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Permit 2027 Selva Madera Ct CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 10-00000121 Date 2/10/10 Property Address . . . . . . 2027 SELVA MADERA CT Application type description RESIDENTIAL ADDITION/ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 12500 ---------------------------------------------------------------------------- Application desc KITCHEN REMODEL ------------------------------------------------------------------------ Owner Contractor ------------------------ ------------------------ BARRICK, FREDERICK PHILLIPS BUILDERS LLC 2027 SELVA MADERA CT. 1250 SELVA MARINA ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (904) 349-2999 --------------------- Structure Information 000 000 ---------------------- Construction Type . . . . . TYPE 5-A Occupancy Type . . . . . . RESIDENTIAL Flood Zone . . . . . . . . ZONE X ---------------------------------------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc . - Permit Fee . . . . 115 . 00 Plan Check Fee 57 . 50 Issue Date . . . . Valuation . . . . 12500 Expiration Date . . 8/09/10 ---------------------------------------------------------------------------- Special Notes and Comments *2007 FLORIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS . 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 115 . 00 115 . 00 . 00 . 00 Plan Check Total 57 . 50 57 . 50 . 00 . 00 Grand Total 172 . 50 172 . 50 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. T CITY OF ATLANTIC BEACH 10- 11A 800 SEMINOLE ROAD,ATLANTIC BEACH,FIL 32233 OFFICE:(904)247-5826 0 FAX NO,:(904)247-5845 WWW.COAB-US BUILDING PERMIT APPLICATION DUVAL COUNTY 1�JOBADDRE8S-. 2.VALUATION OF WORK 13.SQ.FT.UNDER ROOF or /';�'f--'a a, - I IOW; 5.CLASS OF WOW 6.US*0f STRUCTURE: 11 NEW BUILDING 11 DEMOLITION &'RESIDENTIAL LOT_BLOCK_SUB DIVISION OU ADD 11 CONVERTING USE 0 COMMERCIAL T DESCRIPTION OF WORK: _2.)TION lii?')�LTERATION 13 ACCESSORY BLDG. 0.FIRE SPRINKLER: 0 REPAIR 11 POOL/SPA 13 YES 11 N/A 13 MOVE 0 OTHER ONO PROPERTYOWNER: CONTRACTOR; ARCHITECT/ENGINEER: 9.NAME: 15.COMPANY NAME: 23.COMPANY NAME: 16.NAME: 24.LICENSEE NAME: MIC 041�t)a S ��O% 10.ADDRESS: 11. FL RIDA ICENSE NO.: 25.STATE OF FLORIDAMLI �,V\ _(e.109 mr+r.104 9(' i.,'-r-7 Z 14- 0) 18.ADDRESS: 26.ADDR i I-j s 04 /0�/-')'r";,.,A e Ir-, 4-6- .1 ;v 713's sc:" "to 11.OFFICE PHONE: 12.FAX NO.: 19.OFFICE PHONE: 20.FAX NO.: 27.OFFICE PHONE: NO.: 2-11 1 1�y 13.CELL PHONE: 21.CELL PHONE: 29.CELL PHONE: 3-1 2, 6; 14.EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS: r- AV FEE SIMPLE TITLE HOLDER: BONDING COMPANY: MORTGAGE LENDER: OF oTHr:R THAN owslEm 31.NAME: 33-NAME: 35.NAME: 32.ADDRESS: 134.ADDRESS: 36.ADDRESS: Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced 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. This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six(6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heatem,Tanks, Air Conditioners,etc. OWNER'S AFFIDAVIT- I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. I will not occupy or use the referenced building or any part therof,until all inspections are finaled and prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law. 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. OWNERorAGENT� CONTRACTOR Power of Attorney or i��Lefter Required) "(9ualifier Only) Signed: Date: Signed: Date: Before me 4. day of 2010 in the county of Before a thhq (IRV f 000, -,2010 in the county of Duval,State of Florida,has personally appeared Duva,State of Florida,has personally appeared herin by himself/herself and affirms that all statements and declarations are herin by himself/herself and affirms that all statements and declarations are true and accurate. "o.-�- true and accurate-. Is Public at drge.SIV 10 L-C NotaryP licatLa S; te hof Clu�n of erso Y L.G M Perso SHI L ifica, M cl� 42 Produc.ed Id2e Is x-'-,s Feb 1 .201 Notary V Y L. 2 By National LLL ly �k Not AM y C, 11 c- tate of Florida CODE COMPLIANC Z Si n xPires Feb 14,2010 C CITY OF ATLANTIC BEACH B # 516533 Bldg Perrnitapp&ConstrS iMgt2010 SEE PERMITS FOR ADDITIONAL ssn. QUIREMENTs AND CONDITIONS. r i REVIEWED BY: /" I F1 Py DATE: ,4 800 Seminole Road Atlantic Beach,Florida 32233 It Telephone(904)247-5800 FAX(904)247-5845 Construction Site Management Plan Compliance A construction site management plan conforming to Atlantic Beach City Code Sec 6-18 has been approved as a part of this building permit. The Construction site management plan was approved based upon the following information. 1. Parking plan -parking plan showing how site will be accessed and all onsite and abutting street parking areas. 2. Location of construction trailers, loading/unloading area and material storage area. 3. Location of chemical toilet area-chemical toilets must be kept out of City right-of-way and not further than 15 feet from structure under construction. 4. Location of dumpster- dumpster must be from approved waste company (in accordance with Chapter 16 City Code). As of 2009,approved dumpster companies for Ad. Beach are Advanced Disposal,Realco Recycling, and Shappells. Dumpsters are to have tarp covers or rigid covers on windy days. Dumpsters must be removed prior to issuance of Certificate of Occupancy or Completion. 5. Traffic control plan, showing access with dimensions, area to be stabilized, narrative on phasing of construction with adequate parking and delivery of materials. 6. Site cleanliness. Contractor must have the entire construction site cleaned by Friday of each week. This means removal of scrap lumber,concrete remnants and other such construction debris including cans,metal,plastic and paper. 7. Erosion and Sediment Control. Contractor must maintain all elements of the approved Erosion& Sediment Control Plan(silt fence, catch basin filters, etc.) until sod or other stabilization has been placed and approved by Public Works. 8. Other activities, where special conditions are identified by the Building Official. Failure to comply with the Construction Site Management Ordinance may result in a Stop Work Order being issued in accordance with City Code Sec. 6-17 (3) Revised 6/2009 City of Atlantic Beach APPLICATION NUMBER Buildin (To be assigned by the Building D partment.) % g Department 400-Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: City web-site: hftp://www.coab.us APPLICATION REVIEW AND-TRACKING FORM Property Addressv.- ALP S ka-'_A)'4e_J-f ea. Dmartm"t review required Ye No Auilding_,,/ Applicant: �"Wannlirn-_g&Zoning Tree Administrator Project: ezi Public Works Ail Public Utilities Public Safety Fire Services op, Revie fee $ 1) t i atur6�' Other Agency* Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept.of Environmental Protection Florida Depf of Tr�ansportabon St.Johns River Water:Ma��ef�ent Diiftict Army Corps of Engineers or Division of Hotels and Restayrants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: dApproved. RDenied. (Circle one.) Comments: C U 'I� ILD N�G �___ PLANNING &ZONING Reviewed by: Date:'2 - TREE ADMIN. Second Review: FlApproved as revised. FIDenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: F]Approved as revised. F]Denied. Comments: Reviewed by: Date: Revised 05114109 CITY OF ATLANTIC BEACH PRODUCT APPROVAL SPECIFICATION SHEET (short form) As required by Florida Statute 553.842 and Florida Administrative Code 913-72,please provide the information and approval numbers on the building components listed to be utilized on the construction project for which you are applying. We recommend you contact your local product supplier should you not know the product approval number for any of the applicable listed products. Statewide approved products are listed online @ www.floridabuilding.org Category/Subcategory Manufacturer Product Description FL Approval#(s) EXTERIOR DOORS a. Swinging b. Sliding c. Sectional/Roll Up d. Other WINDOWS a. Single/Double Hung b. Horizontal Slider c. Casement Fixed if-I�, Z 2_2 2 4:�_l X 6'0 A 1,� Q&7 1 Z-7 f. Skylights g. Other PANEL WALL a. Siding b. Soffit c. Storefronts d. Glass Block e. Other ROOFING PRODUCTS a. Asphalt Shingles b. Non-Structural Metal c. RoofingTiles d. Single Ply Roof e. Other STRUCTURAL COMPONENTS a. Wood Connectors b. Wood Anchors 7 c. Truss Plates r d. Insulation Forms e. Lintels f. Others NEW EXTERIOR ENVELOPE L I understand that,at the time of inspection,the following information must be available to the inspector on the jobsite, 1. A copy of the product approval. 2. The list of performance characteristics which the product was tested and certified to comply with. 3. A copy of the applicable manufacturers'installation requ Further,I under! ( strated during inspection. Fa tWVftT0WK I 'X FA' R �T' U1. F ATLANTIC B]�AC#_ --------- R)MITS FOR ADDITIONA4. /�pplicant Sigi i ature UIREMENTS AND CONZMONS. RE"'/ M , H:/Product approval spec sheet short formxlsx DBY:Z�21= DATE: 3-4/40 CITY OF ATLANTIC BEACH IS 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 10-00000121 Date 3/26/10 Property Address . . . . . . 2027 SELVA MADERA CT Application type description RESIDENTIAL ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 12500 ---------------------------------------------------------------------------- Application desc KITCHEN REMODEL ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ BARRICK, FREDERICK PHILLIPS BUILDERS LLC 2027 SELVA MADERA CT. 1250 SELVA MARINA ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (904) 349-2999 --------------------- Structure Information 000 000 ---------------------- Construction Type . . . . . TYPE 5-A Occupancy Type . . . . . . RESIDENTIAL Flood Zone . . . . . . . . ZONE X ---------------------------------------------------------------------------- Permit . . . . . . MECHANICAL GAS PIPE PERMIT Additional desc . . Sub Contractor . . SAWYER GAS COMPANY Permit Fee . . . . 84 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 9/22/10 ---------------------------------------------------------------------------- Special Notes and Comments *2007 FLORIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS . 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 84 . 00 84 . 00 . 00 . 00 Plan check Total . 00 . 00 . 00 . 00 Grand Total 84 . 00 84 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. N MECHANICAL PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 p Ph(904) 247-5826 Fax(904) 247-5845 JOB ADDRESS: S�e IV-4 AA 6%&r C. C 4 PERMYr# /0— 0)1 PROJECT VALUE $ NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION Air Conditioning: Unit Quantity Tons Per Unit Heat: Unit Quantity BTU's Per Unit Seer Rating_ Duct Systems: Total CFM REQUIRED REPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI# Air Conditioning: Unit Quantity Tons Per Unit REQUIRED Heat: Unit Quantity BTU's Per Unit Seer Rating_ Duct Systems: Total CFM REQUIRED FIRE PREVENTION Fire Sprinkler System Quantity (Requires 3 sets of plans) Fire Standpipe Quantity (Requires 3 sets of plans) Underground Fire Main Value (Requires 3 sets of plans) Fire Hose Cabinets Quantity (Requires 3 sets of plans) Commercial Hoods Quantity (Requires 3 sets of plans) Fire Suppression Systems Quantity (Requires 3 sets of plans) FIRE PLACES MISCELLANEOUS: Prefabricated Fireplace Qty Automobile Lifts Gas Piping Outlets Boilers BTU's Elevators/Escalators ALL OTHER GAS PIPING Heat Exchanger Quantity of Outlets Pumps #Vented Wall Furnaces Refrigerator Condenser BTU's #Water Heaters Solar Collection Systems Tanks (gallons) 2so 'S '. 11, Wells OTHER: 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 goverrang 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 Mechanical Company 46 9,e-d-s Office Phone F��-6��I Fax 2(f Co. Address: 9 City J4jjo,%v,)1e 13c4._State T� zip '322,10 License Holder(Print): State Certification/Registration# C2 1 o-f 4 A Notarized Signature of License Holder Sworn and subscribed before me this day of 20 Signature of Notary Public BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach,FL 32233 Office (904)247-5826 Fax(904)247-5845 JobAddress: 'ZOL-7 Se-h/A 01 )IONP-ACK , Permit Number: Legal Description Parcel A Valuation of Work Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/pro osed structure(s) c rcle one): Commerciar Residential If an existing structure,is A fire sprinwer system installed? (Circle one): Yes No N/A Florida Product Approval# For multiple products use product approval form Describe in detail the type of work to be performed: N e-w Property Owner Information: Name: ?AT PtLf- Address: 2-4 2,-7 Se L VJ9 P�00 Q(y-, eA C City A, fg � Ei State�E-Zip i�-Z3 3 1�h-one 90,? - �3 lo I Jiq 3 0 E-Mail or Fax# (Optional) — Contractor Information; Company Name:A41 W�0� 1?,u I w Qualifying Agent: %�a Address: 12-S5SeLf41Wr)PjA C/Yyl,. city PrA. tate 0,2, -3 Office Phone -�?4 11 ai q Job Site/Contact Number Y\4 t 9�+v Lk, State Certification/Registration# C G C, 3)4 Architect Name&Phone# Engineer's Name&Phone# Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address a *�is he e ade I a* a e d he work and instal s i ndi ca or installation has commencedprior to the a',laws thisjurisdiction. This permit becomes null -4 ic ti 0 1 11 r-i'to 0 ot t t sta, t'o s� k is s a eriod of s�*xj6u)months at any time after 8 b f r d to mZ m a ha rk e er me -pp nce 0 aper r Ity t all wi I "�0 c i t , Or, c 6 on�y tr"t n r us Jectric R? Is, -s,Reaiers, s ,'d 0'or s co t wo thin s p i 0� �o`,WEO a el Pools, urnaces,Boilei and vo k' not "en ed' f d. understand t at sep t,Per ts M, t be secured "rk is co "nce ara T n jr C a bmaA on�ftonen,eta WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. ]IF YOU INTEND TO OBTAIN FINANCING9 CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I here certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this 1�work will be cotnplied with whether speciffed herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any otherfeaderal,st�ate, or local law regulati construction or the peFfo�mance of construction. Signature of Owner Signature of Contractor//--',-/ Print Name t�( Print Name ............. .................................................... Irl-1.U. ...................... Swory3dind subser' before me Sw d b g��a, 1f1sc AW this I.A .Dayof 20 to 'a,;o j%� 201,6 n L li�—. ] r Not Public L GRAHAM otgry pubiie State o-Morid 'y MM' 0 EXFCY a4h= Karen Louise Wansley Bonded Thru N My rommission DD613575 Ex ires 12/08/2010 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Oil Application Number . . . . . 10-00000121 Date 3/25/10 Property Address . . . . . . 2027 SELVA MADERA CT Application type description RESIDENTIAL ADDITION/ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 12500 ---------------------------------------------------------------------------- Application desc KITCHEN REMODEL ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ BARRICK, FREDERICK PHILLIPS BUILDERS LLC 2027 SELVA MADERA CT. 1250 SELVA MARINA ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (904) 349-2999 --------------------- Structure Information 000 000 ---------------------- Construction Type . . . . . TYPE 5-A Occupancy Type . . . . . . RESIDENTIAL Flood Zone . . . . . . . . ZONE X ---------------------------------------------------------------------------- Permit . . . . . . ELECTRICAL PERMIT Additional desc KITCHEN REMODEL Sub Contractor GATEWAY ELECTRIC COMPANY . 00 Permit Fee . . . . 58 . 60 Plan Check Fee Issue Date . . . . Valuation . . . . 0 Expiration Date . . 9/21/10 ---------------------------------------------------------------------------- Special Notes and Comments *2007 FLORIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS . 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 58 . 60 58 . 60 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 58 . 60 58 . 60 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. �'- Ij a MJe-r a C�- 1 C) 0 Underground up NEW SERVICE 21Z" Underground Pole OResidential (Main) Service 00-100 amps 0101-150amps 0 15 1-200amps O—amps 4 of Meters OCommercial (Main) Service 00-100 amps 0101-150amps 0151-200amps O_amps OCT Service amps Conductor Type Size_ _ OMulti-Family (Main) Service 00-100 amps 0101-150amps 0 15 1-11-00amps O—amps # of Unit Meters OTemporary Pole 0 amps SERVICE UPGRADE 0— -amps 0 CT Service amps NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.) 0100amps 0150amps 020ki,.nps 0 _amps OCT Service amps ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS, ACCESSORY STRUCTURES, ETC. Outlets/Switches: 0-30amps - --31-100amps 101- 200amps Appliances: 0-30amps _ _31-100amps 101- 200amps A/C Circuits: 0-60amps —6 1-1 00amps Heat Circuits: # circui�s Oa __kw Number of Lighting Outlets, Including Fixturcs: OTHER ELECTRICAL PROJECTS OSwimming Pool 0 Sign OSmoke Detectors_ Qty OTransformers KVA OMotors_hp FIRE ALARM SYSTEM (Requires 3 sets of plans & Fire Alarm Checklist) Qty_volts/amps_.. - VALUEOFWORK$ REPAIRS/MISCELLANEOUS OReplace Burnt/Damaged Meter Can OSafety Inspection OPanel Change OOH to UG 00ther: Permit becomes void it work does not commence within a six month period or work is suspended or abandoned tor six months. I hereby certify that I have read this applicatior and know the same to be true and correct. All provisions of laws and ordinances governing this work will be compl;,:d with whether�,pecified 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 Electrical Company C_C4 i C_ —Office Phone 7-U9 C>Z—? —Fax Co. Address: c) city' State KL_Zip ) License Holder (Print): 0:-V�NY-L4 P�,\6_n S�_4 State Certification/Registration #?,,(En6kLk Notarized Signature of License Holder ,�Ae,0-7 te14 moj-x 20 Sworn and subscribed before me this day of Signature of Notan, Pu JEANNA C. IPPOLITO Notary Public-State of Flodds -.=My Commission Expires Sep 18,2010 I Commission#DID 579780 Bonded by National Notary Assn. PREPARED 3/25/10, 9 : s9 : 10 PAYMENTS DUE RECEIPT CITY OF ATLANTIC BEACH PROGRAM BP820L ----------------------------------------------------------------------- APPLICATION NUMBER: 10-00000121 2027 SELVA MADERA CT FEE, DESCRIPTION AMOUNT DUE ------------------- ------------------------------------------ ------------- ELECTRICAL PERMIT 58 . 60 TOTAL DUE 58 . 60 Please present this receipt to the cashier with full payment . ELECTRICAL PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd, Atlantic Beach,FL 32233 Ph(904) 241 826 Fax(90 247-5845 JOBADDRESS: Z_07�_7 15elQ& n+ PERMIT# IC - NEW SERVICE F-10verhead Underground 0 Underground up Pole 0 Residential(Main) Service 00-100 amps 0101-150amps El 151-200amps 0 ___amps of Meters 0 Commercial(Main) Service 00-100 amps 0101-150amps 0 151-200amps 0 ---amps OCT Service amps Conductor Type Size- OMulti-Family(Main) Service of Unit Meters 00-100 amps 0 10 1-1 50amps 0 151-200arnps 0 ____aMpS OTemporary Pole 0 -amps SERVICE UPGRADE 0 __amps 0 CT Service amps NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.) 0100amps 0150amps 0200amps 0 ___amps OCT Service amps ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC. Outlets/Switches: C :to 0-30amps 31-100amps 101-200amps Appliances: 0-30amps 3 1-I 00amps 101-200amps A/C Circuits: 0-60amps 61-1 00amps Heat Circuits: # circuits @_____kw Number of Lighting Outlets, Including Fixtures: OTHER ELECTRICAL PROJECTS 0 Swimming Pool 0 Sign 0 Smoke Detectors_Qty 0 Transformers KVA 0 Motors hp FIRE ALARM SYSTEM (Requires 3 sets of plans &Fire Alarm Checklist) Qty volts/amps VALUE OF WORK$ REPAIRS/MISCELLANEOUS 0 Replace Burnt/Damaged Meter Can 0 Safety Inspection 0 Panel Change OOH to UG El Other: 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 Electrical Company Office Phone —Fax City State Zip 319,:0 Co.Address:P,D, B o-A (a Q 06-7 License Holder(Print): 01 T- r-tj State Certification/Registration#6-9- V0 I Ll 0'7 Notarized Signature of License Holder Sworn and subscribed before me this day of 20 Signature of Notary Public CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 10- OFFICE:(904)247-5826 9 FAX NO.:(904)247-5845 VWM.COAB.US BUILDING PERMIT APPLICATION DUVAL COUNTY B,4 Frj,,�NIDEIR W*M �QPFQ NEW BUILDING 11 DEMOLITION RESIDENTIAL LOT BLOCK SUB DIVISION DADDITION 11 CONVERTING USE 11 COMMERCIAL 467t.OESCRIPTION."OFM AI;RCICTION 11 ACCESSORY BLDG. U1!FEPAIR OPOOL/SPA 13 YES 13 N/A 11 MOVE 11 OTHER 13 NO ENGINEEWAV�V6,,,4777 9.NAME: 15.COMPANY NAME: 23.COMPANY NAME: Va AIJ 1214-1(,1.ZjX 1?PJ7 tL es 16.NAME: 24.LICENSEE NAME: 10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.: ,;,702,-7 e,10* C-6CJ2-.r711f 18.ADDRESS, *e* 26.ADDRESS: Z- — Sf'1s*e A4,4 0 1, ?2.Z'S 11.OFFICE PHONE: 12.FAX NO.: 19.OFFICE PHONE: 20.FAX NO.: 27.OFFICE7qE��FAX NO.: 2*1-f X-2,f-1 13.CELL PHONE: 21.CY4*E� 2 29.CELL PHONE: ,,q ?d; 14.EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS: NO,I J.� RTGAGE�LENDER ft 'v" zV N1 ��1117!, '14R, 31.NAME: 33.NAME: 35.NAME: 32.ADDRESS: 34.ADDRESS: 36.ADDRESS: Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced 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. This permit becomes null and void if work is not commenced within six(6) months, or if construction or work is suspended or abandoned for a period of six(6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc. OWNER'S AFFIDAVIT-I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning.I will not occupy or use the referenced building or any part therof, until all inspections are finaled and prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law. 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 F!M F!FYI T---4,%, 101- 6ormi �'W-1 W R N Date: fore m is day of 2010 in the county of v tate of Florida,has persQn I lopeared NelaFy Publi6 btate at IfleMs M�'c hz'-i S H49%14909i�NRA�RWftaffirms at all statements and declar ionsare rin by himself I herself and affirms that all statements and declarations are "W&QqWio1n DD613575 t a and acc t.. of 4 County ta P. too I ry f ersonally Known r ly duced Identification- P ced No I ST BE C I T Y FiF AA-T-L- SEE PERMITS FOR ADDITIONAL BIR-EQUWANMNTS AND CONDITIONS. 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