587 Beach Ave row and bulkhead M f+ L_
CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
800 Seminole Road
•_�>c Atlantic Beach,Florida 32233-5445 904-247-5800
Fax 904-247-5845
PLEASE SUBMIT(3) OMPL TE SETS OF PLANS WITH APPLICATION.
Date—
PERMIT
ate Z /�
PERMIT# /
Job Address nn J ISSUED BY THE CITY ! 3 C�Cit
Permitee: AISG A& a k�n>{G Q v�o Telephone#
Permittee Address: _2375 LNI� Vcb* DLy� swols2
Requesting Permission to Construct:
lA
Location: (Reference to Cross-Street) 6 0- S
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
Bell South Telephone Company Yes( ) No ( Date:
Ferrell Gas Yes( ) No ( ) Date:
Comcast Yes ( ) No ( ) Date:
Yes( ) 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 ? aM,#-S gr2Jl!
Superintendent)located at_ ! 'g 7 _ g (Contractor's Project
4. All materials and equipment shall be subject to Inspection by the Director of Public pWorks orA 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 showin ny increase in Impervious area on owner's lot or in the city
Richt of Way are to be Included with this application
7. This permittee shall commence actual construction in good faith withdays. 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.
3. 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 Worlds shall be notified twenty-four (24) hours prior to starting work and again
immediately upon completion.
OWNER ANDREA NICOLE CURRY
f t
Signed: D te: ! l� NOTARY PUBLIC
Before me this day o n he County of Duval, STATE OF FLORIDA
State Of Florida,has ersonally appeared Commf#FF128532
Notary Public at Large,Stat of F orida,County of Duval. 6 Expires 6/222518
My mmissio ex fres: – ersonally K n:
Produced Identification:
�,�\�Q�,�Et,El�►tOiE(110N
FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
o Bureau of Beaches and Coastal Systems ,
r - 3900 Commonwealth Blvd—MS 300
FLOR A Tallahassee, FL 32399-3000 s Pe*mkNumber:
(850)488-7708 ILE
No.of Pages Attached:
FIELD PERMIT PURSUANT TO SECTION 161.053 or 161.052,FLORIDA STATUTES
FINDINGS OF FACT AND CONCLUSIONS OF LAW: The request for a permit was considered by the staff designee of the Department of
Environmental Protection and found to be in compliance with the requirements of Chapter 6213-33,Florida Administrative Code(FA.C.). Approval is
specifically limited to the activity in the stated location and by the project description,approved plans(if any),attached standard conditions,and any special
conditions stated below pursuant to Paragraph 161.053(5),Florida Statutes. This permit may be suspended or revoked in accordance with Section 62-
4.100,FA.C.
PROJECT LOCATION: '
PROJECT DESCRIPTION:
SPECIAL PERMIT CONDITIONS: This permit is valid only atter all applicable federal,state,and local permits aro�tain� does not authorize
contravention of local setback requirements or zoning or building codes. This permit and public notice shall be posted on the site immediately authorize upon
issuance and shall remain posted along with local approval until the completion of any activity authorized by this permit. Other special conditions of this
permit include:
STANDARD PERMIT CONDITIONS: The permittee shall comply with the attached standard field permit conditions.
APPLICANT INFORMATION: I hereby certify that I am either: (1a)the owner of the subject property 1 (1b)I have the owners consent to secure
this permit on the owner's behalf;and that(2)I shall obtain any applicable licenses or permits which may be required by federal,state county,or municipal
law prior to commencement of the authorized work; (3)I acknowledge that the authorized work is what I requested;and(4)I t bib a
compliance with all permit conditions. accept resPon . ty
Applicant's Signature Dalt
Telephone No.
Applicant's Printed Name Address
If applicant is an agent /
pruned name of property owner property owner's address proper owner's ldephone no.
DEPARTMENT FINAL ACTION AND FILING AND ACKNOWLEDGMENT: This field permit is approved on behalf of the Department of
Environmental Protection by the undersigned staff designee,and filed on this date, pursuant to section 120.52, F.S.,with the undersigned designated
Deputy Clerk,receipt of which is hereby acknowledged.
Staff Designee/Deputy Clerk Printed Nance ofDesigneaDeputyClerk Date
PUBLIC NOTICE IS ON THE BACK OF THIS PERMIT. EXPIRATION DATE:
(Emergency permits issued pursuant to Section 62B-33.014,FA.C.,are valid for no more than ninety days and other a permts ane v r or no more
than 12 months. The staff designee may specify a shorter time limit.)
EMERGENCY PERMIT:D YES D NO Approved plans are attached: DYES ONO
AND PUBLIC NOTICE CONSPICUOUSLY ON THE SITE
DEP form 73-122(Updated 01/06) Vhite Copy-Tallahassee Office] [Yellow Copy-Applicant) (Pink Copy-Staff Designee]
���o,�rE�u��.otlrnox •.
FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
o Bureau of Beaches and Coastal Systems
r - _ 3900 Commonwealth Blvd—MS 300
FLOR DA Tallahassee, FL 32399-3000 permit Number: _
_ (850)488-7708
No.ofPagesAttached:
FIELD PERMIT PURSUANT TO SECTION 161.053 or 161.052,FLORIDA STATUTES
FINDINGS OF FACT AND CONCLUSIONS OF LAW: The request for a permit was considered by the staff'designee of the Department of
Environmental Protection and found to be in compliance with the requirements of Chapter 62B-33,Florida Administrative Code(FA.C.). Approval is
specifically limited to the activity in the stated location and by the project description,approved plans(if any),attached standard conditions,and anyecial
conditions stated below pursuant to Paragraph 161.053(5),Florida Statutes. This permit may be suspended or revoked in accordance with Sectispec
62-
4.100,F.A.C.
PROJECT LOCATION:
PROJECT DESCRIPTION:
SPECIAL PERMIT CONDITIONS: This permit is valid Only after all applicable federal,state,and local permits are obtained and does not authorize
contravention of local setback requirements or zoning or building codes. This permit and public notice shall be posted on the site immediately upon
issuance and shall remain posted along with local approval until the completion of any activity authorized by this permit Other special conditions of this
permit include:
STANDARD PERMIT CONDITIONS: The permittee shall comply with the attached standard field permit conditions.
APPLICANT INFORMATION: I hereby certify that I am either. (la)the owner of the subject property or 1 b I have the owner's consent to secure
this permit on the owner's behalf;and that(2)I shall obtain any applicable licenses Or P 1Y— ( )
law prior to commencement of the authorized work; P+'�ts which may be required by federal,state,county,or municipal
(3)I acknowledge that the authorized work is what I requested;and(4)1 accept responsibility for
law Prior
compliance with all permit conditions.
Applicant's Signature Date Telephone No.
Applicant's Printed Name Address
If applicant is an agent
printed name ojproperty owner property owner's address property owner's telephone no.
DEPARTMENT FINAL ACTION AND FILING AND ACKNOWLEDGMENT: This field permit is approved on behalf of the Department of
Environmental Protection by the undersigned stat designee, and filed on this date, pursuant to section 120.52,F.S., with the undersigned designated
Deputy Clerk,receipt of which is hereby acknowledged.
Staff Designee/Deputy Clerk Printed Name ojDe ik e.Deputy Clerk
Dote
PUBLIC NOTICE IS ON THE BACK OF THIS PERMIT. EXPIRATION DATE:
(Emergency permits issued pursuant to Section 6213-33.014,FA.C.,are valid for no more than ninety days and oI I er field permits are valid ori no more
than 12 months. The staff'designee may specify a shorter time limit.)
EMERGENCY PERMIT:❑ YES ❑ NO Approved plans are attached: ❑YES ❑NO
AND PUBLIC NOTICE CONSPICUOUSLY ON THE SIZE
DEP form 73-122(Updated 01/06) Phile Copy-Tallahassee Office] [Yellow Copy-Applicant] (Pink Copy-StaffDemgnee]
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FILE
R.O.W.Permit Attachment of for
R.O.W.Permit# issued _3200 Atlantic Beach,FL 32233
Owner's Name: Ap,�;jj1wis �k. k, JII'(gg
Property Address: 5 K7 61aAaW hva
Subdivision:
Lot#/Block#:
R.E.#: 17ci_47—oacra
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMNT ,PERMIT, issued on this day of
200_, by Atlantic Beach; Florida, a municipal corporation organized and existing
er the
undlaws 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:; .
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
,�� `' ` �1 y�►w�a CITY OF ATLANTIC BEACH
�-+ / 1 � ••p�ar.a-.
r' �) 800 SEMINOLE ROAD
J J ATLANTIC BEACH,FL 32233
3 yt' 904 247-5800
la'F.
//__ Revision Request Sheet
Date: Z (o Received by: Resubmitted:
Permit Number: Clearance Sheet Number: I-i A
Original Plans Examiner: Project Name-
Project Address: Cy i
Contractor: Q Contact Name: a$ • Q Q
Contact Phone Number: Contact Fax Number:
Revision/Plan Check/Permit Fee(s)Due: $
Description of Proposed Revision to Existing Permit
Pending Hold:
Structural:
Plumbing:
Mechanical:
Electrical:
Mise: 7?7/) /7
Additional Increase in Building Value: $ / Additional Square Footage:
Clearance Sheet/Site Plan Revised: / Environmental Health Approval:_
By signing below,I(print name) / affirm that the above revision is inclusive of the
prop ed changes.
Signature f C ractor/Agent(Contractor must sign if increase in valuation) Date
Office Use Only
Date: a01 Approved: X Rejected: Notified by:
Plan Review Comments:
0/5—
Plans ExViner Date
Created 08/05/08.j10
City of Atlantic Beach APPLICATION NUMBER
s % To be assigned b the Building Department.)
/ 1 Building Department ( 9 Y g
800 Seminole Road _
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845 /�
E-mail: building-dept@coab.us Date routed:
City web-site. http://vvwwcoab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: D p ent review required Yes No
uildin
Applicant: 4&'ea'ea' AA /7?g -S -Manning &Zo--n-Mrh
-TFUee.7Mministrator
S s s c 1j��► ublic Work
Project: L
�s V/,5 i�a � � � �'T is Safe
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: [�pproved. ❑Denied.
(Circle one.) Comments: _r
BUILDIN O_� /
�'J�WkJAQaOI �rl��✓��efC��vzS
PLANNING &ZONING Reviewed by: Date:-?-'/ 3—/S—
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denie .
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 APPLICATION NUMBER
To be assigned by the Building Department.)
Building Department ( 9 p
800 Seminole Road
1- 'I Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:UIN Z ��
City web-site. http://Vvwwcoab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: D parUnent review required Yes No
uildin
Applicant: Aeoea, arming &Zoni
C c
''� 1Y�� e- ministrator
Project: �5 G If � �' C �✓ ublic Work
�
C� is Uti i i
Vf� �� / Q v' C 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: pproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed by:2 L� Date: ( /�
TREE ADMIN. ❑App enied.
Second Review: roved as revised. ❑
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 APPLICATION NUMBER
2EI
(To be assigned by the Building Department.)
Building Department800 Seminole Road� Atlantic Beach, Florida 32233-5445- - Fax 904irPhone(904)247 5826 ( ) 2
� Date routed:
4 I.Ir
E-mail: building-dept@coab.us
Cityweb-site http://wwwcoab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: D p en review required Yes No
uildin
m�S anning &Zoni
Applicant: / c e ministrator
// /7
Project: SG G z C L ublic Work
! ,[� is Uti i i
V/ / Q c �! �7_ Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receiptof Permit Verified By Date
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 &ZONING2�1 Z��
Reviewed by: Date: 1
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied.
r
$WK , Comments:
BLICU ILITIES
C7 — / Reviewed by: Date:
PUBLIC SAFETY
FIRE SERVICES Third Review: ❑Approved as revised. []Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
APPLICATION NUMBER
City of Atlantic Beach (To be assigned by the Building Department.)
Building Department
800 Seminole Road
Atlantic Beach, Florida 32233 5445
Phone(904)24 7-5826 Fax(904)247-5845 Z,
Date routed:
E-mail: building-dept@coab.us
City web-site: http://wvvwcoab.us
APPLICATION REVIEW AND TRACKING FORM
D p ent review required Yes No
Property Address: ngOf j9uildin
AA !7')�S anning &Zoni
Applicant: e. ministrator
ublic Work
Project: �GL 1 (: [ is Utili i
Public Safety
Fire Services
Review fee $ Dept Signature
Review or Receipt Date
Other Agency Review or Permit Required 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. ❑
Denied.
(Circle one.) Comments:
E
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
rx '
CITY OF ATLANTIC BEACH
s1
J 800 SEMINOLE ROAD
J.
ATLANTIC BEACH,FL 32233
(904) 247-5800
Revision Request Sheet
Date: Z (O Received by: Resubmitted:
Permit Number: Clearance Sheet Number:
Original Plans Examiner: Project Name:
Project Address: Q-Cy 1.4 V9
Contractor: D '4' Contact Name: ,9 S
Contact Phone Number: I& ,Contact Fax Number:
Revision/Plan Check/Permit Fee(s)Due: $ 111
Description of Proposed Revision to Existing Permit:
Pending Hold:
Structural:
Plumbing:
Mechanical:
Electrical: p
Additional Increase in Building Value: $ / Additional Square Footage:
Clearance Sheet/Site Plan Revised: / Environmental Health Approval:
By signing below,I(print name) / affirm that the above revision is inclusive of the
prop ed changes. n
Signature f C ractor/Agent(Contractor must sign if increase in valuation) Date
Office Use Only
Date: Approved: Rejected: Notified by:
Plan Review Comments:
Plans Examiner Date
Created 08/05/08.jlo