Fillable Private Use Of ROW Application (Town of Fort Myers Beach)

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Private Use Of ROW Application (Town of Fort Myers Beach)

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U.S.A. forms for Town of Fort Myers Beach

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Private Use of Right-of-Way Permit A
pplication
(Private Use of Public Streets, Parking in Public Rights-of-Way)
Town of Fort Myers Beach 2525 Estero Blvd. Fort Myers Beach, FL 33931 June 18, 2020
Phone : 239 765-0202 Permits @fmbgov.com Fax: 239 765-0909
NOTE: Required with application submittal: Liability insurance, hold harmless agreements, and
real survey or a drawing or sketch of the property with dimensions including adjacent or abutting
structures, landmarks, etc. All permits must conform to that as set forth in Resolution 18-20
Applicant:
STRAP # __________________________________________________________________
Property Owner (if different from Applicant): _______________________________________
Phone: _____________________________________________________________________
Mailing Address:___________________________________________________________________
Email Address:____________________________________________________________________
(All approved Private Use of Right-of-Way License Requests must be picked up by
Applicant)
Abutting Strap Number:__________________________________________________________
Abutting Zoning Districts: ______________________________________________________
Total square footage of right-of-way requested to be used: ____________.
(A standard parking space is 162 square feet = measured 9 x 18 feet)
Signature of Applicant Date
Signature of Owner (if different from Applicant ) Date
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signature
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Private Use of Right-of-Way Permit A
pplication
(Private Use of Public Streets, Parking in Public Rights-of-Way)
Town of Fort Myers Beach 2525 Estero Blvd. Fort Myers Beach, FL 33931 June 18, 2020
Phone : 239 765-0202 Permits @fmbgov.com Fax: 239 765-0909
HOLD HARMLESS AND INDEMNIFICATION AGREEMENT
____________________________ (Applicant) assumes all risks in the operation and maintenance of the
permitted area during the term of the permitted use. Applicant is solely and accepts that it is solely
responsible and answerable for any and all accidents or injuries to persons or property arising out of or
caused pursuant to Applicant’s use of the permitted area. Applicant agrees to maintain the permitted
area in good repair and in a neat and clean condition. Applicant agrees to follow all state, federal and
local laws and ordinances relating to the use of the permitted area during the term of the permit.
____________________________ (Applicant) agrees to defend, indemnify and forever hold the Town of
Fort Myers Beach, Florida, its officers, agents, officials and or employees from all claims, for any loss,
damage or injury of any kind or character whatsoever without limitation, including reasonable attorney’s
fees, sustained by any person or property whatsoever kind and or nature, whether direct or indirect, as
a result and in relation with the use of the permitted area; including, but not limited to, the defense of
any claim and any and all costs in any judicial or quasi-judicial proceedings and for any and all damages
or penalties of any kind or nature.
_____________________________ (Applicant) agrees to vacate the permitted area after reasonable
notice to allow the Town or any Town-authorized contractor to make repairs within the permitted area;
or, utilities located within the permitted area. Applicant agrees to hold the Town harmless for any
disruption, loss or termination of business during the repair period.
_____________________________ (Applicant) agrees that it has obtained any required insurance and
has listed the Town of Fort Myers Beach, Florida as an additional insured on said policy and that a
certificate of endorsement has been made a part of said insurance policy. A copy of the Certificate of
Insurance will be given to Town upon the Town’s request. The Town intends that said insurance shall
provide a source, in addition to the Applicant, from which the Town may seek payment of the Applicant’s
liability for both its own negligence, as well as actual or alleged negligence of the Town and or the cost
to the Town of defending any such claims.
APPLICANT ACKNOWLEDGES THAT THIS HOLD HARMLESS AND INDEMNIFICATION AGREEMENT HAS
BEEN READ AND IS UNDERSTOOD FOR ITS CONTENTS AND SIGNING THIS DOCUMENT IS A FREE ACT.
Applicant agrees that this Agreement is intended to be as broad and inclusive as permitted by the laws
of Florida and that if any portion thereof is held invalid, it is agreed that the balance with continue,
notwithstanding, in full force and effect.
I, _____ (Property Owner), hereby certify that
_______________________________________ is my authorized agent/representative of the property
described herein. All answers to the questions in this registration and any supplementary information
attached to and made part of this registration is honest and true.
Signature of Property Owner
Typed or printed name of Property Owner
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signature
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Private Use of Right-of-Way Permit A
pplication
(Private Use of Public Streets, Parking in Public Rights-of-Way)
Town of Fort Myers Beach 2525 Estero Blvd. Fort Myers Beach, FL 33931 June 18, 2020
Phone : 239 765-0202 Permits @fmbgov.com Fax: 239 765-0909
STATE OF _____ _____ COUNTY OF ________________
The foregoing instrument was certified and subscribed before me
by means of
_____ physical presence OR ____online notarization,
this ______day of ___________________,
20_____,
by __________________________________________________________, _____ who is personally
known to me
OR ____ who has produced ______________________ as identification.
(SEAL) Notary Public Signature
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signature
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Town of Fort Myers Beach June 9, 2020
2525 Estero Blvd. Fort Myers Beach, FL 33931
Phone : 239 765-0202 Permits @fmbgov.com Fax: 239 765-0909
This page is required for ALL Building Permit Applications
ACKNOWLEDGEMENT OF TOWN OF FORT MYERS BEACH REGULATIONS BY THE QUALIFIER
NOTICE OF ADDITIONAL RESTRICTIONS: In addition to the requirements of this permit, there may be additional restrictions applicable to this property
that maybe found in the public records of this County, and there may be additional permits required from other governmental entities such as the Water
Management District, State agencies, or Federal agencies.
WARNING OF WORK IN THE COUNTY RIGHT-OF-WAYS: This permit does not authorize construction or installation of any structure or utility, above or below
ground, within any right of way or easement reserved for access, drainage or utility purposes. This restriction specifically prohibits fencing, sprinkler systems,
landscaping other than sod, signs, water, sewer, cable and drainage work therein. If such improvements are necessary, a separate permit for that purpose
must be obtained from the Building Department.
INSPECTIONS: This permit is void if the first inspection is not made within six (6) months from the date issued or if no inspection has been made for a
period of six (6) months from the most recently passed inspection. The permit is void if the zoning classification is violated. Applicant agrees to comply with
the sanitary regulations and understands that the proposed structure may not be used or occupied until an approved certificate of occupancy is issued.
Applicant further understands that failure to obtain permit or misrepresentation of the improvements is a misdemeanor and upon conviction, applicant can
be punished as provided by the law. Failure to comply with the mechanics lien law can result in the property owner paying twice for improvements
NOTICE OF CLEARING RESTRICTIONS: Issuance of a Demolition Permit for a structure does not authorize removal of vegetation beyond the footprint of the
structure. A Demo Permit is not a clearing permit.
WORK IN THE SPECIAL FLOOD HAZARD AREA: Be advised that Substantial Damage/Substantial Improvement requirements will apply to structures located in
the Special Flood Hazard Area with Finished Floor Elevations below the Base Flood Elevation.
CERTIFICATION: Application is hereby made to obtain a permit to do the work and installations as indicated. I, THE QUALIFIER, certify that I have not
performed any work or installation prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. The permit or application fee may have additional fees imposed for failing to obtain permits prior to commencement of
construction. The permit application or approved permit expires if work is not commenced within 180 days from the date of issuance. I, THE QUALIFIER
understand that the structure cannot be used or occupied until a certificate of occupancy is issued. By signing this permit application, I, THE QUALIFIER, agree
that I have been retained by the property owner to provide contracting services for the trade for which I am listed. Furthermore, it is my responsibility to
notify the Building Plan Review and Inspection Division should I no longer be THE QUALIFIER responsible for providing said contracting services. I, THE
QUALIFIER , agree that I understand the review and issuing of this permit does not exempt me from complying with all County Codes and Ordinances.
Job Street Address:_________________________________________________________________________________________
I, _____ (Qualifier ), hereby certify that
_______________________________________ is my authorized agent/representative of the property described
herein. All answers to the questions in this registration and any supplementary information attached
to and made part of this registration is honest and true.
Signature of Qualifier
Typed or printed name of Qualifier
STATE OF _____ _____ COUNTY OF ________________
The foregoing instrument was certified and subscribed before me
by means of __ physical presence
OR_online notarization,
this ______day of ___________________, 20___, by ______________________, ___ who is
personally known to me OR ___ who has produced ______________________ as identification.
Notary Public Signature
(SEAL)
Town of Fort Myers Beach June 9, 2020
2525 Estero Blvd. Fort Myers Beach, FL 33931
Phone : 239 765-0202 Permits @fmbgov.com Fax: 239 765-0909
NOTICE OF COMMENCEMENT INFORMATION
Per Florida Statutes 713.135 a Notice of Commencement (NOC) is required for construction of improvements totaling more than $2,500, with certain
exceptions. For A/C Repairs or Replacements a notice of commencement is required for improvements more than or equal to $7,500. The applicant shall
file with the issuing authority prior to the first inspection either a certified copy of the recorded NOC or a notarized statement that the NOC has been filed
for recording, along with a copy thereof. In order to comply with the state requirement, permits will be placed in inspection hold until proof of the NOC is
filed with the building permitting and inspection department. The issuing authority shall not perform or approve subsequent inspections until the applicant
files by mail, facsimile, hand delivery, email or any other means such as certified copy with the issuing authority
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.
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Private Use Of ROW Application (Town of Fort Myers Beach)

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Completed 18 July 2020

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