870 MAIN ST - ROW -JEA POLE :"js r v ‘ CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
J r: ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RIGHT OF WAY PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ROW-1040
Job Type: RIGHT-OF-WAY PERMIT
Description: JEA POLE
Estimated Value:
Issue Date: 5/16/2016
Expiration Date: 11/12/2016
PROPERTY ADDRESS:
Address: 870 MAIN ST
RE Number: None
PERMIT INFORMATION: PUBLIC WORKS:
All silt must remain on-site during construction.
Full right-of-way restoration, including sod, is required.
FEES:
Total Payments: $0.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BIIILDING CODES.
.-0,1 J; City of Atlantic Beach _ APPLICATION NUMBER
% Building Department 1 �ZEC:-.I. T-gD (To be assigned by the Building Department.)
2 800 Seminole Road
� Atlantic Beach, Florida 32233-5445 ' MAY 0 6 ZOtb /(p- 44() - /0.
Phone(904)247-5826 • Fax(904)247-5845
'401119 E-mail: building-dept @coab.us 113Y: Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ('7 /////h /V c Department review required Yes No
Building
Applicant: ai� Planning &Zoning
Tree Administrator
Project: ;j ;: ii 'Po , Public Wor'
• .
Public Safety
Fire Services
Review fee $ Dept Signature
I
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:
APPLI TION STATUS
Reviewing Department I First Review: Approved. ❑Denied.
(Circle one.) Comments:
5 -AdiFF17' ui r1� � r`1
BUILDING )
PLANNING &ZONING r �---
Reviewed by: � Date: ! 3/e
TREE ADMIN. Second Review: A roved as revised.
❑ pp ['Denied.
' ;al< IC WO S Comments:
UBL`IC UTILITIES
. -6 PUBLIC IC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
CITY OF ATLANTIC BEACH
, T CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS _-
800 Seminole Road 904-247-5800
. Atlantic Beach,Florida 32233-5445 Fax 904-247-5845
PLEASE SUBMIT(3)COMPLETE/SETS�OF PLANS WITH APPLICATION.
Date Or
7C 1f,-) 3 , 7'v 1 6 PERMIT#
S ISSUED BY THE CITY
Job Address , /(_,J /'(,64,-7
Permitee: TIC 4 Telephone#
Permittee Address: Z I (1/P4' C.-76-+'l,C-7
Requesting Permission to Construct: (l ) 4 61,:,c L/ , ..-6u',y )-7,- k , ii..? y-> rel.,- 0//'
c1, ,.• t 2 ,k 1.9 t1 3 S i"7ei 4, ,cr.
Location: (Reference to Cross-Street) / .S1._ Cv/
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 Yes( ) No ( ) Date:
Bell South Telephone Company Yes( ) No ( ) Date:
Ferrell Gas Yes( ) No ( )
Date:
Comcast 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
`, 1,.,.7 (Contractor's Project
performed under the supervision of i�
Superintendent)located at 7 ,/ l.V'S> l h,L-,‘�1 )�iA(<< Telephone#:-C'G > 2?i>
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 (-C days. If the beginning date is
I 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 i
Signed: Date:
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.
01 My commission expires: Personally Known:
Produced Identification:
ENGINEERING DESIGN
ORACLE PERMIT MAXIMO DATE REL
PROJECT#: 17690 N.O.: 8003205 WO#: 23642023 __ CONST:05106/2016
CIR. TREE TRIMMING
SUB-STA NEPTUNE BEACH 17690 . N.O.: 561 REQ'D:YES
CELL
ENGINEER: Robert Simpson _ N.O.: N/A ZIP CODE: N/A
CUSTOMER/ SVC PHONE
LOCATION: 860 MAIN ST./POLE INSTALLATION 561 CENTER: SSSC N.O.:665-7793
r r' e '6
• l i t �*G�I - -g 990
STA 1, P# 8160 MAIN ST./ INSTALL 35/4W FOR ,��, 2
FUTURE HOME. RUN 2/OP TO STA 2. ,�_ _ / a °g. o •
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- STA 2, P# 835 MAIN ST. �..�56 F .1.
r
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IF
ot.i- p,-/, City of Atlantic Beach APPLICATION NUMBER
�s ? Building Department (To be assigned by the Building Department.)
sss 9 Y 9 p )
r � ``,. 800 Seminole Road
Jew
Beach, Florida 32233-5445 I /O- 4o -
Apthlantic one(904)247 5826 Fax(904)247-8845 mtiIAY Q 5 2016
--„of31.0 E-mail: building-dept @coab.us Y Date routed: f�//
.
City web-site: http://www.coab.us . .
v-
APPLICATION REVIEW AND TRACKING FORM
Property Address: (!7d 4?/9' N c Department review required Yes No
Building
Applicant: _ r Planning &Zoning
Tree Administrator
Project: 1J 1 Public Wor
Cgublic Uti
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: VlApproved. ['Denied.
(Circle one.) Comments: ✓GL 4veltej 42,ftn q/
1
BUILDING
PLANNING &ZONING y ,` - A9)/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:
'devised 05/14/09
• `J"�` CITY OF ATLANTIC BEACH
i� l ,
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
/j 800 Seminole Road 904-247-5800
L__,__;___I/%/ Atlantic Beach,Florida 32233-5445 Fax 904-247-5845
PLEASE SUBMIT(3)COMPLETE SETS
G/,OF PLANS WITH APPLICATION.
Date / I fit(� 3 / (/D I 6 PERMIT#
Job Address ' '20 / -( 4-? S ISSUED BY THE CITY
Permitee: 4 / / Telephone#
Permittee Address: al (Ale I- &vc..G, ��'/
Requesting Permission to Construct: 6 ) S Li,.,..ss C1 ,A.drdyi pi9te /'u I-) ,iv 061
Location: (Reference to Cross-Street) ! :S_/: (4/,
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 Yes( ) No ( ) Date:
Bell South Telephone Company Yes( ) No ( ) Date:
Ferrell Gas Yes( ) No ( ) Date:
Comcast 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 ornnFlor da Department of Transportation Standards and be
performed under the supervision of /G. 5,i, .p`6°h (Contractor's Project
./
Superintendent)located at 7 west (h,,,%.t1 S' . J,-i(// Telephone#: 6o5 7?' s
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 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
•
Signed: Date:
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. I
My commission expires: Personally Known:
I
Produced Identification:
ENGINEERING DESIGN
ORACLE PERMIT MAXIMO DATE REL
PROJECT#: 17690 N.0: 8003205 WO#: 23642023 CONST:05/06/2016
CIR. TREE TRIMMING
SUB-STA NEPTUNE BEACH 17690 I N.O.: 561 REQ'D:YES
ENGINEER: Robert Simpson CELL
_ N.O.: NIA ZIP CODE: N!A
CUSTOMER'
L
SVC
OCATION: 860 MAIN ST./POLE INSTALLATION 561 CENTER: SSSC P N 0.-6657793
Ni STA 1, P# 860 MAIN ST./ INSTALL 35/4W FOR 29�980�Q
FUTURE HOME. RUN 2 10P TO STA 2. _ a • � •
��
STA 2, P# 835 MAIN ST. G 935
TREE - •°c ��.
TRIMMING REQUIRED
0
I
THIS GOES WITH PERMIT # 2016/00765.910 ~ ms `r
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