105 OCEAN GATE DR -TRACKING �,G City of Atlantic Beach -
-,.. • APPLICATION NUMBER
:--`, Building Department (To be assigned by the Building D artment)
} 800 Seminole Road P _ /
i .
., , Atlantic Beach, Honda 32233-5445 'S 04 411001
Phone(904)247-5826 • Fax(904)247.5845
T ; E-mail: building-dept@coab.us 1 Date routed: ��'01,45
City web-site http://www.coab.us t
APPLIICATIION REVIEW AND TRACKING EKING FORUM
property /f rlelres,Fz: WS La a t
OCEANANT Department review required Yes No
Building
Applicant: _ • Ckt" Planning &Zoning
Tree Administrator -
ProjeCt PiliCk"1 -- PA), ,,ubli-- -
D Akol_ _.._._ Public Utilities �--�--- - -�-
Public Safety_
Fire Services - -
Review fee ;_ Dept Signature
Other Agency Review or Permit Required Review or Receipt
of 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
-
L
Reviewing Department First Review: Approved
nDenied
(Circle one.) comments:
BUILDING
PLANNING&ZONING
Reviewed by: Date:��7 l�--
_____
TREE ADMIN. —
PUBLIC Denied.
Second Review: .]Approved as revised.
n
PUBLIC b Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by '
:
Date: 1
FIRE SERVICES Third Review: -----I
[]Approved as revised. ❑Denied.
Comments: i
1
I
Reviewed by: Date: 1
::vised 07/27/10
I
rS L.L`1 jl 5
. 4,4_ CITY OF ATLANTIC BEACH 1
mow' APR 1.5
t = . t CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AN -EASEMENT ) A
800 Seminole Road __
nrl� 'z Atlantic Beach,Florida 32233-5445 BV
904-247-5800
PLEASE SUBMI — -23720.45
PLET SETS OF PLANS WITH APPLICATION.
•
• Date IS
Job Address p PERMIT B
ISSUED BY THE CI
Telephone# ?v Y- 3 ?y_ r t o 4_
Permittee Address: - -1 mot. -L 2.d_
m f - r. x 7-3
Requesting Permission to Construct:
1,1. ,
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/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 Flori40 Department of Transportation Standards and be
performed under the supervision of eat, (`E h,
Superintendent) located at 9 _ _ col '^ (Contractor's Project
4. All materials and equipment shall be s b- �'�to inspection by the Director of Public pWork 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 showin• an increase in im•ervious area on owner's lot or in the cit
Ri•ht of Wa are to be included with this a. •lication.
7. This permittee shall commence actual construction in good faith with ds.more than 60 days from date of permit approval, then permittee must review he perlm t the with the Diirrector of date is
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 a •
immediately upon completion. again
OWNER
10 Signed �� -�,t 411 1 .ix.•',.., I
1�. Date• Sapp -� .
JOYCE PA.FREEMAN
Before his • I ( _, .� Notary Public.Rots 01 FIOtWa I•
State Of Florida,his has personally a day of 4_lu. in the County of Duval, 1 z�
p Y appeared M11_ • - I My Comm. ion Jun 10,2017
Notary Public at Large,State of Florida,County of Duval. 1 ,R;,;;; ComnM=t1011#EE 876497
My commission expires: Li 10 SZQ/"]
Personally own:
Produced Identification:
Permit Attachment of for
Permit# issued ,20_Atlantic Beach,FL 32233
Owner's Name: %.utc l i S 1-6.L•.{Art Property Address: NS" d o -4 c
R.E.#:
Subdivision: Uce _G'_4e Lot#/Block#: L04- 2t i34 c.k S�
REVOCABLE ENCROACHMENT` PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT,issued on this I1 day of Opri 20_6
by Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State of
Florida, hereinafter referred to as "CITY" and gaol,.. . 144. 4.* 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 kS hq(l �t�•-S i• . LLr-j v bra J( 12. Q w
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:
151 vvvLuov•l-- (20( �4-Fl...f;c Be,c Ft. 31%33
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."
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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.
DAT and SIGNED this day of 4 /______, 20/5
If Ili
,4 BY: _:.Or■C— :'
Property Owner if
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this —day of , 206 personally appeared before me, a Notary Public
and for said County and tate, Z ebb,e— 'moo�,e 5 Y r if
/D,� 0��� �4` the property owner of
Atlantic Beach,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.
Notary Public in for said County and State
4 .o.�","�e,''•., JOYCE M.FREEMAN I
1 ,r �\ ;t Notary Public-State of Florida I
CITY OF ATLANTIC BEACH, FLORIDA, a • =";, ,. =MyComm as x ere i n 78:2017
�����►��
municipal corporation: i "'•.,,, ;;,,. w d 97 I
Approved: or '
4 0,1,•,
el 0 11, _
Doug Layt•. , ' blic Works Direc .r
For Permit ,ere city sidewa is impacted,
City Manager approval required:
Nelson Van Liere,City Manager
Page 2 of 2