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22 N Saratoga Cir FNCE17-0030 fence permit CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 FENCE WALL OR BARRIER - FENCE MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-SS14 PERMIT INFORMATION: PERMIT NO: FNCE17-0030 Description: install 6-foot wood fence w/2 gates Estimated Value: 2350 Issue Date: 4/17/2018 Expiration Date: 10/14/2018 PROPERTY ADDRESS: Address: 22 N SARATOGA CIR RE Number: 1718130000 PROPERTY OWNER: Name: SEC HOLDINGS LLC Address: 209 DEER HAVEN DR PONTE VEDRA BEACH, FL 32082 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: Fences By Gator, LLC Address: 13142 Ebbtide Court Jacksonville, FL 32225 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. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. * 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. City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) I '>1 800 Seminole Road Atlantic Beach, Florida 32233-5445 _W3 D Phone(904)247-5826 - Fax(904)247-5845 19 E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us 11 APPLICATION REVIEW AND TRACKING FORM Property Address: �S"a De artment review reauired Yes No ac _Ap_� 9!�, L If - N- ,J Bu I ing Applicant: W a.f LU Pill n ing Zoning Tree A inis Project: i ns�nn tv%o4 woo 7�®rks C4 Public Utilities %_J Public Safety Fire Services 71 Review fee Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection EFIori.iida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and fobacco Other: APPLICATION STATUS Reviewing Department First Review: ElApproved. ODenied. (Circle one.) Comments: P-N'ot applicable BUILDING t PLANNING & ZONING 3y) Reviewed by: ;Z��ate: ( h 77 TRE�DMIN. Second Review: [—]Approved as revised. OlDenied. ONot applicable C,WZSO�R�K C ments: P'U UBLIC UTILITIES P�B-_�47—(7 LIC SAFETY Reviewed by: Date: FIRE SERVICES [Third Review: []Approved as revised. []Denied. E]Not applicable v C Comm s. omments: Reviewed by: Date: Revised 05/19/2017 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 FfiL&II—w3c) Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: 0 (d v City web-site: http://vmw.coab.us I APPLICATION REVIEW AND TRACKING FORM Property Address: aQ "z4ajp De artment review rea u i red——Yes No \J Buil ing D e a kment review r1equired Applicant: -6a Nr , Planning Zoning T T ree A minis Project: nsvAll 0-�VA wpoj 2A(_p Public Public Utilities--) Public Safety 4Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. 'of Environmental Protection lor �t EFlori.ida 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: /zApproved. []Denied. E]Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by-//��� Date6//2- I TREE ADMIN. Second Review: oApproved as revised. OlDenied. F]Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by:_ Date:— FIRE SERVICES Third Review: E]Approved as revised. ElDenied. [:]Not applicable Comments: Reviewed by:__ Date: Revised 05/1912017 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road FtJ -OD,3 D Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: v City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Zk(� "-'a4CLAD Department review required Yes No Builcrin-g-') Applicant: Ftnu-s d'Planning &Zo�ning )a wL - Tree Ad-m`in"i-sTrM0T-- Project: �0-�D(-A W00A 2AQ C Public*Srks Public Utilities V-) 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. E]Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date 7 TREE ADMIN. Second Review: F]Approved as revised. []Denied. F]Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: []Approved as revised. E]Denied. []Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 FpJ L&(J--tD3 C) Phone(904)247-5826 - Fax(904)247-5845 lil!) E-mail: building-dept@coab.us Date routed: 9- City web-site: http://viww.coab.us I — APPLICATION REVIEW AND TRACKING FORM Property Address: ZkQ '—ataj? De artment review reauired— Yes No ADe a ent review required 'm Buil ing Applicant: FoU3 EN -Cia Nr i Plan ing Zoning T T ree A minis ic "s Project: it) 1.1 to-�Do4 wo kdQ Pub ct 4,__Public Utilities Public Safety Fire Services Review fee $ Dept Signature [Other Agency Review or Permit Required Review or Receipt Date Florida Dept. of Environmental Protection of Permit Verified By 1 10 Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and�obacco Other: APPLICATION STATUS Reviewing Department First Review: [:]Approved. [?fDenied. [:]Not applicable (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by Date: TREE ADMIN. Second Review: VApproved as revised. ElDenied. [:]Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by:.--J(I*" Date: FIRE SERVICES Third Review: ElApproved as revised. OlDenied. [—]Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 CITY OF ATLANTIC BEACH DEPARTMENT OF PUBLIC WORKS 1200 Sandpiper Lane Atlantic Beach,FL 32233-4318 TELEPHONE:(904)247-5834 FAX:(904)247-5843 www.coab.us CONTRACTOR: DATE: 7-17-17 Fences by Gator,LLC PERMIT#FNCE17-0030 13142 Ebbtide Court ADDRESS: 22 Saratoga Circle N. Jacksonville,FL 32225 Atlantic Beach,FL 32233 Email: fencesbygatorAgmail.com PERMIT APPLICATION TO INSTALL 6' FENCE WITH(2)GATES APPROVED Your permit application has been denied by the Public Works Department for the reasons)—isred bet�/el submit this information at your earliest convenience in order for us to approve your application. If you have any questions, please contact Scott Williams,Interim Public Works Director at 904-247-5834 or email swilliams@coab.us. PUBLIC WORKS CORRECTION ITEMS: (Submit thefollowing information to the Public Works Department) 0 A Revocable Encroachment Permit must be obtained. PUBLIC WORKS CONDITIONS OF APPROVAL: (Thefoltowing comments will beprinted on yourpermit as Conditions of Approval) • All runoff must remain on-site during construction. • Roll off container company must be on City approved list(Advanced Disposal, Realco Recycling,Shapell's, Inc., Republic Services). Container cannot be placed on City right-of-way. • Full right-of-way restoration,including sod, is required. • All old fencing must be removed from job site by Contractor. cc: Toni Gindlesperger,Building Department Jennifer Johnston,Building Department CITY OF ATLANTIC BEACH 800 Seminole Road /APR -11 -201 Atlantic Beach,Florida 32233 REVISION REQUEST CORRECTIONS TO PLAN REVIEW COMMENTS Dat/ Revision to Issued Permit Corrections to Comments Permit 4 Project Address,;Z ;2, 5 qk2-,9 1 o G Contractor Contact Name- /t'414 C--e < cz 6,!!q Phone'/,/,)'!!�/ 3V� C/o Email Description of Proposed Revision/Corrections: Permit Fee Due $ Re-v , re J�Q-(--' C�-( i- Additional Increase in Bu $ Additional S.F. By signing below,I affirm the Revision is inclusive of the proposed changes. (printed name) Signature of Contractor/Agent(Contractor must sign if increase in valuation) Date (Office Use Only) Approved Denied Not Applicable to Department Revision/Plan Review Comments Department Review Required: Building Planning &Zoning 4`7Reviewe&15T&'vvL" 'or— Tree Administrator ,,�KE�Iic�Works TIM . s Public Safety D i tie Fire Services City of Atlantic Beach ��00 li-miriolo, Poarl, Allariti( f;r-jr.1i 11 ',2) Ph'ift- (901) 2111 '306 la�. i,)04) �4/ I)p4l.' cc_�17 R V EEF Jo b A ci,J f f. -2 A 7(.4,A 41 J� Legal 0,2—Tirtion ._C, JUN 2 2 2017 Valuation of Work(Replacement C 7 Hpated/Coriled 5F A, L f r)�,t) on Class Of Work(Circle one) Addition Alt#�ration Rr�p;ir riloip Dr:rno Pori! Use Of existing/proposed structure(s)(Circle one): (orrim-rcial #�R,��eaLlal If an existing structure,is a fire Sprinkler system installed?(Circle one): le�,, f 4 o Su b mit a I ree Removal Permit Applicatiorl if any trees;�t r, I ri bf�,rr�rro rited or Af ficlavit rf I lo T re R err ova I Descr,bein cletaill the—type of k to be performed: -ire 2 Florida Product Approva I it_ PropertV Owner Information for multiple products u,.rw product approval form Name: t�1 Addres%: Cit,y & lip_32_a�-Z— Prior,,: E-M;�l Owner or Agent(If Agent,P0 ,ve 0- ttorney or Agency Letter Required) !CLqntrqCtoL�nfqrrnation Name o f Compan" Address I h�'Ilk Qualifying A.gent: 6a A 5 it Cit JA,-se c ift-5 oi �Q` vit-tiIfState Ztp____3_2_Z2 Office Phone C 5 CaE 2 U qr —Job Site/Contact Number to - C State Certification/Regi5tration# " - &C� Architect Name&Phone# E-Mail C-S Engineer's Name&Phone WOrkerS Compensation E.empt/In-_.,.,�/ 1_12-�e Enpl--.xiee�/_E.pJ,,.n.n Dat, APPlication is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installaition has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING; SIGNS, li".1ELLS, POOLS, FURNACES,BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning, WARNING 7-0 OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND F0 OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE tECORDING YOUR NOTICE OF COMMENCEMENT. 4 actor) 4S 'a Y�e �1k_6e2_kj�V, (Signature of Contractor) (including contracto ) ri rned and sworn to(or affirmed)before me tilis 2J day of Signed and Sworn to(or affirmed)before me thia�_ e , ____ 7 by__DGL&LD0_r) i 10, Zu->1-1- by W(-ti _F-nait�;-re of Notar�-., ign ture of Notary) JE(Sig]nture Lof_NotiLr_y) t 7— JENNIFER JOHNSTON M Y COMMISSION#GG 042984 EXPIRES:October 27,2020 WnallY Known OR Personally Known OR Bonded Thru Notary Public UnderMters hiced-Identification f-4_Produced identificati., Idenfihcatjon� Type of Identification: C Lot# 6 0 Lot# 7 E Lot# 5 :3 '7 0 S69'26'51'E 75.0W '0 (p) am =—a U) OX V i:r 9.81 �5.01 —ms 0 (4.9� Nu- 0 ztj F �c�t tt 11 A Lot# 18 Lot# 16 t 11'0") A IF, L4 86 RY� VOL, DWELLING 5' DRAINAGE y. EASEMENT 0 C3 "T± --- -.30'—BRL— dc A 0 0 0 lax an A S69'31'25'E 324.�3 S69*31'25'E 324. a N69*31'25'W RBL (.4) '.7�(M(p) N697W40'W Saratoga Circle North- 64Y R/W 2S C.-bd Asphdt C a) E CONCRETE 0 YARD YARD COVERED OR ENCLOSED METAL S10RAGE BMDWG PLEASE SEE SHEET 1 OF 2 FOR LEGAL DESCRIPTION, CERTIFICATIONS. :3 0 FHA/VA WELL AND SEPTIC TANK DIMENSIONS ( if applicable ), LEGEND. a SYMBOLS. ABBREVIATIONS, NOTES. SIGNATURE AND SEAL ETC. SHEET 2 OF 2 ALONE DOES NOT CONSTITUTE A FLORIDA BOUNDARY SURVEY BUILDING SETBACK LINES, IF SHOWN, ARE TAKEN FROM PLAT GRAPHIC SCALE 0 m 30 Sheet 2 of 2 IN n= I inch = 20 ft- Boundary Survey 020117-4 for SEC HOLDINGS, LLC This is a Double—Sided Document Survey Certifications. This is a Double—Sided Document Surveyor's Standard Notes SEC F4cPjLCj_j"_q_S L_ I_C 1� Legal Description has been Furnished or Confwmed by Client or by HIS/Her Agent& Legend and Abbreviations. 2 Lands ohm tereon we not irIdeperidently obstructed for POst-Plat Nhts-of-woy,fosemenlN etc 22 North Saratoga Circle AC =Acres A -Delta or Central Angle BLDG Bull d RAO-Radius 4)3) Measurements shown hereon are in accordance with US Standard Feet, Jacksonville, Florida 32233 BRL Buildin inRastriction Lime CH Chard Beaming&Distance Bearings shown hereon based on Reference Bearing Une as indicated on Sheet 2 of 2. CM Concgrete Monument 5) contiguous lots lie In some block, unit, phase, section, etc unless noted. CONC �L Arc Length Type of Survey: BOUNDARY with Improvements. Concret P Plat Coll 6) 08 Deed Books M� Field Measured Value EC Edge of Concrete C Calculated Value 7) Stated Legal Purpose of Survey. Acqusition\Mortgoge\Permits\Plonning. EP E of Atipholt/Povernent (D) Deed Call 8 This Survey Is not Intended to Locate any subsurface Improvements. foundations etc, L rk Tt ESMT Edg:emant andmo I le FT. Feet P 9) This Survey is Not Intended to Reflect or Determine Ownership. Old Republic Title Insurance Company FIP, Found iron Pipe(SlzeDelintated) IR 1froonn Plopd 10) This Survey Is NOT Insured for Multiple use&Fiduciary and all other obligations ore limited FIR Found Iron Rod(Size Delineated) LB Licensed Sur y Business to the Car ifyees listed above/rIght utilizing survey for purposes in item 7 above. LS Licensed Surveyor LS Licensed Su"rvayor 11) Construct �mprovements to Iron Markers as Described Only. nof now or formerly(owned by) RLS Registered Licensed Surveyor OHW Overhead Wire/Line PLS Professional Licensed Surveyor 12) All Above-ground Evidences of Utilities lie Within their respective easements unless noted. Lilagal Dilleiscriptic)ns ORB Official Records Book Any conflicting uses onto or from easements ore listed as PON am Sheet 2. ORV Official Records Volum PSY PrOfMI01101 SUrWeyDr&MOPM Fences and Driveways though property permitted, are common POI's PC Point Of Curvature () Fire Hydrant 13) Ail boundary dimensions shown he7ron are field measured and are In PCPt Permanent Control Point S c agreement with the plot and or legal description unless noted PP Pa Sanitary Sewer Manhole 14) Streets shown hereon are centered+\-In thei respective right-of-way unless noted P Po?net Of Intersection _D= PIK Porker-Kolon or g Nall V Stornivater Drainage Manhole 15) Elevations, If shown, are based on North American Vertical Datum of lgsB, POB Point Of Begminarilng JEA 16) State Plane Coordlimat1%If shm,based on the North Annerton Datin of 19A Florida East Zen&(19W) LOTw- 17 Ill C)I C K POIC Point Of Commencement (D = JEA Manhole - 4 POI -Point of Interest CCEC=Clay County(tactic Cooperou" 17) Some leaturd(especially fentes)relationihip to od=�t property Me(s)may be grq*dy exoWated PRC -Point of Reverse Curvature CUA-Cloy Utility Authority Ot tholdif d*Mtd IXW�line would cliscure a ' Dionerdan listed okys mides graphic depiction, SUBDIVISI10N- ATLANTIC BEACH VLLA No. 2 PRM -Permanent Reference Monument 18) Water Lines Shown are to current waters edge at tinnill of survey. This li PT -Point Of Tongency COJ-CIty of Jacksonville me Is Aw 9 Mew High Water Line'as per Chapter IT7.39 F A C or other opplicable7l—es. PLAT/MAP BOOK, 0 1 PAGE (a), RBL -Reference Bearing Line FP=Florida Power 19) Team Dw'*"Of Calten,POdkuWY 116011 Or PVC CORIblictim a".1o'dolest a TO or ON Subject Tract R/W =Right—Of—Way Line FIPL=Florida Power&Light jo SIP =Set Iron Pipe(SlzeDelineated), JEA-Jacksonville Electric Authority N*Y 05"M by In,tk#at manxie 6'Mde Felim(W*rL%Ish efe)the Wildly UK' PUBLIC RECORDS OF DUVAL COUNTY. FLOR A SIR =Set Iron Rod(Size Delineated) em etior vi many Unies ks between the face and PW side inding M once lego y cW physioly'on line'. 00C-olifivicke Rural ftkk Compendia 20) SO. Square F.A.C.=norldo Administrative Code IME CIVIL & SURVEYING, 11 Star -F =Face aide of Wood Fence S Sec?ion T Township p =Post Side of Wood Fence Reproductions of this Sketch ore not valid unless LLC R Range 0=WELL Sealed with Florida PSM embossed seal. 910 E. RED HOUSE BRANCH ROAD am : Pool Equipment on Pad THE. SKETCH OF SURV[.Y DEPICTED HEREON CONFORMS 10 IAM Air Conciltionef/Heat Pump on Pad THE STANDARDS OF PRACTICE SET FORTI-I BY THE ST. AUGUSTINE, FLORIDA 32084 0 - Fire Hydrant FLORIDA HOARD OF LAND SURW-YORS IN ACCOMANCE VATI-I — OPP- Power Pole CRAPTER 5"7.0%17.053,PURSUAIT TO CHAPTER 472,RORIDA STATUTES, F 0=4 I" c3b C-- = Guy Anchor(If Dimensioned-Dimension to Ground Entry Point-Underyound Extent not Determined) AND WAS DONE I IRECT SUPERVISION, ED = Water Meter X X c F�Cut� on rate Found 4889 A nd Ise Cis DescrIbed A Set PK c#4889 9 0 4- 4-G 0. S 4-7�5 N FOUND CONCRETE MONUMENT AS DESCRIBED bron don. Sh u 9art(9j>9rn oil, (=Orn 0 SET CONCRETE MONUMENT # 4889 This Survey is Su, 0 1 r Multiple uses. 0 PRM/BLOCK CORNER FOUND UNNUMBERED 1/2- IRON PIPE Fiduciary obligati n .. 0 FOUND UNNUMBERED 1/2" IRON PIPE ( unless noted otherwise) a Certifyees above using S SET 1/2" IRON ROD #8139 AT PROPERTY CORNER (unless noted otherwise) Survey for purposes li ed in item 7 Above. WIRE FENCE —X—X TImOthY L. Blackmon, PSm PVC/MNYL FENCE—a— @ COPYF:?IGH r' PRC)TECTED 9 0-4-. -4 S 7 9 0 S 4_ WOOD FENCE —a— DO NOT COPY OR REPRODUCE WITHOUT PERMISSION -S.u r v c3 r <9><?r-n ci 1 C>r-n CHAIN LINK FENCE e— Date of Field Survey:02/02/2017 Drawing\Job # 020117.4.cvr.dwg Drawn by TB Sheet 1 of 2 REVOCABLE ENCROACHMENT AGREEMENT REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach,Florida, a municipal corporation or anized and erting under the laws of tile State of lorida, hereinafter referred to as"CITY"and IE7e of Atlantic Beach,Florida,hereinafter C rQ 5 L rt-!� referred to as"USER". WITNESSETH: That the CITY does hereby grant the USER permission on a revocable basis as described herein tile right to enter upon tile property for tile purpose as described in the City of Atlantic Be Ch. This work is generally described as \C_� t(-Q 7,�_tz t�C_ Any facility maintained, repaired, nd/or installed'in tile exercise or the privilege granted remaills subject to relocation or removal on thirty(30) days' notice by CITY to USER, said notice to USER shall be given by certified mail, return receipt requested,to the following address i�:t—kcx,4�c -a.t .CC&CJ— • In the event it is necessary for the CITY or tile City's approved representative or other franchised utility to enter upon the above described casement or property of the CITY, the USER shall replace at tile USER's sole expense, any and all material necessarily displaced during the action ofmaintaining,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 tile 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." • 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 within 30 days after the day of completion. • This permit shall inure to the benefit of,and be binding upon,the USER and their respective successors and assigns. • USER shall meet tile 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 casements, public right- of-ways and other public land. USER further agrees that the CITY and its officers and employees shall be saved harmless by tile 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. Pro- rty 6�v Date- STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instl-Urnent was acknowledged this q4t-Nday Of J. 20 by 5trp tv who personally appeared before rne and (printed name of Signer) acknowledged that he/she signed tile instrument voluntarily for the purpose expressed in it. Signature o Notary Public,State of4k*k6 --- C7 C 0 m5l 0. Department Approval: Personally Knowr L,-" - - . Produced ldentiftgalion(Type) f Z/ t i b Fi c - o r MilWt o r le­ ian; Sco W�ill ams, Kayle Moore,Public Utilities Director HAMaster Forins\Pubkc Utilities Works For S\ReVGCable Encroachment Agreement 2.5 18.dorx Revision Date:2/5/18 RIGHT-OF-WAY / EASEMENT PERMIT Permit#Issued by the City of Atlantic Beach PERNVITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job AddresZ �jAaA-TiZA At Phone22V 5­7�- Zoe�;� Pcrmittec� e��s/ )A',.�rn a i Requesting Permission to Construct /1--e- rAC/fl C, Location(Reference to Cross-Street) C'/k r • Permittee declares that prior to filing this application they have ascertained the location of all existing utilities, both aerial and underground and the accurate locations are shown on tile sketches. • Whenever necessary for(lie construction, repair, improvement, maintenance,safe arid efficient operation, alteration or relocation of all,or any portion of said street or easement as determined by tile Director of Public Works,any or all 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 hercon as required by the Director of Public Works and at the expense of tile Permittee unless reimbursement is authorized. • All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under tile supervision of �,( j. gle�ckj$(Project Superintendent) with Company NameaA-f�01— FLI.Irl"115� P h o n e 46- -11, 41 f • All materials and equipment shall be subject to inspection by the Director of Public Works, • All city property 5hall be restored to its original condition as far as practical, in keeping with City specifications and the manner satisfactory to the City. • 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. • The permittee shall commence actual construction in good faith within_days. If the beginning date is more than 60 days from date of permit approval then pennittee must review the permit with the Director of Public Works to make sure no changes have occurred in the area that would affect tile permitted construction. • It is understood and agreed that(lie rights and privileges herein set out are granted only to(lie extent ofthe City's right,title and interest in tile 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 arid all loss,damage and cost of expenses arising in any manner of tile exercise or attempted exercises by (lie holder of file aforesaid rights and privileges. • The Director of Public Work-,shall be notified twenty-four(24)hours prior to starting work and again irninedia ely upon completion. &7-Z�6�n Date Perinitice(sigidd in presence of Notary Public) t STATE OF FLOFJDA,COUNTY OF DUVAL The foregoing instrument was acknowledged this day of 20 by__.___ 5+ea�� r w;io personally appeared before me and (printid narne of Perrnittee) ncknowledged that he/she signed the nntrument voluntarily Ibr the purpose expressed in it. (It& �&- �&�- Personally Known Signature of Notitry Public,State of AmidT- Produced Identification(Type) cot-15 1'0-