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HomeMy WebLinkAboutCAB Request No 96-02 AJT Application and Submittal 8900 Astronaut Blvdrricci ExperienceFxcn11er,,c;e MCCi is picking up the following listed documents from the following client: Client Name and Address Contact Person and Phone # City of Cape Canaveral City Clerk's Office 100 Polk Avenue 321-868-1220 Cape Canaveral, FL 32920 Mia Goforth m.aoforth@cityofcapecanave ral.org, MCCi Job Name: NOTES REGARDING SCANNING Dept: Building Formats Prepared b Melissa DotyLarge Items Type of Items CONTAINING No. Reports/memos Minutes, Maps, Records, Etc. RANGE (Date Range, Number Range, etc.) Community Appearance Board 216, Applications 252 Architectural Building Plans: # of Pages/FYS Commerical-216 Residential-252 CAB Request No. #96-02 47 Pages/1997 216 #1 AJT Application/Submittal 8900 Astronaut Blvd #2 CAB Request No. #96-01 216 RaceTrac Petroleum 39 Pages/1996 8899 Astronaut Blvd. 252 #3 CAB Request No. #97-20 22 pages/1997 Ocean Court-3 Townhomes CAB Request No. #97-19 Recreation Complex -Allison Storage 216 #4 8570 Commerce Street 53 Pages/1997 CAB Request No. #97-18 Recreation Complex 7300 N. Atlantic Ave CAB Request No. #97-16 Call One Accessory Building 216 #5 8810 Astronaut Blvd 35 Pages/1997 252 CAB Request No. #97-17 Tezel Residence _ CAB Request No. 97-15 12 Pages/1997 216 #6 Canaveral Cruise Lines: 7099 N. Atlantic Ave " �0 0 City of Cape Canaveral COMMUNITY APPEARANCE BOARD APPLICATION & GENERAL INFORMATION CrrY OF CAPE CANAVERAL TO BE COMPLETEDAPPLICANT Date Submitted: 1 July 1997 Project Name (if applicable): AJT Corporate Headquarters Project Address: 8900 Astronaut Blvd. Legal Description: Section 15 , Township 245 , Range 37E Lot(s) , Block Parcel 756 S. 100' of 750 Subdivison Names of Property Owner(s): AJT & Associates, Inc. Owner(s) Address: 101 George King Blvd. Cape Canaveral, FL 32920 Phone #: 783-7989 Fax #: 783-7597 Architect/Engineer (if applicable): Richard G. wood Phone #:783-7989 1-1% Fax #: 783-7597 Signature of Applicant: ��� �J� �lG Richard G. Wood, P.E. Vice President Date: /Ia/7 NT r3 Associates, Inc. %1 (Official Use Only) Is application complete: `!ES O; if no, date application was returned to applicant Board will consider application on: ; Application Fee: ; Fee Paid YES 0; Application Reviewed by - Date Reviewed: 105 POLK AVENUE • POST OFFICE BOX 326 . CAPE CANAVERAL. FL 32920-0326 TELEPHONE 14071 868.77nn . Gay sen,7% wee — � 4I /��{Iyl.�jQl.'Q n * r " "f.�t�i � .' Mi�S."if�.: �.`• t•..S' =.tea*��iva�:i s �_���2 it i J �6'r �� a4r^� c.',�.;K.::.,C �.r'-�C.. •,ssn,..� •4: N:•^ ;' �� %1" r,' ..:�l...u:'r.•.isi%uttiaif•r•:SI.C„$i`.t,�i+f.•::vF;,?;,,5:�`��•ci.•s.'%.•ra��+s�ri �'t,.�•vs� �;'�.�l�btl'."¢"�'.'�:�F-''S.�::�"�r�"�.. • i 1City of Cape Canaver I CRY OF CAPE CANAVERAL September 17, 1997 MEMORANDUM: TO: Andrea Bowers, City Treasurer FROM: G. J. Moran, Building Official Ae: AJT & Associates, Inc. / $ 70.00 Fee F.or Community.Appearance Board / Refund Please make .refund in the -amount of $ 75.00 to AJT & Associates, Inc. that was received ',by,the city -on 7/18/97 -for review by the Community Appearance Board as it has been .., determined not to be applicable. cc: Bennett Boucher, City Manager Richard Woods, AJT file attach: Copy of application receipt. fA- 105 POLK AVENUE • POST OFFICE BOX 326 • CAPE CANAVERAL, FL 32920-0326 TELEPHONE 14071 868.1200 • FAX 14071 7aa.z1-7n City of Cape Canaveral CITY OF CAPE CANAVERAL FILE COPY Certified No. P 287 915 468 COMMUNITY APPEARANCE BOARD REQUEST NO. 96-02 MOTION AND CONDITION(S) OF APPROVAL Re: Request No. 96-02, AJT & Associates, Inc., (8900 Astronaut Boulevard) - Phase I, Warehouse and Phase II, Main Headquarters Building - Representative was Richard G. Wood, V.P. of AJT & Associates, Inc. The Community Appearance Board of the City of Cape Canaveral has heard information pertaining to the above referenced request at the Community Appearance Board meeting held on the 20th day of January, 1997, and based on the information provided, the Community Appearance Board entered the following motion and conditions of approval as follows: Based on the information provided by the applicant, by majority vote, (with one member abstaining due to potential monetary gain), the Community Appearance Board approved Request No. 96-02, AJT & Associates, Inc., with the following conditions. 1. A minimum of four, maximum of six trees shall be located along the northwest buffering area towards Al A consisting of any type of tree already chosen within the submitted landscaping plan. 2. Approval based on the drawings submitted. 3. The facing on the front entrance of the main headquarters building shall be green marble, as depicted within the drawings submitted. 4. The color scheme for the warehouse and main headquarters building shall be sand and slate blue. 105 POLK AVENUE • POST OFFICE BOX 326 • CAPE CANAVERAL, FL 32920-0326 TELEPHONE (407) 868-1200 • FAX (407) 799-3170 01 COMMUNITY APPEARANCE BOARD MOTION AND CONDITIONS REQUEST NO. 96-01 JANUARY 20, 1996 PAGE 2 The above conditions must be completed prior to final inspection and issuance.of a Certificate of Occupancy. Note: The Community Appearance Board is a quasi-judicial board that has based its decision to approve your request, with conditions, based on the submitted plans. Should there be any modification or change to the plans that affects any issues relating to this approval, the applicant shall re -apply to the Community Appearance Board for further consideration. COMMUNITY APPEARANCE BOARD CITY OF CAPE CANAVERAL, FLORIDA 911 4ic�a� K ren A. Haye , Chairperson I, Susan L. Chapman, Secretary to the Community Appearance Board, hereby certify that a true and correct copy of this document has been furnished by certified mail to the applicant or its representative(s) on this 3k5~day of January, 1997. Susan L. Chapman, Boar Secretary p 7 ma:lm s � . � ''��_.�`-� ?��� mar � ____ __- .�• AJT & Associates, Inc. Proposed Headquarters 0 0 0 ORIENTATION OF PHOTOGRAPHS NTS J milli wumnu■ �pnummnml inmmm■ .uu10' 0, M n aunmW ��.uuuuu.n �. W��V T II■UI■I41 wlnuwlinm��_ il�lUll■I11111 ,�F; '1 �- _ 7MII■..... �� • .:�� eu 01 nevi, Ilnll In1uN .! firs � _ u l i11f',p111W . 11nriG wS :miiiiIlllll — �/ �■�� � �IIIi�I�l1I111�1/l --- WIN ,�ulfnuu I mn�J '�IIIa11111I � ` • h■�li�unumr�p■= ■11�■1111/ ; : ie !■■■ .IIII. iu� � �■�L1lIIII��� ;,, �}�, _ _ �IIIIIIIIln��4■ �� 71111■Illy inn%� � !■IIIII■`= • � ■1111l�0lfi� .IL�I■rA• l�lhll�a it■I- III.A '_�� ���1■iiiiiii.I� IIIIU II af�n�inflnn�I'1■1 e,+� JJ! uuulll �.. •� � �I ;��; �.■■.■.■.■.iuif■. ?ta■iiu�■ :::'u�'".'aluul iiiillu. AJT bt ASSOCIATES INC 18 December 1996 Community Appearance Board City of Cape Canaveral 105 Polk Ave. Cape Canaveral, FL 32920 Re: AJT Headquarters - Community Appearance Board Submittal In accordance with Ordinance No. 16-95 of the City of Cape Canaveral, Brevard County, Florida, the following items are included in our submittal package. Listed by section and line number, the following list itemizes the locations of the required documents. Sec.22-44 (b): (1) Vicinity map with photo orientation - Attached Booklet Vicinity map with zoning - Attached Booklet, Drawing Package; page 14, Presentation Board. (2) Landscape plan (concept) with all site elements - Drawing Package: page 13 Presentation Board. (3) Preliminary elevations - Draining Package; page 1, 5-7, Presentation Board. (4) Materials, textures and color board - Drawing Package; page 4, Attached Booklet, Presentation Board. (5) Color photographs of site and setting - Attached Booklet Sec.22-45: (a) Dimensions and orientation - Drawing Package; page 3, 4, 6, 7, 9-16, Presentation Board. (b) Location, height and use of building (etc.) - Drawing Package; page 4, 6. 7, 13-16 (c) Location and arrangement of manmade and natural ground cover - Drawing Package; page 13, Presentation Board. (d) Proposed ingress and egress facilities - Drawing Package; page 13-16, Presentation Board. (e) A conceptual preliminary landscaping plan - Drawing Package; page 13, Presentation Board. (f) Unusual grading or slopes - Drawing Package; page 15. (g) Location of walls and fences (etc.) - Drawing Package; page 16. (h) Location, size and graphic content of proposed exterior signs (etc.) - Attached Booklet. (i) Other data to clarify the presentation - Drawing Package. E N G I N E E R I N G A R C H I T E C T U R A L 101 George King Boulevard. Cape Caca.eral. Fldf -a 32925 C A P E C A N A V E A A L H U N T S - :®an-assoc.com E N V I R O N M E N T A L Tel (407) 783-7989 Fax I-.' 'g3-7597 1 L L E M I A M I All items required by ordinance no. 16-95 are submitted within the drawing package and attached booklet. The items of information included in the presentation boards are fully duplicated in the submitted packages and were developed for group presentation and clarification. These boards will be brought to the Community Appearance Board Meeting on January 20, 1997. The point of contact for questions or concerns is Doug Dodd @ 783-7989. Sincerely, Doug Dodd Architectural Designer A.JT & Associates, Inc. Proposed Building Site Photo # 1 * AJT & Associates, Inc. Proposed Building Site Photo # 2 * * See key plan for photo view location. AJT & Associates, Inc. Proposed Building Site Photo # 3 AJT &. Associates, Inc. Proposed Building Site Photo 4 4 * See key plan for photo view location 'fit y' ♦ � � � 1 n , ely, ..� , . 4t4 .-�•°���; - �• '� AJT SITE VOW- _ S s P �.. . q r- y w '� y n .. #, u ,�, � �-� _ ARM e• ice'_ Y fry - Y",s{. �. - • f . .�,ii� w - .-u ,Lw • _ - Ad „E ■IMF ~ s. ! .r-+� - - �, - ..C'- a '-oQ6 Wl ift NOW- 77. . r A3s ' f - o Y• - . r •! .. .. - i y'- '�[' r " i� •-`'� omits `,ram, y""� y' `� e - � � � '��' � �R • ' ��.a •~ ` �'•�_ r vL'� - ,�,� a �"... • • ! '� � •... ros' :r .� .. � .fit �. r ' � � � -. • _ ' �: �.M .,�� '�^, 4WA� 1 . , c , iLhf �a t� • +a t ! iCr■". ilk Ilk 1 •� - �[a.- .��� • .. a �� Q r A)T 18 December 1996 AII bt ASSOCIATES INC Community Appearance Board City of Cape Canaveral 105 Polk Ave. Cape Canaveral, FL 32920 Re: AJT Headquarters - Phase I (Warehouse) Phase II (Office) AJT96.364 The project will be completed in a two phased construction. Phase I consists of the retention and drainage structures, entrance road and warehouse facility. Phase II consists of a four story office building with parking lot. Landscaping will be provided to meet all city ordinances as the construction progresses by phase. This letter transmits the following information in support of our application for project review in anticipation of a scheduled January 20' review meeting. The material is provided in the attached booklet and full size plans as appropriate: Booklet 1- Headquarters rendering 2- Warehouse rendering 3- Exterior sign sketch 4- Key plan of site 5- Site photos 6- Aerial photo Drawings (Warehouse - Phase I) 1- Cover sheet showing artist's conception (rendering) 2- Floor plan 3- Building elevations Drawings (Office - Phase II) 1- Cover sheet showing building front elevation 2- Building elevations 3- Cross section of building through stairway 4- Floor plans (four floors) Drawing (General) 1- Landscaping plan for the entire project 2- Traffic plan for the site 3- Site grading and drainage plan 4- Project site plan Sincer Richard G. Wood, P.E. Vice President E N G I N E E R I N G A R C H I T E C T U R A L 101 George King Boulevaro, CaDe Canaveral. Flonca 32920 C A P E C A N A V E R A L N U N T $ a^ 4 all-assoc.com E N V I R O N M_E N T A L Tel (407) 783-7989 Fax (407; '?3-79 y7 V I L L E M I A M I AJT & Associates. Inc. Artist sketch of proposed corporate sign View ew 7�t �,.....�• lit!"'\J COMMUNITY APPEARANCE BOARD CITY OF 7olo, APPLICATION & GENERAL INFORMATION i 'e. ems'. TO BE COMELLT�_DBY APPLICANT Date Submitted: 02 December 1996 Project Name (if applicable): AJT Warehoused g� ha5e S Project Address: 8900 Astronaut Blvd. Legal Description: Section 15 , Township 24 , Range 37 Lot(s) ' N/A , Block N/A Parcel 756 & Portion of 750 Subdivison N/A Names of Property Owner(s): AJT, Inc. Owner(s) Address: 101 George King Blvd. , Cape Canaveral, FL 32920 Phone #: 783-7989 Fax #: 783-7597 Architect/Engineer (if applicable): Richard G. ood Phone #: 783-7989 783-7597 JX# Signature of Applicant: Date: 02 December 1996 ------------------------------------------------------------------------------------------------ (Official Use Only) 6E�NO; Is application complete: if no, date application was returned to applicant Board will consider application on: Application Fee: PP a S ;Fee Paid YE NO; Application Reviewed by: V Date Reviewed: r / 99 7Gl l� 105 POLK AVENUE • POST OFFICE BOX 326 • CAPE CANAVERAL• FL 32920-0326 TELEPHONE (407) 868-1200 • FAX (407) 799.3170 City of Cape Canaveral COMMUNITY APPEARANCE BOARD CITY OF PRE -SUBMITTAL MEETING CAPE CANAVERAL BUILDING OFFICIAL & APPLICANT � PLAN CHECKLIST LEVELS I AND 11 PAGE 1 YES NO SUBMITTED YES NO Size, height, number of units and location of proposed and existing structures. Dimensions. Total gross area and percentage devoted to structures, parking and landscaing. Number of units. Number of parking spaces and loading zones. Traffic flow diagram. Parking. Driveway(s). Zone of neighboring property 1 1 t Clw M I G N S E W Location and dimension for the following areas (if applicable) To be determined by the Building department Park(s). Canal(s). 10S POLK AVENUE • POST OFFICE BOX 326 • CAPE CANAVERAL, FL 32920-0326 TELEPHONE (407) 868-1200 0 FAX (407) 799.3170 PAGE 2 YES NO NIA COMMUNITY APPEARANCE BOARD PRE -SUBMITTAL MEETING BUILDING OFFICIAL & APPLICANT PLAN CHECKLIST LEVELS I AND II Waterway(s). Boat slip(s). Swimming pool(s).(reFlecb1l Pool) Recreation. Trash: centrally located dumpster independent cans Sidewalks: existing '111, planned Dune crossovers. Other (specify) Y Type of enclosure for communal trash container(s). Vicinity map. t/ Location of planned landscaping with types. COMMUNITY APPEARANCE BOARD PRE -SUBMITTAL MEETING BUILDING OFFICIAL & APPLICANT PLAN CHECKLIST Level I Review - (small commercial/industrial projects square feet or less: through (3) residential units PAGE 3 ES . NO NA \ / -1/ J Vicinity map I ating all zoning classifications including orie tion of the color photographs. �bL lled t plan locating improvements. (9 copies) three color photographs of site and setting nnq area). At least two ele ations to scale 1 /8 or more. (9 copies) Presentation of the materials, texture and colors. Level 2 Review - Commercial. 4 or more multi -family units and industrial exceeding 850 square feet: Details sections and specifications. YES NO Vicinity map locating all zoning classifications, including orientation of all color photographs. Rendered plot plan depicting, in detail, location of landscaping and all the elements on the sits copies) COMMUNITY APPEARANCE BOARD PRE -SUBMITTAL MEETING BUILDING OFFICIAL & APPLICANT PLAN CHECKLIST Level 2 Review - Commercial. 4 or more multi -family units and industrial Continued exceeding 850 square feet: Details sections and specifications. PAGE 4 YES NO N/A All preliminary elevations 1 /8 or more. (9 copies) JZ Materials, texture and colors board depicting location of colors. Minimum of three color photographs of site and setting. Square footage of building areas YES NO NIA Living. Total under roof. Parking: # of spaces 46 , # of handicap spaces 15 Other (specify): City of Cape Canaveral CITY OF CAPE CANAVERAL STAFF REPORT January 15, 1997 TO: Community Appearance Board Members FROM: G. J. Moran, CBO Building Official," SUBJECT: AJT Warehouse & Corporate Headquarters Application Application for approval by the Community Appearance Board has been received by the Building Department. The application meets all requirements for submittal as stipulated in Ordinance 16-95. All Fees relating to the submittal have been paid. Site Plan approval for this project was granted by the Planning & Zoning Board on January 8, 1997. 105 POLK AVENUE • POST OFFICE BOX 326 • CAPE CANAVERAL, FL 32920-0326 TELEPHONE (407) 868-1200 • FAX (407) 799-3170 City of Cape Canaveral COMMUNITY APPEARANCE BOARD CITY OF APPLICATION & GENERAL INFORMATION CAPE CANAVERAI C&Pd Date Submitted: 02 December 1996 Project Name (if applicable): AJT warehouse Project Address: 8900 Astronaut Blvd. Legal Description: Section 15 , Township 24 Range 37 Lot(s) N/A /� . Bloc A Subdivison N/A Parcel 756 &Portion of 750 Names of Property Owner(s): AJT, Inc. Owner(s) Address: 101 George King Blvd., Cape Canaveral, FL 32920 Phone #: 783-7989 Fax #: 783-7597 Architect/Engineer (if applicable): Richard G. ood Phone #: 783-7989 F 'x #783-7597 Signature of Applicant: Date: 02 December 1996 (Official Use Only) Is application complete: 01/N0; if no, date application was returned to applicant Board will consider application on: Jaen/ -Ld , /9 7 Application Fee: ; Fee Paid. 0; Application Reviewed y: Date Reviewed: V 105 POLK AVENUE • POST OFFICE SOX 326 • CAPE CANAVERAL. FL 32920.0326 TELEPHONE (407) 868-1200 0 FAX (407) 799.3170 r City of Cape Canaveral COMMUNITY APPEARANCE BOARD cITYOP PRE -SUBMITTAL MEETING CAPE CANAVERAL BUILDING OFFICIAL & APPLICANT PLAN CHECKLIST LEVELS I AND II PAGE 1 YES NO SUBMITTED �,� J)y� Size, height, number of units and location ➢ti . a . d /�g C - Z of proposed and existing structures. Dimensions. C - 2 Total gross area and percentage devoted to structures, parking and landscaing. c- - 7-- Number of units. C - v Number of parking spaces and loading zones. Traffic flow diagram. C - ? Parking. C - 7 C - T- Driveway(s). C - 7 Zone of neighboring property C- -- -1 1 N S E W Location and dimension for the following areas (if applicable) To be determined by the Building department YES NO N/A ✓ Park(s). y Canal(s). 10S POLK AVENUE • POST OFFICE 80X 326 • CAPE CANAVERAL, FL 32920-0326 TELEPHONE (407) 868-1200 0 FAX (407) 799.3170 COMMUNITY APPEARANCE BOARD PRE -SUBMITTAL MEETING BUILDING OFFICIAL & APPLICANT PLAN CHECKLIST LEVELS I AND II PAGE 2 YES NO NIA Waterway(s). Boat slip(s). -�-- Swimming pool(s). j d i Recreation. LZ Trash: centrally located dumpster C -7 e independent cans r " Sidewalks: existing "� planned L �. Dune crossovers. C-� �' Z Other (specify)------------ P Type of enclosure for communal trash container(s). a),r � A,,,% nz Vicinity map, e- S I J Location of planned landscaping �[p. with types. 0414 / _ aa_F3 aL' 3 COMMUNITY APPEARANCE BOARD PRE -SUBMITTAL MEETING BUILDING OFFICIAL & APPLICANT PLAN CHECKLIST Level I Review - (small commercial/industrial g_rojects 850 square feet or less: -through (3) residential units PAGE 3 ES NO NZA Vicinity map locatingall zoning g classifications including orientation of the color photographs. S C Z c-s Scaled plot plan locating improvements. (9 copies) Minimum three color photographs of site and setting P 4 C 1 / (surrounding area). y At least two elevations to scale 1 /8 or more. FaceeT (9 copies) -� Presentation of the materials, texture and colors. Level 2 Review - Commercial 4 or more multi family units and industrial exceeding 850 square feet: Details, sections and specifications YES NO NZA Vicinity map locating all zoning classifications, ge,61' including orientation of all color photographs. Rendered plot plan depicting, in detail, location of 2 G_� landscaping and all the elements on the site "" copies) COMMUNITY APPEARANCE BOARD PRE -SUBMITTAL MEETING BUILDING OFFICIAL & APPLICANT PLAN CHECKLIST Level 2 Review - Commercial 4 or more multi -family units and industrial Continued exceeding 850 square -feet:- Details sections and specifications PAGE 4 YES NO N v All preliminary P y elevations 1 /8 or more. (9 copies) Jz Materials, texture and colors board depicting P 9' location of colors. V /_ —Z Minimum of three color photographs of site and setting. Square footage of building areas YES NO N/A y Living. Total under roof. C - Z' Parking: # of spaces / Z ,�. , t-- v # of handicap spaces `� G Other (specify): IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT Bl' DISCUSSION AT THE MEETING: • You must disclose orally the nature of your1,conflict in the measure before participating:; ti_ • You must complete the form and file it within 15 days after the vote occurs with the person responsible for recording the minutes of the meeting, who must incorporate the form in the minutes. A copy of the form must be provided immediately to the other members of the agency,�a'nd the form must be read publicly at the next meeting after the form is filed. r+ r Gb 1 1 i� rt 1 - M DISCLOSURE OF LOCAL OFFICER'S INTEREST 1, J O�(��7-���0 , hereby disclose that on J Z� , 19q-7: (a) A measure came or will come before my agency which (check one) inured to my special private gain; _ ✓ inured to the special gain of my business associate, Q �-[� a,6�L inured to the special gain of my relative, inured to the special gain of whom I am retained; or , by 1-1 inured to the special gain of , which is the parent organization or subsidiary of a principal which has retained me. (b) The measure before my agency and the nature of my conflicting interest in the measure is as follows: � J� '��.-✓L \ tS �5 c.v � d�.YL � rf't�12 $i iL� � I�U I ,S � • f , b Qko js 1�is✓C lfc>r-�t �� �A2 �� j Q-7 Date Filed Signature NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES §112.317 (1991), A FAILURE TO MAKE ANY REQUIRED DISCLOSURE CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING: IMPEACHMENT, REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN SALARY, REPRIMAND, OR A CIVIL PENALTY NOT TO EXCEED $5,000. CE FORM 813 - 10-91 PAGE FORM 813 MEMORANDUM OF VOTING CONFLICT FOR COUNTY, MUNICIPAL, AND OTHER LOCAL PUBLIC OFFICERS LAST NAME- FIRST NAME -MIDDLE NAME NAME OF BOARD. COUNCIL. COMMISSION, AUTHORITY. OR COMMITTEE C M II.ING ADDRESS THE BOARD. COUNCIL. COMMIS \©ION. AUTH ITY OR COMMITTEE ON A WHICH I SERVE IS A UNIT OF: %� 5 l 5 l--LNt`�-- �" ' KCITY O , COUNTY O OTHER L AL"► E CITY COUNTY NAME OF POLITICAL SUBDIVISION: 1 V �r DATE ON WHICH VOTE OCCURRED MY POSITION IS: J►%,\) ZoIG O ELECTIVE X APPOINTIVE WHO MUST FILE FORM 811 This form is for use by any person serving at the county, city, or other local level of government on an appointed or elected board, council, commission, authority, or committee. It applies equally to members of advisory and non -advisory bodies who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes. Your responsibilities under the law when faced with a measure in which you have a conflict of interest will vary greatly depending on whether you hold an elective or appointive position. For this reason, please pay close attention to the instructions on this form before completing the reverse side and filing the form. INSTRUCTIONS FOR COMPLIANCE WITH SECTION 112.3143, FLORIDA STATUTES A person holding elective or appointive county, municipal, or other local public office MUST ABSTAIN from voting on a measure which inures to his special private gain. Each elected or appointed local officer also is prohibited from knowingly voting on a measure which inures to the special gain of a principal (other than a government agency) by whom he is retained (including the parent organization or subsidiary of a corporate principal by which he is retained); to the special private gain of a relative; or to the special private gain of a business associate. Commissioners of community redevelopment agencies under Sec. 163.356 or 163.357, F.S., and officers of independent special tax districts elected on a one -acre, one -vote basis are not prohibited from voting in that capacity. For purposes of this law, a "relative" includes only the officer's father, mother, son, daughter, husband, wife, father-in-law, mother-in- law, son-in-law, and daughter-in-law. A "business associate" means any person or entity engaged in or carrying on a business enterprise with the officer as a partner, joint venturer, coowner of property, or corporate shareholder (where the shares of the corporation are not listed on any national or regional stock exchange). ELECTED OFFICERS: In addition to abstaining from voting in the situations described above, you must disclose the conflict: PRIOR TO THE VOTE BEING TAKEN by publicly stating to the assembly the nature of your interest in the measure on which you are abstaining from voting; and WITHIN 15 DAYS AFTER THE VOTE OCCURS by completing and filing this form with the person responsible for recording the minutes of the meeting, who should incorporate the form in the minutes. APPOINTED OFFICERS: Although you must abstain from voting in the situations described above, you otherwise may participate in these matters. However, you must disclose the nature of the conflict before making any attempt to influence the decision, whether orally or in writing and whether made by you or at your direction. IF YOU INTEND TO MAKE ANY ATTEMPT TO INFLUENCE THE DECISION PRIOR TO THE MEETING AT WHICH THE VOTE WLL BE TAKEN: • You must complete and file this form (before making any attempt to influence the decision) with the person responsible for recording the minutes of the meeting, who will incorporate the form.in the minutes. • A copy of the form must be provided immediately to the other members of the agency. • The form must be read publicly at the next meeting after the form is filed. CE FORM 8B- 10-91 PAGE I St�Ve ff-o htrzli�� �� �- `/� G �Qe�a,�i�rn 9M u/�' r 0 m