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104 Sylvan Dr JEA ROW permit CITY OF ATLANTIC BEACH r� 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 RIGHT OF WAY - SINGLE OR TWO FAMILY RIGHT OF WAY MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: ROW17-0023 Description: remove 30-ft. wood pole, install 40-ft. wood pole Estimated Value: 0 Issue Date: 11/7/2017 Expiration Date: 2/5/2018 PROPERTY ADDRESS: Address: 104 SYLVAN DR RE Number: 170648 0010 PROPERTY OWNER: Name: SHUCK ROBERT R ET AL Address: 104 SYLVAN DR ATLANTIC BEACH, FL 32233 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: JACKSONVILLE ELECTRIC AUTHORITY Address: 21 CHURCH ST W 3RD FLR JACKSONVILLE, FL 32202 Phone: PERMIT INFORMATION: Please see attached conditions of approval. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. * A notice of Commencement is only required for work exceeding an estimated value of $2,500. For HVAC work, a Notice of Commencement is only required when HVAC work exceeds and estimated value of$7,500. IMM it Ali a, SYLVAN DR co .W �x• s� 171 4m Am� J City of Atlantic Beach APPLICATION NUMBER js r Building Department (To be assigned by the Building Department.) 800 Seminole Road - Atlantic Beach, Florida 32233-5445 /n�� g M VC)1" ` _ G CJ Phone (904)247-5826 • Fax(904)21XI46 5 2017 E-mail: building-dept@coab.us Date routed: IC City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 0'A Sy`VCL O f Department review required Yes No Building Applicant: Planning &Zoning (� Tree Administrator Project: Ltf\� t '3E_Vk , `-� (��P �(QQ\,#Ct ublic rks IT Public ilities W ` \_to- w�0 d 0� Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B 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. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING r Reviewed b Date: TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. [-]Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 ' r11ATJrJ� City of Atlantic Beach APPLICATION NUMBER �S n� Building Department (To be assigned by the Building Department.) r W 800 Seminole Road Atlantic Beach, Florida 32233-5445 W 11 vc i G U Phone (904)247-5826 • Fax(904) 247-58410CT 2 5 2017 E-mail: building-dept@coab.us Date routed: (C W 119- City I -City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: O �k Sy�0&e) O� Department review required Yes No Building Applicant: #; Planning &Zoning C Tree Administrator Project: �0_0'\ t IS _k . \-00oAl Q(��Q S Q�UfCQ ublic Works } \', W��d �1 f-� Public ilities _toPublic Safety Fire Services Review fee $ Dept Signature v� ell 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: RJApproved. [-]Denied. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING // Reviewed by: � Date:(Q Z 7 ( 1 TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ❑Not applicable rB,LI,C ORKS ) Comments•UTILITIES —Z ce —/ PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 .fes ELECTRIC GRID ENGINEERING CUSTOMER/ Svc LOCATION 110 SYLVAN OR - POLE REPLACEMENT FOR CTS1 PERMIT CENTER SSSC SuB-STA. NEPTUNE BEACH CIR. NO. 565 OPNm 8004474 w0: 30183033 CONSTRUCTION NOTES: 1. AT STA-01: -REMOVE 30/4W POLE. -SET NEW 40/4W POLE. -INSTALL MINI-CELL TOWER EQUIPMENT. -REATTACH SECONDAY's AT A MIN, OF 48" BELOW CELL TOWER ANTENNA, (SEE ATTACHED STANDARDS DWG.) ,q 475 ti�yo 473 110 = o �zs el P, 40" 44, \�� 210 m IV2 -- : '_---- STURDIVANT AV 6lQ U Ln LCA 2/00 2/BP 469 1-8 I PUBLIC WORKS ATLANTIC BV {✓}APPROVE_______. — { }DENIED { OT APPLICABLE TO DEPT ENGI E �A N ONE NO.665-6813 CELL NOs 349-3960 DATE REL CONST 10/24/17 CONST. COMPLETED BY DATE , AS-BUILT RECEIVED rtr4 ir'.' CITY OF ATLANTIC BEACH 'J J CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS !� �•• � 800 Seminole Road 904-247-5800 ?<�a � Atlantic Beach,Florida 32233-5445 Fax 904-247-5845 PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION. Date ��G �[l 12 17 PERMIT# c v I - L,)pa - C ISSUED BY THE CITY 3 Job Address / ✓� v r" . Permitee: LC Telephone# 3 Permittee Address: � /E -7ZO,92— Rcquesting Pcrmission to Cons uctl 'U ✓ �_3D/ �P j r 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/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 orlorida Departmeof Transportation Standards and be 14 performed under the supervision of - ur�d// (Contractor's roect Superintendent) located at 2 //✓, CZa,-.h Telephone#: I��GJ _b�/_Ij 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 anv 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 �0 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. OCT 2 Q 2017 My commission expires: Personally Known: Produced Identification: