955 SAILFISH DR W RES20-0275 revision for driveway 8-11-21 Revision Request/Correction to Comments **ALL INFORMATION
s'—L1r HIGHLIGHTED IN
rs ( "' City of Atlantic Beach Building Department GRAY IS REQUIRED.
' 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT it: k E Sam` 0275
El Revision to Issued Permit OR El Corrections to Comments Date:.a // /
Project Address: q5-s-- , )- `5 I- LD e511 66
Contractor/Contact Name: � t/]��r �.�n�5/2C tail;/6'
Contact Phon(7 -{) -114 9 Email: — ! C • .s - GO
Description of Proposed Revision/Corrections:
,1c/ 7�, rear- veS
sc,✓1 affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• Will proposed revision/corrections add additional square footage t� riginal submittal?
❑No El Yes(additional s.f.to be added: _) 52 5(17
• ill proposed revision/corrections add additional increase in building value to original submittal?
11No ❑*Yes (additional increase in building value: 3/iz'�Y )(Con ct r must sign if increase in valuation)
*Signature of Contractor/Agent: 7
(Office Use Only)
❑ Approved ❑ Denied ❑ Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments
Department Review Required:
Building
Planning&Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services Updated 10/17/18
8/11/2021 Google Earth
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RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION
City of Atlantic Beach HIGHLIGHTED IN GRAY IS
, .x. II 800 Seminole Road, Atlantic Beach, FL 32233 REQUIRED.
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address `I j sSe4i 165I-, LL.),:: Permit Number s ' t,/2 'da 7
Contractor Information
Company v �Lr IJ, n.y G r (Z Qualifying Agent „ r<e c C�c.SaYI
Address PC, X. 5 �� �J City&JeA L" cjState T1 Zip &�cb
Phon(e-i(S-1) S - 1 1 Email Y-Le_r 0--)CdL 0A , rY-1
State Certification/Registration ft C 8 a _ 1 1 C_:.)
Architect N r Phone Email
Engineer N A Phone Email
Workers Compensation Insurer OR Exempt Expiration Date 3/33..-f.2«
• 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.
• All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the
supervision of �pt1,Zcer CC'i.-j .'• (Project Superintendent)
with(Company Name) S 1� �ji t;, ( Cz—7 Phone (1n,) e28 - 1 1 4
• All materials and equipment shall be subject to inspection by ffie Public Works Director.
• 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 1 (3 days. If the beginning date is more than 60
days from date of permit approval then permittee must review the permit with the 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 Inde' ify,defend and save harmless the City of Atlantic Beach from and against any and all loss,damage and cost of
expens• :rising in any manner of e : ercise or attempted exercises by the holder of the aforesaid rights and privileges.
• The P ' is Works Director shal se ified 24 hours prior to starting work and again immediately uponn,comple ion.
on, % Date g / // 0,24 :.
Z l
Permittee figned in presence of Notary Public) <ll
STATE OF FLORIDA,COUNTY OF DUVAL �y
The foregoing instrument was acknowledged this 1141 day of_� �1,7s t ,20 2�
by c lLndt_lf' Nktr ri)' c 2.*Vvl- ,who personally appeared before me and
(printed name of Permittee)
acknowledged that he/she signedIptittrITItterettRIVitet1,71trIrose expressed in it.
6` B?, Notary Public State of Florida
Jacqueline F Tacandong
. a My Commission GG 193555
4.1 0),.oa,.. Expires 03/07/2022 [ 1 Personally Known 14e
E
Signa . : .f Notary Public, e )6 Produced Identification(Type)
H:\Applications&Forms\Word&Excel Document Originals\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
LAN:7-j, REVOCABLE ENCROACHMENT AGREEMENT
'y City of Atlantic Beach **ALL INFORMATION
.4• r."
A 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
7 IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and
existing under the laws of the State of Florida( hereinafter referred to as"CITY" and
7 ( r'c'_ S g. -p- ". /te-I of Atlantic Beach, Florida, hereinafter
referred to as"USER".
WITNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon
the property for the purpose as described in the City of Atlantic Beach.
This work is generally described as -i re.L -) f pq,ve r^ S
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 USER,said notice to USER shall be given by certified mail,return
receipt requested,to the following address T S s' S.,..; 1-(i S L Dr L s- .
• In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter
upon the above described easement or 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 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 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."
• 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 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 easements, public
right-of-ways and other public land. USER further 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 all of said
liabilities are hereby assumed by the USER. v
C� Date
/( I Z(
Property er/Agent(signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this I l day of ./k , 20 2t ,
by there$a- .Ah.1 .F(cnnt.) ,who personally appeared before me and
(printed name of Signer)
acknowledged that he/she signed the instrume essed in it.
.'9 Pvb Notary Public State of Florida I
O �i
1 r ; Jacqueline F Tacandong
1,0,
o Y My Commission GG 193555 Department Approval:
Sign u e of Notary P ic,State of Florida
`nary ao''t, Expires 03/07/2022 p pp
[ ] Personally Known
lyl,Produced Identification(Type) fL- yes _ * Scott Williams, Public Works Director
H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18