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925 SEMINOLE RD - AT & T ROW I (,,,,,A,„,..„ City of Atlantic Beach APPLICATION NUMBER ,, Building Department E/1 To be assigned by the Building Department.) - "'- ,(� v 800 Seminole Road l CNV '. ` -: �., Atlantic Beach, Florida 32233-5445 W �� `-"-�� -041- Phone(904)247-5826 • Fax(904)247-5845 OCT rjrtit_r E-mail: building-dept@coab.us 29 20'D to routed: 1 U L fi?M City web-site: http://www.coab.us BY APPLICATION REVIEW AND TRACKING FORM Property Address: 915 DevItnote Department review required Yes No B . Applicant: VAT t- k` (P10nning &Zonin i Tre dministrator cf--E� Project: J-ell(\.l l (Ae._ Pe-h Public Work - T- ' lc Utilities l t Public Safety Fire Services ;Review fee $ Dept Signature 1 Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection • Florida Dept. of Transportetion 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. I 'Denied. I Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed byaliatjetaitio Date: `®--3/-/I, TREE ADMIN. Second Review: A roved as revised. I Not applicable ❑ pp nDenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: [lApproved as revised. ['Denied. I 'Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 City of Atlantic Beach APPLICATION NUMBER Jr1 Building Department r: 1 e assigned by the Building Department.) 800 Seminole Road ►° Atlantic Beach, Florida 32233-5445 :r Phone (904)247-5826 • Fax(904)247-5845 ){:,18 --4.0100- E-mail: building-dept@coab.us a routed: C (-1/2- ie City web-site: http://www.coab.us �K_...._ APPLICATION REVIEW AND TRACKING FORM • 9Z5 J l 'Lrequired Yes No Department review Property Address: �I.j1 V B Wd'I. Applicant: P1 k C.gLauninci&Zonin.� C {� Tree Administrator Project: e l yC�� --E� JPet' 1 Public Wor� Tthi tc Utilitie§a Pblic Safety Fire Services ;Review fee $ Dept Signature Review or Receipt Other Agency Review or Permit Required of Permit Verified By Date 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 First Review: Approved. (Denied. INot applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: .- ate: /0-50/1/ TREE ADMIN. Second Review: I 'Approved as revis d. ❑Denied. nNot applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. nNot applicable Comments: Reviewed by: Date: Revised 05/19/2017 01.-up,-.4_, City of Atlantic Beach APPLICATION NUMBER as ,, Building Department (To be assigned by the Building Department.) ,(1 s 800 Seminole Road �,�J`�J'j (-- 47 ç ,_. . �r Atlantic Beach, Florida 32233-5445 Phone (904)247-5826 • Fax(904)247-5845 ��L�509' E-mail: building-dept@coab.us Date routed: t U Z(Q City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 92_5 e,v 1r )l e Department review required Yes No B uiidiu Applicant: PN-T- ` - lining_&Zon1 Tree Administrator tra tor Project: erv � V.--J 6e-k-w /) Public Wo ks T '' t l ` Tc Utilitj Public Safety Fire Services Review fee $ Dept Signature j 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. Denied. 7111ot applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by:/.% — Date: Ii ( 4 TREE ADMIN. Second Review: Approved as revised. I (Denied. ['Not applicable PUBLIC WORKS Comments: • PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: I lApproved as revised. ❑Denied. ['Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 I1,L=VL1 V GV %, OCT 2 6 2018 s 't� RIGHT—OF—WAY/EASEMENT PERMIT ,tt,� - Ent v). Permit #Issued by the City of Atlantic Beach f PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job Address Seminole Rd (between Plaza St and 11th st) Phone (678) 429-1829 Permittee Anthony Pellegrini AT&T 83E68213N Email mark.adamson@rtsassociates.net Requesting Permission to Construct Conduit structure between 2 existing manholes. Please see plans for additional information. Location(Reference to Cross-Street) Plaza St, 9th St, 10th St, and 11th St • 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 the sketches. • 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 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. • All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the supervision of Richard Yeater (Project Superintendent) with Company Name Danella Construction Corp of FL Phone 904-575-0070 • All materials and equipment shall be subject to inspection by the Director of Public Works. • 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. • 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 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. • 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. • The Director of Public Works shall be notified twenty-four(24)hours prior to starting work and again immediately upon completion. 9 -eDate 1 0 1 a 3 I ao i SZ Permittee(sign d in presence Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL r The foregoing instrument was acknowledged this day of ©C[ober ,20 I t3 , by A✓1 -11 o n P It eq f i it ,who personally appeared before me and (prifited name of Permittee) acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. 4)44,4,1 P(Aa S c,tti- Personally Known Signature of Notary Public,State of Florida Produced Identification(Type) P % BRENDA A.PAUSCriE, MY COMMISSION M FF937851 EXPIRES;Novsnba 19,2019 PUBLIC UTILITIES PLAN REVIEW COMMENTS Date: /t y G �/ k Application#: % 6d Project Address: 9�S C.5.. /7/k) Check Box Check APPLICATION TRACKING COMMENTS to Add Box to Commen Print Underground Avoid damage to underground water and sewer utilities. Verify vertical and Water Sewer horizontal location of utilities. Hand dig if necessary. If field coordination is Utilities needed, call 247-5878. Meter Boxes Ensure all meter boxes,sewer cleanouts and valve covers are set to grade Sewer Cleanout and visible. 0 0 A sewer cleanout must be installed at the property line. Cleanout must be RT1 Sewer covered with an RT1 concrete box with metal lid. Cleanout to be set to grade 0 0 Cleanout and visible. A reduced pressure zone backflow preventer must be installed if irrigation will RPZ be provided or if there is a private well on the property. Backflow preventer ❑ ❑ Backflow must be tested by a certified tester and a copy of the results sent to Public Utilities. Plans note the building will be unsprinkled. If plans change, any fire line Sensus installed must be metered with a Sensus touch-read meter in a properly sized Touch-Read vault and an appropriate backflow preventer installed. Backflow preventer 0 0 Meter must be tested by a certified tester and a copy of the results sent to Public Utilities. Fire Sprinkler Backflow If fire sprinkler system is provided, call 247-5878 for backflow requirements. 0 0 Requirement At a minimum,will require a double check backflow preventer. Fire Line Fire lines must be metered with a Sensus touch-read meter. Meters larger ❑ ❑ Meter than 2" must be installed in a vault as noted in JEA specifications. Utility Map See attached Utility Map. Disconnect &Cap Disconnect and cap water and sewer lines. 0 0 Inspection Must call the Inspection Line at 247-5814 to request an inspection of the ❑ ❑ Prior disconnected and capped water and sewer lines prior to demolition. ❑ ❑ ❑ ❑ ❑ 0 O 0 0 1 1140 -----------...._ - ' J 0l - 395 390 359 355 351 34 4. n 1151 1130 \-6 1 .. . .,M,.> .W E 0 H-'- I O n p"p 41011 .21 • . . a .�.r...'.... 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