Permit Elec 1021 Atlantic Blvd 953 Lil Caesars 2012 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00001346 Date 10/04/12
Property Address . . . . . . 1021 ATLANTIC BLVD
Tenant nbr, name . . . . . . UNIT 953 LIL CAEARS
Application type description COMMERCIAL INTERIOR BUILD-OUT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 50000
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Application desc
build out
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Owner Contractor
------------------------ ------------------------
EQUITY ONE ATLANTIC VILLAGE, MAYES CONSTRUCTION LLC
16 NE MIAMI GARDENS DR 13930 MCGREGOR BLVD
ATTN: TREASURY DEPT FT MYERS FL 33919
MIAMI BEACH FL 33179 (239) 633-3722
--- Structure Information 000 000 COMMERCIAL BUILD OUT
Construction Type . . . . . TYPE 5-B
Occupancy Type . . . . . . BUSINESS
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Permit . . . . . . ELECTRICAL PERMIT
Additional desc . . WIRE COMM ALT, DATA & PHONES
Permit Fee . . . . 138 . 20 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 4/02/13
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Special Notes and Comments
2010 FLORIDA BUILDING CODE, FLORIDA FIRE PREVENTION CODE
2008 NATIONAL ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
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Other Fees . . . . . . . . . STATE ELEC DCA SURCHARGE 2 . 07
STATE ELEC DBPR SURCHARGE 2 . 07
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 138 . 20 138 . 20 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 14 4 . 14 . 00 . 00
Grand Total 142 . 34 142 . 34 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALI, CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: /2)Z-/ PERMIT# 12 3
JEA INFORMATION REQUIRED ON ALL PERMITS 00 AMPS Zd! VOLTS PHASE
VALUEOFWORKS 6/ 000
NEW SERVICE El Overhead F-1 Underground Underground up Pole
I Residential(Main) Service
0-100 amps 1 :101-1 50amps 1151-200amps amps # of Meters
I Commercial(Main) Service
i ]0-100 amps L i 10 1-I 50amps L 151-200amps amps I CT Service amps
Conductor Type Size
]Multi-Family(Main) Service
�0-100 amps 0 10 1-1 50amps 151-200amps
amps of Unit Meters
'Temporary Pole I I amps
SERVICE UPGRADE amps I CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
� 1100amps 1-1150amps L1200amps �-1 amps F I CT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: C2_L_0-30amps 3 1-1 00amps 10 1-200amps
Appliances: 0-30amps 31-100amps 101-200amps
A/C Circuits: ---7-0-60amps 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
� I Swimming Pool 1 1 Sign [ I Smoke Detectors___Qty Transformers KVA '�Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans
Qty_volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
I Replace Burnt/Damaged Meter Can Safety Inspection I I Panel Change I iOH to UG
Other:
0
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby certify that I have
read this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether
specified or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of
construction.
Property Owners Name Phone Number
Office Phone e 6 gv-,Fax
,DEBORAH AMANDA WHItE
Co. IWIT!gIff C I.Cc City A le'61,-S State Zip
EAPIF ro;mayz 1,ZU I a
e
State Certification/Registration ::�C: 06,j e)
Licen
Notarized Signature of License Holder
Sworn and subscribed before me this i4�day of 2 0
Signature of Notary Public
1 6' 1-"� r—Z OL b 6 0 S- 3
OCT-04-2012 15:27 advanced audio 2399191019 P.002
THfS 00CUGIENT HASA COLOR ED BACKGROUND-r,11CROPHIN r1rJG-LINEMAR K, PATENTEDPAPER
STATE OF FLORIDA
' AC# 6275534
)3EPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD SEQ#L12081602347
jmgmj&r1j�1.—CXNSZ NBR,
6=261=212804302'S ISC1300416,9
The ELECTRICAL CONTRACTOR
Named below 19 CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2014
YAKSH I %TOHK m
ACCENT ELECTRONIC SYSTEMS INTEGRATORS, INC.
2400 TRADE CENTRR, WAY
NAPLES FL 34109
RICK SCOTT KEN LAWSON
GOVERNOR DISPLAY AS REQUIRED BY LAW SECRETARY
OCT-04-2012 16:28 advanced audio 2399191019 P.004
%r- -19, LVtl %oWUSILY 40A
"40% 2480 Thompson Street
Tax CO tar Fort Myers, Florida 33901
a
%of oce www.ieete.com Toh (239)533-6000
LCOW Busilla an Tsx Account: W07141
Dear Business Owner:
Your 2012-2013 Lee county Local Business Tax Receipt is attached below. Tha receipt is non-
wil off ce es not al NY
regulatory and is Issued using the information currently on file th our i . It do Ign
compliance with zoning, health or other regulatory requirements nor is it an andorsernent of work
quality.
Annual account renewal nofices are mailed in August to the address of Tecord at that Sme;to ensure
delivery of your annual notice, mailing addresses may be updated online at wwWledG&-0m--
If there is a change in the business name,ownership, physical location or I the business is being
dosed,please fdlow the InsWerions on the back of this WIter to transfer or to close the account.
I hope you have a successful year.
4x.qk�
Lee County Tax Collector
D*wh and dlWay botkom portlon and kew uppw pornon for your reccab
%00cft% LEE COUNTY LOCAL BUSINESS TAX RECEIPT
2012 - 2013
TaxAtor ACCOUNT EXPIRES SEPTEMBER 30, 2013
ACCOUNT NUMBEIR: OSM41
%Orwe may engW th ffebwan—es-1 BF
C99MED MECTRICAL CoNnUCMR
Location
2CM OLD 41 RD STE 4M6
WNffA SMNW FL 34135
i TM LOCAL BUSINESS TAX FlEcEIPT IS NON REQUIATORY
ACCENT ELECTROMC SYSTEMS INMRATORS]NO THIS 18 NOT A BILL-DO NOT PAY
GCKk00ER ANDREW R
2W OLD 41 RD STE 0 PAID SISM7-93-1 09M4W2 02:01
BONITA SMNGS FL 34135 $90-00
OCT-04-2M 15:27 advanced audio 2399191019 P.001
10/04/12
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENDp EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT arrWEEN THE ISSUING MWRER(S),AUTMORIZED
REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER.
IMPORTANT-If Ow cortificaj;holder Is an ADDITIONAL INSURED.InG 110111CA- les)must he wWom;d-. If SUOROGATION 13 WAIVED.Sweet to
the terms MW conditions of"policy.certain DOW=may require an andomment. A statement on this certificate does not corWw rights to the
cardficate holder In lieu of such andofsamordis).
PRODUCR
Liberty Xns%=ance Agency KAM:
Priam
Kmor Oak Two, Suite 800
1910 Cochra- Road
Pittsburgh VA 15220 ACCEff-1
Pbme:412-571-5700 Fax;412-571-9909 J;Y�R ID�61
INSURERM AFFORMa COVERAGE
Accent Electronic Syate= INSURERA, 14990
Inte rators Inc BISURFA 9.
2680Y Old 41 Roacl, Suite 6 -INSURER c.
350nit& SprIngs FL 33923 INSURER 0:
INSURERE:
INSURER F;
COVERAGES CERTIFICATE NUM13ER: REVISION NUMjE-R,
THIS IS TO C6R7fFY THAT THE POLIC4166 OP IMKIRANCE LIGSTFD DELOW HAVE BEEN ISSUED TO THE IN8UfeD NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. N07WITHSTANONG ANY REQUIREMENT,TERM OR C=MON OF ANY CONTRACT OR OTHER DOCUMENY WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES WSCRIBED HFREtN IS SUBACT TO ALL THE TERMS,
EXCLUSIONS AND C014DITIONS OF SUCH POLICIES.IJMrT3 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
law, -.1- AUFM;= --
LTR TYPE Or BISURANCE INSR POLICY NUMBER (MUMDNYYV) L9ffTS
OW&WAL LIABLIT Y
EACH OCCURRENCE $1,000,000
A X COMMERCIAL GENERAL LIABILITY CL.90657470 9/13
__-'jCLAIMS-MADE OCCUR -i�E EV(Any aft pmon) $10,000
PERSONAL&ADV iWURY $1,000,000
_!�ENIERtAGGREGATE s2,000,000
GMAGGREGATIE LINT APPLIES PER.
PRODUCTS.COMP)OP AGG $2,000,000
POLICY[j]PRO- F"I LOC
JECT $
AMOMOOM LJABKJTY COMBINED SINCLED-Mir
A X ANY AU'ro AU90657470 08/09/12 08/09/13 (Eaaccideffl) $1,000,000
ALL OWNED AU"TOB BODILY INJURY(Par P—) 6
SCHEOULWAUTOS i6DILVINJURY(Per aedd9m) S
PIROPERTY QAMA0E
HIRED AUTOS (Porawdent) 5
x NON-OWNED AUTOS
A UNIBULLA LAS OCCUR UL90657470 08/09/12 08/09113 .EACH OCCURRENCE 52,000,000
CLAIMS-MWE
AGGREGATE 92POi9,000
DEDUCTIBLE 3
RETENTION 3 5
A WORKERS N WC90 08/09/12 09/09/13 X WCSTATU- "OTW—
ANDE1111PLOYMWLIABILKY VJU TORY LIMITS t LUR
ANY FROPRIETORPPARTNERIEXEC .
OfFICERNAEMBER EXCLUDED? um"N /A El.E04CH ACCIDENT $1,000,000
In NN)
;a$,-C1b.e under E.L. FA EMPLOYEE S 1.1000,000
PTIO OF OPM7XW below E-L.DISEASE-POLICY umrr sl,0001000
DESCRPTM Of OPERATKM I LOCATRMI VEHICM(Affech ACORD 101,Additional Rompft Ifeam*paw Is required)
CERTIFICATE HOLDER CANCELLATION
ONOULD ANY OF THE ABOVE DESCRIBW POLICIES BE CANCELLED 13EFORE
CITY-PL TH EMATION OATE THERKV.NOTWE W11LL BE 10111ANIZIREI)IN
AC=DANCE V4M THE POLICY PROVIISIONS,
CITY OF ATLANTIC BPACK AUT'NORIZE13 REPRMffrATIVE
800 SEMMOLE ROAD
ATLANTIC BEACH FL 32333 L
ACORD 25(2009109) TheACORD namoandlogoare rug CORPORATION. All rights reserved.