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1979 FRANCIS A.T.&T. PERMIT City of Atlantic Beach APPLICATION NUMBER (To be assigned by the Building Department.) Building Department '' •• II _ 800 Seminole Road rl r ' Atlantic Beach, Florida 32233-5445 _ Phone(904) 247-5826 - Fax(904)247-5845 3 1 V 5 g p Date routed: E-mail: buildin de t@ coab.us City web-site. http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: I"��"1 �'�' `�5 > Department review required Yes No Building ¢ 'r` Planning &Zoning Applicant: Tree Administrator ^^ or Project: W� Public Utilities ublic Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Dateof 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: 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 07/27/10 CITY OF ATLANTIC BEACH CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS 904-247-5800 � 800 Seminole Road Atlantic Beach,Florida 32233-5445 Fax 904-247-5845 Date 02/03/2015 PERMIT# ISSUED BY THE CITY Job Address Between FRANCIS AVE & DUTTON ISLAND RD E Permitee: AT&T—JOB#MAINT. FRANCIS AVE Telephone#Wk904-727-1552 EMAIL: SM948NCa.ATT'.COM Permittee Address: 735 Mill Creek Rd JACKSONVILLE FL 32211 ATTN.- SERGIO MARTINEZ Requesting Permission to Construct: JOB# MAINT. FRANCIS AVE PROPOSED TO PLACE 224 FT OF BURIED SERVICE WIRE AT 24" MIN DEPTH AS INDICATED ON DRAWINGS. USE CASE 1 MOT Location: (Reference to Cross-Street) FRANCIS AVE 1. Applicant declares that prior to filing this application he has ascertained the location of ail 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: TECO Yes(X) No ( ) Date: 02/03/15 Ferrell Gas Yes (X) No ( ) Date: 02/03/15 Comcast Yes(X) No ( ) Date: 02/03/15 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 JEFF FENLON (Contractor's Project Superintendent) located at 11711-1 PHILLIPS HWY, JACKSONVILLE, FL 32256_Telephone#: 904-268-0361 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 7. This permittee shall commence actual construction in good faith with 60 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 dZJ03 _ Dat Signed: e: /7 Before me this day of in the County of Duval, State Of Florida, has personally appeared Notary Public at Large,State of Florida,County of Duval. 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