72 Levy Road ROW19-0024 Culvert in Driveway RIGHT OF WAY PERMIT PERMIT NUMBER
� ROW19-0024
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ISSUED: 8/9/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 11/7/2019
MUST CALL INSPECTION • • 914) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL • 'K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • ' i + BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC ' CH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
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.
JOB ADDRESS: PERMITTYPE: DESCRIPTION: VALUE OF WORK:
72 LEVY RD RIGHT OF WAY SINGLE OR TWO CULVERT IN DRIVEWAY $4100.00
FAMILY RIGHT OF WAY
TYPE OF
• • GROUP:
� !!�� 170797 0050 ATLANTIC BEACH SEC H
COMPANY:
Cox Construction of NE 2281 Windjammer LN E JACI<SONVILLE FL 32224
Florida Inc.
• ADDRESS:
LEWIS BILLY E 72 LEVY RD ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR 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.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
2 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list(Advanced Disposal,Realco Recycling,Shapells,Inc., Republic Services,Donovan Dumpsters,
Phillips Containers,JDog/Dennis Junk Removal,All American Roll Off,WCA Waste Corporation). Container cannot be placed on City right-of-way..
Issued Date:8/9/2019 1 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road o q --ou z4
$ si Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
i C,; v% E-mail: building-dept@coab.us Date routed:
City web-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address.
< Z_ Department review required Yes No
Building
C� �- C _ i Zoni
Applicant: � �C �fe(.�('�� --�->- -P n- -2—L
j � �\ •� / Tree Administrator
Project: l� t f e (`-� t /1 L�J (; (�F Pub 11_CTVor
IC iii
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: ❑Approved. ❑Denied. Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: 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
�~ RIGHT-OF-WAY/EASEMENT PERMIT APPLICATION **
ALL INFORMATION
City of Atlantic Beach ) HIGHLIGHTED IN GRAY IS
800 Seminole Road,Atlantic Beach, FL 32233 \ REQUIRED.
PE EE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES //`��
Job Address8 Permit Number (Ro wl ' ��z`T
Contractor Informatidn i L L L E W ( - O- 'I'll hC
COX
Company coy Qualifying Agent
Address City State Zip 'Z.Z
Phone oL�) ,2g• EmailN)�Xo tS—b=*1CJ�CQVL054 -�
State Certification/Registration#
Architect Phone Email
Engineer Phone Email
Workers Compensation Insures OR ExemptmExpiration Date
• 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 Public Works Director,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 Public Works Director and at the expense of the
Permittee unless reimbursement is authorized. �� �Z� A *nEl
• All work shall meet City of Atlantic Beach or Florida Departrrfen'/nt��of Transportation Standarrmed under the
supervision of S t,cCCGS—�_w4 t SSuuperintendent)
with(Company Name) X��
• 111
All materials and equipment s a esu ect o inspection bie Public Works
• All city property shall be restored to its original condition as far as practical,in k g 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 -of-way are to be included with
this application.
• The permittee shall commence actual construction in good faith within ay f the beginning date is more than 60
days from date of permit approval then permittee must review the permit with t e Public Works Director 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 Public Works Director shall be notified 24 hours prior to starting work and again immediately upon completion.
Date
Permittee(signe in Bence of Notary Public)
STATE OF FL IDA,COUNTY OF DUVAL1r.
The foregoin i as acknowledged this !��— day of �rA./ 20
by who personally appeared before me and
rmittee)
_
BRITTANYMAA
ackno :t h � EA� ii�kfMnt voluntarily for the purpose expressed in it.
Commission 9 GG 314017
+` My Comm.Expires Mar 19,2023
B
dej throw ational Notary Assn.
071117
ersonally Known
Signature of Notary P b c, tate of Florida [ I Produced Identification(Type)
H:\Applications&Forms\Word Documents\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
1'.
To whom it may concern,
Scott Williams with City of Atlantic Beach public works
has informed us to apply for this permit regarding the
rear access to our warehouses. He informed me we are
to use 15' minimum diameter RCP or schedule 80 pipe
extending 3 feet beyond the driveways. He informed us
that in this case the concrete bulkheads were not
required. Please feel free to call me at 904 868 0866 .
Thank You,
Aaron Cox
City of Atlantic Beach APPLICATION NUMBER
BuildingDepartment 77 ( o be assi ned b the Building
p
uildin Department.)
800 Semnole Road JULL [ 6 2019 g
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845{ Y:
E-mail: building-dept@coab.us Date routed: J
City web-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address.
'7z' _ �
L v ( Department review required Yes No
( f Building
Applicant: �� �O T�0 C'A' P Zonm _
r Tree Administrator
Project: �f (A 4� ('}�� ub1�c"�VOor
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 Ji
St. Johns River Water Management District l ,
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. ❑Denied. El Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING 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
rS+yLir�, City of Atlantic Beach APPLICATION NUMBER
j� Building Department (To be assigned by the Building Department.)
800 Seminole Road
ri Atlantic Beach, Florida 32233-5445 l
j s
Phone(904)247-5826 • Fax(904)247-5845
�.;t E-mail: building-dept@coab.us IL Date routed: 7h� 0�1)/(
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z LE-.v -C Department review required Yes No
()op y
j Building_
Applicant: lP— Zonin
r' Tree Administrator
Project: e. (` t T\ �� �(��� Puf3icf`—vaorfzs--
c iii
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 Q/
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:
APP CATION STATUS
Reviewing Department First Review: Approved. []Denied. []Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: � ��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
PUBLIC UTILITIES PLAN REVIEW COMMENTS
Date: Z`1 Application#:
Project Address: Z Le v
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. ❑ ❑
A sewer cleanout must be installed at the property line. Cleanout must be
RT3 Sewer covered with an RT1 concrete box with metal lid. Cleanout to be set to grade ❑ ❑
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 ❑ ❑
Meter must be tested by a certified tester and a copy of the results sent to Public
Utilities.
Fire Sprinkler If fire sprinkler system is provided,call 247-5878 for backflow requirements.
Backflow At a minimum,will require a double check backflow preventer. ❑ ❑
Requirement
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 IEA specifications.
Utility Map See attached Utility Map.
Disconnect
&Cap Disconnect and cap water and sewer lines. ❑ ❑
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 13
p,. 1
_i
95
0 b. , 1 50
I
LEVY RD
„
10"GRAVITY SEWER MAIN74
;, _,, ,f
LAL
72
148
�gTysr 8" GRAVITY SEWER MAIN
M
Asir
I
MH-0a826 1
8„pV•
m
AI
e�
• y �
iR
r
F u
} 0 A
� ay
85
75j! ',c t`s ��
0
734
00
T T � ,•_�
yS
r�