132 BELVEDERE ST - DRIVEWAY 0 •= :ft CITY OF ATLANTIC BEACH
,rte
'' 800 SEMINOLE ROAD
O . -,, , Zti ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
DRIVEWAY PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-DWAY-699
Job Type: DRIVEWAY
Description: PAVER DRIVEWAY AND PATIO
Estimated Value:
Issue Date: 4/1/2016
Expiration Date: 9/28/2016
PROPERTY ADDRESS:
Address: 132 BELVEDERE ST
RE Number: 170588-0000
PROPERTY OWNER:
Name: Atlantic Beach Pinnacle Properties, LLC
Address: 132 BELVEDERE ST
PERMIT INFORMATION: PUBLIC WORKS: UTILITY DEPT.:
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 silt must remain on-site during construction.
If on-site storage is required, a post construction topographic survey documenting proper construction
will be required.
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 Sunshine Recycling.)
Full right-of-way restoration, including sod, is required.
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.
IEEE ':IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
4 4 0 ` CITY OF ATLANTIC BEACH
it.4 zr 800 SEMINOLE ROAD
J . , . :.� ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
i3 9*
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.
0.xviy.e, City of Atlantic Beach APPLICATION NUMBER
r _ Building Department EC��F D (To be assigned by a Building Department.)
- � 3 w .800 Seminole Road /‘' O�
Atlantic Beach, Florida 32233-5445 p 24725745 p 9 2i)I6 1.
Phone(904)247-5826 • Fax(904) — z3/
Ay_,on >� E-mail: building-dept @coab.us Date routed:
City web-site: http://www.coab.us __ --
APPLICATION REVIEW AND TRACKING FORM
i
Property Address: 2. •g� Department review required Yes No
Building
Applicant: Q .a) 73 Planning &Zoning
Tree Administrator
Project: YLr yi f� J Ay 47.1 is or
is tilities
—Pk I► , a 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: I Approved. J JDenied.
(Circle one.) Comments:
BUILDING '/PLANNING &ZONING Reviewed by: `""`'�Date: / /I
TREE ADMIN. Second Review: A roved as revised.
❑ pp I IDenied.
'y',,• I'C WO"K Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. I (Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
ir gyp, •r. CITY OF ATLANTIC BEACH
, A CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
,
\ / 800 Seminole Road 904-247-5800
ur:►L% Atlantic Beach,Florida 32233-5445 Fax 904-247-5845
PLEASE SUBMIT(2)COMPLETE SETS OF PLANS WITH APPLICATION. PERMIT#
Date !^ ;/, '
-� , / ; ISSUES BY THE CITY
r ,�-,
Job Address ; �U ( t? � E-mail blIV t"/1C>j to 0
� l riGlli 1 (UsI';
Permitee: 1 i t ,_
\;rr 1! �t�'>� {� Telephone# ",.)3 i '7 1 - 3 n()i
Permitee Address: -, r,-- .,vt ec e -
Requesting Permission to Construct: ' WIT f V 8 p� 1 1 (` ;r,..
.- c) I -
Location: (Reference to Cross-Street) �)1', .Q\Ut?( vibDo� h fed A-e s - 3j.}-1,\ `) ov\A
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:
1 r'
Jacksonville Electric Authority Yes ( Y No ( ) Date: I. fj , v
Bell South Telephone Company Yes (,1 No ( ) Date: a, s, f';�,
Ferrell Gas !
Comcast Yes( ) No( ) Date: -.1', , / IL
Yes ( ) No ( ) Date: 1/.2 1 )f t
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 Permitee 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 b,cce l\ SA t(I'C (Contractor's Project Superintendent)
located at ^`;'<' '-.\ live 1`,04 Or. ,74IFL)34 Telephone#: qV - s'i,‘t; - ) v
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 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. ��^"„64 �
„,.HY As, Notary Pubiic State of Florida
\- `Y ;.5j!.i-yLCr-ham
OWNER /f ," ? W+y c rriirri on =F GS6990
' i ,/ f., to s 02/%1/2013
Z� i
Signed: .�." , Date: £ 2 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. My
commission ex i II d IL Personally Known:
4 I L 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 ,
by Atlantic Beach, Florida, a municipal corporation organized and exist day of if`��
Florida, hereinafter referred to as "CITY" and g under the laws of the State of
hereinafter referred to as "USER". of Atlantic Beach; Florida,
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
Beach Right-of-Way/Easement permit numbers noted above(copies attached)Pscribed in the City of Atlantic
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 p 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 upon the above-described property �' pproved representative or other franchised utility to
any and all material necessarily displaced during the action of maintaining, repairing,oU operating,sole expense,
adding to of the utilities and facilities of the CITY or franchise utility provider. Aerating, replacing, or
The facilities allowed by the permit shall meet the current requirements of the City Code, Buildin Cod
Land Development Code, and all other land use and code requirements of the CITY, including g es,
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 requested to submit as-built drawings showing the change within thirty (30) a
after the day of completion. ) dy s
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 penait and to all of the applicable State and CITY laws
and/or specifications, to include utilities locate requirements and use limitations/requirements of
rights-of-way and other public land. USER further agrees that the CITY and its officers 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 Z Zi day of-1/1 a�
204
By: Yom' /r' -`
Property Owner
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this z----7-day of 4-7AA-r-►Lh
2011/personally appeared before me, a Notary Public in
and for said County and State,
the,Atlantic Beach,Florida, known to me to be theperson(s)described in
and who executed the foregoing instrument; who acknowledged to me that he or she executed the same freel
and .lun . " , and for the es and purposes therein mentioned. y
r
INV
Notary Public in ;•r sai a 41• T Y r':'f Florida
unty and State a� ,,-, , ..ruh,
5} . 'a, 1, 1°V i Ji 31 t1
€� `'r ' ° M Coi rni :on-i=GHQ^,90
CITY OF ATLANTIC BEACH, FLORIDA, ''E . 's°� 'i'o�s
municipal corporation:
Approved:
yten;Public Works Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Nelson Van Liere, City Manager
Page 2 of 2
City of Atlantic Beach
Example Site Impervious Calculation
Existing—Include all hard covered ground:
Item Length/Feet Width/Feet Area/Square
Feet
Main Body of House 50 50 2,500
Additional House 20 20 400
Driveway 20 10 200
Sidewalk 20 3 60
Patio 10 40 400
Out Building 10 _ 10 100
Total Impervious - 3,660
Existing
Total Lot Size: Length x Width:
Example: 100 FT x 75 FT= 7,500 SF
Impervious Existing: Existing Impervious (SF)/Total Lot Size (SF):
Example: 3660 SF/7,500 SF= 48.8%
New—Include all hard covered ground:
Item Length/Feet Width/Feet Area/Square
Feet
Main Body of House 100 50 5,000
Additional House 20 20 400
Driveway(50% paver 20 20 200 (50%)
credit 100
Sidewalk 25 3 60
Patio/deck 10 40 400
Pool 0
Total Impervious-New 5,960
Impervious 1iew: New Impervious(SF)/Total Lot Size (SF):
Example: 5,960 SF/7,500 SF = 79.5%
. .
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ol A T.� City of Atlantic Beach -- APPLICATION NUMBER
js t $, dl Building Department • FIVE ` (To be assigned by a Building Department.)
4 800 Seminole Road l,.
j Atlantic Beach, Florida 32233-5445 ' MAR 2 3 2016 /4 - a 9,
Phone(904)247-5826 Fax(904)?47-5845
j• E-mail: building-dept @coab.us Date routed: p rt.
City web-site: http://www.coab.us 1LD�
APPLICATION REVIEW AND TRACKING FORM
Property Address: /31- ,/Ycc/4 htki. Department review required Yes No
Building
Applicant: O to n 6 r Planning &Zoning
Tree Administrator
Project: AYEr yi 114 j A)1 Jg LI Hitie/ s�
—P AT1
Public Safety
II Fire Services
evie*cr fee $ « xpeSga ,e `` y"
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: ❑Approved. VDenied.
(Circle one.) Comments: Jte /O
BUILDING
PLANNING &ZONING Reviewed b • i/ ! .to j,02,(-4
TREE ADMIN. Second Review: 4[IA roved as revised.
pp ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date: ��1��/tj
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
f 14„tvi. CITY OF ATLANTIC BEACH
t 1 el DEPARTMENT OF PUBLIC WORKS
1200 Sandpiper Lane
• \, Atlantic Beach,FL 32233-4318
"...4 4-) TELEPHONE:(904)247-5834
t) _
my)
:,�, FAX:(904)247-5843
www.coab.us
.r; t.
APPLICANT: �/PN/'
i DATE: 3/24/2016
Blaise Mosler ' E PERMIT# 16-DWAY-699
132 Belvedere Street f ADDRESS: 132 Belvedere Street
Atlantic Beach,FL 32233 v{ ✓✓�� Atlantic Beach,FL 32233
Email: blaisemoslera,gmail.com 3',5/'Ai
i
PERMIT APPLICATION FOR PA ER DRIVEWAY AND PATIO
Your permit application has been y the Public Works Department for the reasons listed below. Please submit this
information at your earliest convenience in order that we may approve your application. If you have any questions,please
contact Scott Williams,Deputy Public Works Director at 904-247-5834 or email swilliamsAcoab.us.
PUBLIC WORKS CORRECTION ITEMS:
(Submit the following information to the Public Works Department)
* Provide construct'• , site ma .:ement pl. -, 1 luding locat'• - of du • er and •o . - - oilet. Ri:h -• ' .y 'e mit
is :• ' - • if usin: righ -of- . for • • ction p. kin:.
** P o 'de dra• :ge pla . sho , ' g • e t• ,'gr. •h • ar - .)
** Pro ,• - er• ion . •• edi -nt • - • •tans • ins,.Ila • -tai
** Sectio 24-66 •)of the L. d Developme• ' : :ulations -•uire on-site st• .:- for increa -. run-a, if addin: , se -
or more i pe 'o■ surf e.
** Cit •d. re• sir-. a 10I' ront.:e , circul. • • eway .
** Provide Delta volume .Iculations a . • -site retention r-- :d per Section 24-.• : . (See attach-. • •rmation
sheet.) .r. i ,e a pre-•ins ruction , •ogra• is survey • --pared b . Florida • -nsed Pr,fessi• • . and S e •
showing ' co'to . .
PUBLIC WORKS CONDITIONS OF APPROVAL:
(The following comments will be printed on your permit as Conditions of Approval)
** 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 silt must remain on-site during construction.
** If on-site storage is required, a post construction topographic survey documenting proper construction will be
required.
** 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 Sunshine Recycling.)
** Full right-of-way restoration, including sod, is required.
PUBLIC WORKS PLAN REVIEW COMMENTS
Date: 3.e23-'4, Application Permit#: °°.‘0411114 f'f
Project Name/Address : Zia2 �/veli t7,
Check Box to
Application Tracking Comments Select
CORRECTION ITEMS:
CSMP Provide construction site management plan, including location of dumpster and portable toilet. Right-
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.
/Pv/
REPM - L r • i • - e • :I 4y61e1 (vi1t / Ike 14 /44ejtt
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
Le-
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. 47'
PCTS If on-site storage is required,a post construction topographic survey documenting proper construction �-1�^/
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-
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 COJ 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.
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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 a day of 1'IQf C I'\
by Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the St te'of
Florida, hereinafter referred to as "CITY" and
hereinafter referred to as "USER". of Atlantic Beach, Florida,
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: Diri C a. t A, I 0 t
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 receip req ested, to the following address:
�z 1'/Jute
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
1
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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 ublic
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 ei day orrn
2010
X, By: SAID C /
Property Owner
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this Z2-day of ‘---)A�r(� h 20
4personally appeared before me, a Notary Public in
and for said County and State,
, the property,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 lun • and for the- es and purposes therein mentioned.
,
Notary Public in r sai t e s unty r�4s Notary Public Staie of Florida
and State gtitirley L Graham
c ,a Expires Commission FF 086990
CITY OF ATLANTIC BEACH, FLORIDA, uf�o Ex 0 211 4/2 0 1 8
municipal corporation:
Approved:
12si"°r aytofn,Public Works Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Nelson Van Liere, City Manager
Page 2 of 2
Perrone, Jennifer C.
From: Perrone, Jennifer C.
Sent: Thursday, March 24, 2016 1:43 PM
To: 'blaisemosler @gmail.com'
Cc: Gindlesperger,Toni
Subject: Plan Review Comments for 132 Belvedere Street
Attachments: Plan Review Comments 16-DWAY-699.pdf
Attention: Blaise Mosler:
Permit application#16-DWAY-699 for 132 Belvedere Street is currently denied by Public Works. Attached are the plan
review comments. Please submit required information at your earliest convenience in order that we can process
approval for our Department.
Thank you,
Jennifer Perrone
Administrative Clerk
City of Atlantic Beach
Public Works Department
1200 Sandpiper Lane
Atlantic Beach, FL 32233
Phone(904) 247-5834
Fax(904) 247-5843
email: iperrone@coab.us
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* CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
{" 800 Seminole Road 904-247-5800
•• Atlantic Beach,Florida 32233-5445 Fax 904-247-5845
PERMIT#
PLEASE SUBMIT(2)COMPLETE SETS OF PLANS WITH APPLICATION.
3 /aa/) / ISSUES BY THE CITY
Date / 1 �j 4,, C
Job Address I 3 ( vealitk J� E-mail E-mail �0�) coal
U\o' 1�c Telephone# ( " i -
Permitee: �(�� p 3a 33 5 wO5
Permitee Address: 1 S' �e\vcAere S}
Requesting Permission to Construct: Paves V('I UC ,A)031 a.nd i1ck ?a\ c
Location: (Reference to Cross-Street) Or �t\\i about (] r\ane S SOU\-1•\ OT Dc&wk Si'.
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: �n1
Jacksonville Electric Authority Yes (4 No ( ) Date: a d 1
Bell South Telephone Company Yes:7 No ( ) Date: t I
Ferrell Gas Yes( ) No( ) Date: I R, I
Comcast Yes ( ) No ( ) Date: 3 Ellf I
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 Permitee 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 05.CCt I t.010-AN (Contractor's Project Superintendent)
located at 1353 A Sevin Q}t,tI Or. ,-5V ?.
FL) .3t Telephone#: AN.-___- S L15 -i1,1.o1,
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 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.
0051Y°4®6 Notary Public State of Florida
r
Shirley L Graham
OWNER
r AT My Commission FF 086990
l eel.0. Expires 02/14/2018 2.0 1 0 Signed: C. ��1 Date: Z 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. My
commission ex.ir• __ / k Personally Known:
��«Ml� L Produced Identification:
Revised 7/29/15
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