,PF
�d 9onded Thru Nn+ary Public Underwriters
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:
Nelson Van Liere, City Manager
Page 2 of 2
I
City of Atlantic Beach �j, T APPLICATION NUMBER
rj } Building Department (To be assigned by the Building Department.)
800 Semin le Road �' I
Atlantic Beach, Florida 32233-5445 Z414
Phone(904 1247-5826 • Fax(904) 45
E-mail: bui]Jing-dept@coab.us _ Date routed:
City web-sit : http://www.coab.us L
APPLICATION REVIEW AND TRACKING FORM
Property Address:,('�� �/� Department review re uired Yes No
Building
Applicant: �` �� Plannin, i Zoning
Tree Adi,unistrator
Project: C ubli orks
C Public L. :'ties
�b �!� �al;y/ Public S iiety
Fire Se, as
Review'fee $ Dept Signature
Other Agency Review or Permit RI uired Review or Recc t Date
g Y q of Permit Verified 3
Florida Dept. of Environmental Protectioh
Florida Dept. of Transportation
St.Johns River Water Management DistFlct
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tob�cco
Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. ❑Denied
(Circle one.) Comments:
BUILDING
I
PLANNING &ZONING Reviewed by: Date: Z- 1
TREE ADMIN. Second Review: ❑Appy ved as revised. []Denied.
Comments:
U LIC UTILIT
PUBLIC SAF TY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Appr ved as revised. ❑Denied.
Comments:
I
Reviewed by: Date:
Revised 05/14/09
ISI II
Cit of Atlantic Beach
:45
APPLICATION NUMBER
y .r�b (To be assigned by the Building Department.)
> � Building Department
800 Seminole Road Atlantic Beach, Florida 32233-5445 `3��14Phone(904)247-5826 • Fax(904)
Date routed:
E-mail: building-dept@coab.us
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
/7�>� ���� Department review re uired Yes No
Property Address: Building
�� � Q Planning &Zoning
Applicant: /�-� Tree ministrator
Cubli rlcs
Project: Public Utilities
�� � v!j to a, ti Public Safety
Fire Services
Review fee $
Dept Signature
Review or Receipt Date
Other Agency Review or Permit Required 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
I Reviewing Department First Review: ❑APProved. enied.-C
(Circle one.) Comments:
BUILDING
PLANNING & ZONING
Reviewed by: Date:
TREE ADMIN. Second Review: #Approved as revised. @Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES r
Date:
PUBLIC SAFETY Reviewed by:,�4
FIRE SERVICES
Third Review: []Approved as revised. ❑Denied.
Comments:
Reviewed by:
Date:
Revised 05/14109
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