363 4TH ST ROW PERMIT C,
N M CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Dill,
RIGHT OF WAY PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-SS14
JOB INFORMATION:
Job ID: 16-ROW-1 303
Job Type: RIGHT-OF-WAY PERMIT
Description: PAVER DRIVEWAY
Estimated Value:
Issue Date: 6/21/2016
Expiration Date: 12/18/2016
PROPERTY ADDRESS:
Address: 363 4TH ST
RE Number: 169843-0100
PROPERTY OWNER:
Name: PHILLIPS, LONNIE
Address: 4648 COLLINSWOOD DR
GENERAL CONTRACTOR INFORMATION:
Name: DIG ARCHITECTURE LLC
Address: 11651 Kingsley Manor WAY
Phone: - -
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 silt must remain on-site during construction.
If on-site storage is required, a post construction topographic survey documenting proper construction
will be required.
Full right-of-way restoration, including sod, is required.
FEES:
Fence/ROW $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC: BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
1� CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach
Department APPLICATION NUMBER
Building
_(To YCa!�-sFgn—e-cTUy-Ahb-B-Liildiiij--De— --ntj
800 Seminole Road partme
Atlantic Beach, Florida 32233-5445 iw.� 0 (v-Ro W_
Phone(904)247-5826 - Fax(904)247-5845
A_1) W E-mail: building-dept@coab.us Date routed: (7
Cityweb-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address. 6�) -4L4-/,,,
Department r-w;-., quired Yes No
Applicant: Building
_C_ Planning & oning
Tree Administrator
Project: u lic or
u lic Utilitlp-q
Public Safety
Fire Services
R eview fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt
Florida Dept. of Environmental Protection of Permit Verified By Date
Florida Dept. of Transportation
St. Johns River Wat�r Management District
Army Corps of Engineers
FDitision of Hotels and Restaurants
DivisioEnof EAIcoholic Beverages and Tobacco
LOther:
APPLICATION STATUS
Reviewing Department First Review: I Approved. []Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: Date:
TREE ADMIN. Second Review: ElApproved as revised.. [E:1 n ied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by. Date:
FIRE SERVICES Third Review: ElApproved as revised. enied.
Comments:
Reviewed by: Date:
ised 05/14109
City of Atlantic Beach
APPLICATION NUMBER
Building Department - C:EEJV�ED] (To be assigned by the Building Department.)
-.v 800 Seminole Road I
r) iullj -)vQ
Atlantic Beach, Florida 32233-5445 JUN 1(o-Rc 1,Sc.)a
Phone(904)247-5826 - Fax(904)247-P5845
r
E-mail: building-dept@coab.us FDat
B Y I.
0"119 7 e routed:
City web-site: http://www.coab.0 _.. _!�� I �'
APPLICATION REVIEW AND TRACKING FORM
Property Address: Department review required Yes No
Building
Applicant: po_w Tl�: CT 0 Planning &Zo-
ning
Tree Administrator
drn 'st
Project: u ic or
U lic Utilitipiq
Public Safety
Fire Services
Review fee $ 17 Dept Signature
Other Agency Review or Permit Required Review or Receipt
of P Date
of Permit Verified By
Florida Dept. of Environmental Protection
'p
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:
APPLIC�q-10N STATUS
Reviewing Department First Review: ZxPlIp"roved. OlDenied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by:_r�__ Date.-
TREE ADMIN. Second Review: ElApproved as revised. FIDenied.
IC WIV 0 R Comments:
JTJ
PUBLIC L TILITIES
(V - E? - /(0
PUBLIC SAFETqY Reviewed by: Date:
FIRE SERVICES Third Review: [JApproved as revised. [-]Denied.
Comments:
Reviewed by: Date:
Revised 05/14109
CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
800 Seminole Road 904-247-5800
U11 Atlantic Beach,Florida 32233-5445 Fax 904-247-5845
PERMIT#
PLEASE SUBMIT(2)COMPLETE SETS OF PLANS WITH APPLICATION.
Date I_T(4W ISSUES BY THE CITY
Job Address 2,(. �&"V!xrjj STq se-1— E-mail PGO
C-4#-A
Permitee: IQ It-140 CAA, Cx Aa�c- :1-u-4vlephone# %A- -sr,.,-,f
Permitee Address: 06 J-tP5*rA.
Requesting Permission to Construct: Ar i�vsv_ L/L12_^&.Vd�7 JsLac-te- L%i 4
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/Municipalitie ECEUVE
Jacksonville Electric Authority Yes No ate:
Bell South Telephone Company Yes N o ate,
Ferrell Gas Yes( No( Da4pN 7 201
Comcast Yes ( No e:
2. Whenever necessary for the construction, repair, improvement, maintenance, s e and efficient operation,
alteration or relocation of all, or any portion of said street or easement as determine y Leirec-Tor_0—TT-1n=- __4_
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 Q LA._7 JgTz.tA*,-F-r-, (Contractor's Project Superintendent)
located at su-:t, - 5,-ms Telephone*: I(Si- 55-3.Z& 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 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
11 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.
The Director of Public Works shall be notified twenty-four(24) hours prior to starting work and again immediately
upon completion.
OWNER
a
c,
a
&
Signed: -7 day
Date: 6/7A6 Before me this
of
a Ch K the (,lbuntl rf Duval, State Of Florida, has personally appear—ed L,->,u/J4f_ oe los
-n N ublic at Large, Sta�q of Florida County of Duval. My
rn es,
C4 commission expir fWi-o0-A 1:d o 061&�I,?415 �ersonally Known:
r( &e2 ,
T)
to A Produced Identification:
2
to Revised 7/29/15
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---.9
by Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State of
Florida, hereinafter referred to as "CITY" and 1-004M of Atlantic Beach, Florida,
hereinafter referred to as"USEW'.
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:
-,& krtA,*M
A-(.b
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 fi-anchised 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 fi-anchise 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 I 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) 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 finther 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 an of said
liabilities are hereby assumed by the USER.
DATED and SIGNED day of 29 )
J�
By:__:7
��Crty U�ner
(fo be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this Ir M day of 5cA,-F_ 2014 personally appeared before me, a Notary Public in
and for said County and State, L.,Nwof iZ. the property owner of
Atlantic Beach,Florida,known to me to be the person(s)described in
and who executed the foregoing instrurnent; who acknowledged to me that he or she executed the same freely
and voluntarily and for the uses and purpose therein mentioned.
pose th
ALBERT MORENO
Notary Public-State of Florida
Notary Public in for said County and State
E Commission#FF 239295
My Comm.Expires Jun 9,2019
Bonded through National Notary Assn.
CITY OF ATLANTIC BEACH, FLO a
municipal corporation:
Approved:
Kayle Moore,Public Works Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Nelson Van Liere, City Manager
Page 2 of 2
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AR94268/ID5903
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WING REPRESENTS A ATLANTIC BEACH, FL 32233
PROPOSED CHANGE IN THE
CONTRACT.DOCUMENTS AND IF
-Ac-CEPTED WILL BECOME A PART
(0 OF THE CONTRACT DOCUMENTS ISSUE DATE
07JUNE16 14.0127
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REQUESTED ol
WATER METER
LOCATION
SITE PLAN - DRIVEWAY �L—lj 8"CONCRETE APRON
SD07 1/8" = 11-011 4TH STREE
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NICHOLAS JAMES RENARD
XOTE f�ENARD AR94268 ID5903 DRIVE\/\/AY
A R C H I F E C -1 U R L
H.o.F.
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SD07
363 4TH STREET
THIS DRAWING REPRESENTS A
ROPOSFD CHANGE IN THE
P ATLANTIC BEACH, FL 32233
CONTRACT DOCUMENTS AND IF
ACCEPTED WILL BECOME A PART
OF THE CONTRACT DOCUMENTS ISSUE DATE
07JUNE16 14.0127