383 3RD ST - PAVER DRIVEWAY e K t!' CITY OF ATLANTIC BEACH
is‘
8P 00 NOLE
N� ATLANTIC BEACH, FL 32233
J v INSPECTION OHO LINE 247-5814 ROAD
A41,01119
DRIVEWAY PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-DWAY-1486
Job Type: DRIVEWAY
Description: CONCRETE TO PAVERS DRIVEWAY
Estimated Value:
Issue Date: 8/3/2015
Expiration Date: 1/30/2016
PROPERTY ADDRESS:
Address: 383 3RD ST
RE Number: 169825-0100
PROPERTY OWNER:
Name: GAJEWSKI,THADDEUS J & MARIANNE, *
Address: 383 3RD ST
•
PERMIT INFORMATION: UTILITY DEPT.: PUBLIC WORKS:
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.
Full erosion control measures must be installed and approved prior to beginning any earth
disturbing activities. Contact Public Works (247-5834) for Erosion and Sediment Control
Inspection prior to start of construction.
All runoff must remain on-site during construction.
Roll off Container Company must be on City approved list and container cannot be placed on
City Right-of-Way. (Approved: Advanced Disposal, Realco, Republic Services, Shappel's and
Waste Pro.)
Full right-of-way restoration, including sod, is required.
PERMIT IS APPROVED ONLY IN ACCORDANCE: WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND 771E FLORIDA
BUILDING . - - - - -
CITY OF ATLANTIC BEACH
.f 800 SEMINOLE ROAD
r ATLANTIC BEACH,FL 32233
J INSPECTION PHONE LINE 247-5814
r�J131�`
FEES:
Fence/ROW $35.00
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PUBLIC WORKS PLAN REVIEW COMMENTS 11
Date: (49 is I I C Application Permit#: 15 �L,�r4� /t 310
Project Name/Address : 3 314 S
Check Box to
Application Tracking Comments Select
CORRECTION ITEMS:
Provide construction site management plan, including location of dumpster and portable toilet. Right-
CSMP ❑
of-Way Permit is required if using right-of-way for construction parking.
DPLN Provide drainage plans showing site topography (flow arrows, etc.) ❑
ESCP Provide erosion and sediment control plans with installation details. ❑
IMPS Provide impervious surface calculations for entire lot (existing and post construction). ❑
Section 24-66(b) of the Land Development Regulations requires on-site storage for increased run-off if
LDCS adding 400 SF or more impervious surface. Provide Delta volume calculations and on-site retention ❑
required per Section 24-66(b). (See attached information sheet.)
MEET Recommend Owner/Contractor meet with Public Works Director to discuss proposed construction. ❑
Call 247-5834 to make an appointment.
REPM A Revocable Encroachment Permit must be obtained. ❑
RMRO All runoff must remain on-site. Cannot raise lot elevation without measures to retain runoff. ❑
RWPM A Right-of-Way Permit must be obtained for use ❑
TSUR Provide a pre-construction topographic survey prepared by a Florida Licensed Professional Land ❑
Surveyor, showing 1' contours.
CONDITIONS OF APPROVAL TO PRINT ON PERMIT:
All concrete driveway aprons must be 5"thick,4000 psi, with fibermesh from edge of pavement to the
DAPR property line. Reinforcing rods or mesh are not allowed in the right-of-way. (Commercial driveways– ❑
6"thick.)
Full erosion control measures must be installed and approved prior to beginning any earth disturbing
ECIN activities. Contact Public Works (247-5834) for Erosion and Sediment Control Inspection prior to start
of construction.
OSRO All runoff must remain on-site during construction.
PCTS If on-site storage is required, a post construction topographic survey documenting proper construction ❑
will be required. —
PLWP Pool–Wellpoint(if used) must discharge into vegetated area 10' minimum from street or drainage ❑
feature (swale, structure or lagoon). A separate pool permit is required.
ROFF Roll off container company must be on City approved list and container cannot be placed on City right- Ea/of-way. (Approved: Advanced Disposal, Realco Recycling, Republic Services, Shappel's and Waste Pro).
RWRS Full right-of-way restoration, including sod, is required.
URCT Any utility cuts in the road must be repaired using Cal Standard Detail Case X and must be overlaid 10 ❑
feet in each direction from the center of the cut. Repair must be shown on the plans.
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 14/ day of `j. ,..,C
by Atlantic Beach, Florida, a municipal corporation or anized and existing under the laws of the Stat0e of
Florida, hereinafter referred to as "CITY" and M rem & sreZof Atlantic Beach; Florida,
hereinafter referred to as"USER".
WTTNESSETH:
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: o n T 7 �� •
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,
discretion of the CITY, be requested to submit as-built drawi showing the e wh, USER shall,at the •
after the day of completion. thirty(30) days
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.
DATED and SIGNED this—c� _____day of z'‘,,,,ii,, Lc ,20
/ ,
//r if _— ftf / '
By
r
'roperty Owner
(to be signed in presence o the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this 2Z day of Yl —
and for said County 201- eonally appeared before me, a Notary Public in
tY and State, the property
Atlantic Beach,Florida,known to me to be the person(s)described in
and wh. ed the foregoing '. trument; who acknowledged to me that he or she executed the same freely
• • vol . ; and or • : - s ,`ifs proposes therein mentioned.
Notary L! oar pu�� Notary Public State of Florida .
Public in:or said •o 1.•ty and State �Shir!ey L Graham
y l My Commission FF 086990
''?o',op' Expires 02/14/2018
CITY OF AT • IC : . ' , FLORIDA, a
municipal corporation:
Approve
Or / /
Doug La
g � Public or D. or
For Permits where city sidewalk is impacted,
City Manager approval required:
Nelson Van Liere,City Manager
Page 2 of 2
f
f
.0'i x a CITY OF ATLANTIC BEACH
, iF. _r CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF
is= �� :_` 800 Seminole Road W'�Y'4 :V�._;____; W Y —� •
Atlantic Beach,Florida 32233-5445
PLEASE SUBMi COMPLETE SETS OF PLANS WITH APPLICATION. Fax 904-247-5845 J
JUN 23 I
Date =2-2 -UCLA'c Ao is-
API
_
•
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Job Address JKIlR D PERMIT#
l ISSUED BY THE CITY
Permitee: - gi L�'�D�
4 5 AS 1 Telephone#
" -.z�,2 a i �
Permittee Address: 3Y3
�' 1" " 5T 477..
Requesting Permission to Construct: 7"c.. '
cJ - 3
Location: (Reference to Cross-Street) -. }
r.
4
lc 1.
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:
sr/ i Jacksonville Electric Authority
U ` Bell South Telephone Company Yes(x) No
Ferrell Gas ( ) Date:
Comcast (p/Zr� /S Yes Yes(X) No ( ) Date:(x) No ( ) Date:
2 Yes(k) No ( ) Date:
Whenever necessary for the construction, repair, improvement, maintenance, safe
alteration or relocation of all, or any portion of said street or easement as determined b
Works, any or all of said poles, wires, and efficient operation,
hereunder, shall be immediately removed p om id street orheasemlent or reset by the Director of Public
required by the Director of Public Works, and at the expense of the Permittee unless authorized
authorized. or'relocated hereon as
3. All work shall meet City of Atlantic Beach or Florida Department of Trans ss reimbursement is
performed under the supervision of v ;
Superintendent) located at Transportation Standards and be
•► -T ��� (Contractor's Project
4. All materials and equipment s all be subject inspection by the Director of Public
5. All city Telephone#: dg�jv
ty property shall be restored to its original condition as far as practical, in keeping with c
and the manner satisfactory to the city. Works or his designee.
6. A sketch of plans covering details of this installation, as well as, a copy g city specifications
part of this permit. Calculations sot this,
p an increase in im,ervious area on owner's ylot shall
in the a
uhf this
Way are to Calculations
included with this a lication.
7. This permittee shall commence actual construction in good faith with Ii
more than 60 days from date of permit approval, then permittee must review the permit with
Public Works to make sure no changes have occurred in the area that would affect ays• If the beginning date is
8. It is understood and agreed'that the rights and privileges herein set out are granted the t Director of the
of
City's right, title and interest in the land to be entered upon and used by the holder,the permitted construction.
times, assume all risk of and indemnify, defend, and save harmless the City of only to the extent of the
and the Holder will, at all
against any and all loss, damage, and cost of expenses arising in any manner of the exercise
exercises by the holder of the aforesaid rights and privileges. y Atlantic Beach from and
9. The Director of Public Works shall be notified twenty-four (24) hours riot to or attempted
immediately upon completion"
P starting work and again m a T.m
OWNER
/ °n
ac-:7
Signed: �_� ' °-_ E
Before e th' �� ate: �i -La- S l0 v o;
State 0 - ' IT ••ay of_ Z �Q C/Z
i•a,has : rs.nall -p.-- ed in the County of Duval, ��� °z._ X
Nota .is at Ler.-,St,to o Flor':i County of Duval.
My comm .ion es: Q�,sc'''ct,
��
Personally Known: •a
��� Produced Identification: oti so
MAP SHOWING SURVEY OF
THE WEST 27.50 FEET OF THE EAST 30.00 FEET OF LOT 30, BLOCK 5, PLAT NO. 1 SUBDIVISION
"A" ATLANTIC BEACH, AS RECORDED IN PLAT BOOK 5, PAGE 69 OF THE CURRENT PUBLIC RECORDS
OF DUVAL COUNTY, FLORIDA.
I
(N.83°39'55"E. 27.70'FIELDS
LOT 31 LOT 29 N.83°42'00"E. I LOT 27 ('
FOUND V2"IRON PIPE 1 !ET 1/2"IRON PIPE
L.B.3872 k7�50 • L.B. 3672
1 20.00 Y r" ----
0.4 0.8' 6'*000 FENCE
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NOTES °o G o
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PER PLAT. v =
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S.83°42100"W B. 3872
( 27.46' FIELD)
THIRD 4PdA4ti STREET
THE PROPERTY SHOWN HEREON APPEARS TO LIE IN FLOOD ZONE "X" (AREA OUTSIDE 500 YEAR FLOOD
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, •�ha CITY OF ATLANTIC BEACH
>. y'a-I'Y CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY A i7,
, i;' 800 Seminole Road .-----I L—l-J ---_– –
-zir.n%' z Atlantic Beach,Florida 32233-5445 90#247-5800[;
Fax 904-247-5845
PLEASE SUBMIyJCOMPLETE SETS OF PLANS WITH APPLICATION. JUN 2 3
Date .2.2 -Zi_oj 6 A°t /1
PERMIT# y
Job Address o Ar I 5 ISSUED BY THE CITY
O J
C?6D
Permitee: a. • u � 5 E -
rA� / Telephone# 7/2 023 a 90/ g--
Permittee Address: J' 3 7ii IRJ S7- 4r,4Lo7 . F6
A c--4 Fl. - ",z2,3 3
Requesting Permission to Construct: p6p4Ac6 EX IA Ti o(-0? -7)R i OA y ` I i
• BR I C K ?A V 6R 5 (o.1 D°irsa v .� 6e�c. Ru,c t. /i [aJ e
(ap x -f 8'osBFr
Location: (Reference to Cross-Street) 5''J 6 rz..g7
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:
cr/ 1 Jacksonville Electric Authority
U f / Bell South Telephone Company / Yes(X) No ( ) Date:
Ferrell Gas /Z/ Lo 19 Yes(X) No ( ) Date:
Comcast l Yes()c) No ( ) Date:
Yes(k) 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 /4Rr'.J ,-A 14A7r,c,2
Superintendent) located at Mszi OuTDaori (Contractor's Project
4. All materials and equipment shall be subject to inspection by the Public Telephone#: his go} ���,d
5. All city property shall be restored to its original condition as far as practical, in keeping kwith 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. date is
more than 60 days from date of permit approval, then permittee must review the perlm thwitth the Diirrector 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 8
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 g ,F,LL
immediately upon completion.
aif 8g
OWNER , •
CL U
Signed: �,J � �� to z 0
Before ath' - �. i - .1 ate: 4 -L2--/S •/02 / 62g� a
=1Gi19ff.ay of_ L 2 in the County of Duval, ( (� Z "'
State 0 I a,ha ors.nall ap.-_ ed
Nota-.is at Ler.-,St:to o Flor'.f:,County of Duval. �'' •r qttl
My comm .ion 'j;es: aa
— - Personally Known: � #.°
J ■ ■ Produced Identification:
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: C pVc l22Te4 ?o Rpy&r S
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
i
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.
DATED and SIGNED this 02,7- day of emu.,..' 6 ,20/3:-.
BY 4e, if__ I ft/if / .
'roperty Owner
(to be signed in presence o the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this 2Z- day of n € , 20 personally appeared before me, a Notary Public in
and for said County and State,
the property owner of
,Atlantic Beach, Florida,known to me to be the person(s)described in
and wh. •.- . ed the foregoing ';strument; who acknowledged to me that he or she executed the same freely
• vol o ,, and for t� : - -s 1. purposes therein mentioned.00
1 L_.....
Apr a., NO Public State of Florida
Notary Public in i or said •o i ty and State =° �: Shirley L Graham
' mad My Commission FF 086990
+ott�°� ExPirea02lta120t8
CITY OF ATLANTIC : - PH, FLORIDA, a
municipal corporation:
Approved:
Doug Layton,Public Works Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Nelson Van Liere,City Manager
Page 2 of 2
MAT" 0111v inr ii a cvn♦G i yr •
THE hSST 27.50 FEET OF THE EAST 30.00 tE T OF LCT 30, BLOCK 5, PLAT NO. 1 SUBDIVISION
"A" ATLANTIC BEACH, AS RECORDED IN PLAT BOOK 5, PN3E 69 OF THE CURRENT PUBLIC RECORDS
OF DUVAL COUNTY, FLORIDA.
I (N.83°39155"E. 27.701F1ELD1 ' •
LOT 31 i WT 29 N.83°42'Ocf E. f LOT 27 h
FOUND 3$?? _.E 4, 7.501 ' SET V2"IIeo?PIPE •
�PIPE L/2 3672
-'_7v " X—x ----
20.00 O.4 0.5. 6'WOOD FENCE
5
74
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N
10
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o O o
G O.
NOTES u. O. O
:• THIS IS A BOUNDARY SURVEY. n m ) W
• NO BUILDING RESTRICTION LINE It = w
PER PLAT. O ■I I� I '
BEARINGS BASED ON THE NORTH o I In 1
RIGHT-OF-WAY LINE OF THIRD o
STREET AS PER MILBERT ' i co
HOMES AS RECORED IN PLAT "
8001(21, PAGE 38. � 3ro L a2 m a
O ,) BALCONY = I-
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::CONCRETE::'.. ,�•
••. DRIVE
AND
•1MA LK
•. 122.75 20.00'
• FOUND V2_IRON PIPE 27.501 SET I/2_IRON PIPE •
L B.367! L.S.3$TZ •
S.83°42100"11(.
( 27.46' FIELD) .
•
TH I R D 4pdA!,'Z STREET
-ii.,L::::' ...-..';
THE PROPERTY SHOWN HEREON APPEARS '10 LIE IN FLOOD ZONE "X" (AREA OUTSIDE 500 YEAR FIX -
014,,J.,./;,„, City of Atlantic Beach
mss - \ Buildin Department / � � APPLICATION NUMBER
,� g p
;;=i ir' 800 Seminole Road / .10 IV�y (To be assigned by the Building Department)
i�b Atlantic Beach, Florida 32233-5 45 2 4 `. _ •Nbl _ / Vgr!o
Phone(904)247-5826 - Fax 0)%247-5845 2145
Mr,..../ E-mail: building-dept @coab.us
City web-site: http://www.coab.us Date routed: /
APPLICATION REVIEW AND TRACKING FORM
Property Address: its ,Q Jr Department review required Yes No
Building
Applicant: Q :O '7-) 4 Planning&Zoning -
Tree Administrator
Project: �4 V r ri t16 6�1,. ublic Work
ublic Utilities
Pubic Safety
Fire Services
Review fee $ 25-- Dept Signature T
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
Reviewing Department First Review: L Approved. ['Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING 59/c v/�—
0
Reviewed by:J Date:
TREE ADMIN. /
Second Review: ❑Approved as revised.IIIILIt WO S omments:
Ors
•UB IC UU LITIEESS
PUBLI SA/4
Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
sit-Ali City of Atlantic Beach
vs ilk,*, ., , Building Department Cry APPLICATION NUMBER
800 Seminole Road (To be assigned by the Budding Department.)
.... ' Atlantic Beach, Florida 32233-5445 JON �/ `' O
Phone(904)247-5826 • Fax(904)247-5845 a i 415 5 _ ,b4.1,Q - ` Vd
''• It rr E-mail: building-dept @coab.us
City web-site: http://www.coab.us Date routed: / 1_.
APPLICATION REVIEW AND TRA KING FORM
Property Address: c f' ? ,Q JT Department review required q ed Yes No
Building -
Applicant: _ Q a) '?')c 4- Planning &Zoning
Tree i•ministrator _=
Project: ■ e I I • ublic Work
Pblic Utilities
arrogato
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
Reviewing Department First Review: [Approved.
❑Denied.
(Circle one.) Comments: J61 t►/ rvPite d
BUILDING
PLANNING &ZONING /
Reviewed by: _ s —
TREE ADMIN.
Milir
,� Date: 1 G /1
Second Review: DApproved as revised. Denied.
PUBLI ORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
Date:
FIRE SERVICES Third Review: DApproved as revised.
❑Denied.
Comments:
Reviewed by: Date:
revised 07/27/10
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PUBLIC UTILITIES PLAN REVIEW COMMENTS
Date: Le If S Initials:
Project Name/Address:
3 b?) 3"' J� Application Permit#: _ 1� � ' (No
Check Box Check
to Add Box to
Application Tracking Comments Comment "Print"
UWSU Avoid damage to underground water/sewer utilities. Verify vertical and horizontal ❑ ❑
location of utilities. Hand dig if necessary. If field coordination is needed, call 247-5834.
MBSC B
Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible.
RT1C 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.
RPZB A reduced pressure zone backflow preventer must be installed if irrigation will be
provided or if there is a private well on the property. Backflow preventer must be tested ❑ ❑
by a certified tester and a copy of the results sent to Public Utilities.
STRM Plans note the building will be unsprinkled. If plans change, any fire line installed must be
metered with a Sensus touch-read meter in a properly sized vault and an appropriate ❑ ❑
backflow preventer installed. Backflow preventer must be tested by a certified tester and
a copy of the results sent to Public Utilities.
FSBR If fire sprinkler system is provided, contact Malcolm Clemons at 247-5839 for backflow
❑ ❑
requirements. At a minimum, will require a double check backflow preventer.
FLM Fire lines must be metered with a Sensus touch-read meter. Meters larger than 2" must ❑ ❑
be installed in a vault as noted in JEA specifications.
❑ ❑
❑ ❑
FIL 0
E COpy
❑ ❑
FILE COPY ❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
•
/'S ,S 800 Seminole Road
Atlantic Beach, Florida 32233
ti�'1 Telephone(904) 247-5800
j > FAX (904)247-5845
\
July 24, 2015
tVri
Mr. & Mrs. Ted Gajewski ‘0.
383 3u-1St.
St.
Atlantic Beach, FL 32233
To Whom it May Concern,
We have been unsuccessful in our attempt to collect the fees for your driveway permit
that was applied for on 6/23/2015. Permits are supposed to be picked up and paid for
prior to the work being completed.
Please send a check made payable to "City of Atlantic Beach" for the amount of$35.00,
in the self addressed stamped envelope and we will mail you your permit.
Thank you in advance for your prompt attention to this matter.
Sincerely,
WCLUI -
ennifer Walker
Administrative Asst.
City of Atlantic Beach
jwalker @coab.us
(904)247-5826