Permit 19 Forrestal Cir S S CITY OF ATLANTIC ]BEACH
J 800 SEMINOLE ROAD
r' ;y ATLANTIC BEACH,FL 32233
j
{ e. INSPECTION PHONE LINE 247-5826
Application Number . . . . 10-00000158 Date 2/12/10
Property Address . . . . . . 19 FORRESTAL CIR
Application type description ELECTRIC ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
Owner Contractor
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MANGANI MATT OWNER
19 FORRESTAL CIRCLE
ATLANTIC BEACH FL 32233
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Permit . . . . . . ELECTRICAL PERMIT
Additional desc . . REPAIR SERVICE METER TO WH
Permit Fee . . . . 90 . 00 Plan Check Fee 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 8/11/10
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 90 . 00 90 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 90 . 00 90 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
CITY OF ATLANTIC BEACH
-�... 10-
,a800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233
OFFICE:(904)247-5826•FAX NO.:(904)247-5845
W W..COAB.US
ELECTRICAL PERMIT APPLICATION DUVAL COUNTY
1.JOB ADDRESS: 2.IS THIS A SUB PERMIT:' 3 DATE
❑NO q
6� Fore I r. ❑YES PERMIT#:
PROPERTY OWNER:
4.NAME: 5.ADDRESS IF DIFFERENT FROM JOB ADDRESS: 6.PHONE:
l�� Smarr-�- 1173-6 Y rd
ELECTRICAL CONTRACTOR:
7.NAME OF COMPANY: �J1e ' _I `--- 8.ADDRESS.:
9.STATE OF FLORIDA LICENSE NO: vwC 10.CELL PHONE: 11.FAX NO.:
12.EMAIL ADDRESS: 13.OFFICE PHONE: 14.
15.Application is hereby made to obtain a permit to do the work and installations as indicated. I certify 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
is�commenced.
CONTRACTORS SIGNATURE:� W/"�+w��y�/�` f,
16.CLASS OF WORK: 17.SERVICE: 18.METER NUMBER:
❑MULTI FAMILY-#OF UNITS: ESIDENTIAL
❑SINGLE FAMILY ❑TEMP SERVICE ❑COMMERCIAL
❑ADDITION ❑TRAILOR 19.BUILDING: 19.CURRENT CODE:
❑ALTERATION ❑SIGN OLD ❑NEW 13'08 NATIONAL ELECTRICAL CODE
1! REPAIR ❑POOL/SPA ❑REWIRE ❑OTHER:
LIST ALL ELECTRICALWORK:
20.TYPE OF SERVICE: OVERHEAD ❑UNDERGROUND ❑UNDERGROUND UP POLE
21.NEW SERVICE: CONDUCTORS PER PHASE: ❑ POWER IS ON ❑POWER IS OFF
22.SIZE OF CONDUCTOR: JAMPACITY: 10 0 ETC-OPPER 13ALUMINUM
23.SWITCH OR BREAKER SIZE: AMPS:j2Lr PH:�_ W: VOLT: VtO RACEWAY SIZE: _
24.EXISTING SERVICE SIZE: AMPS: /ZI- PH: W: VOLT: LZ O RACEWAY SIZE:
25.FEEDERS: #OF AMPS: #OF AMPS: #OF AMPS:
26.LIGHTING FIXTURES: INCANDESCENT: FLUORESCENT&M.V.:
27.FIXED APPLIANCES: 0-30 AMPS: 31-100 AMPS: OVER 100 AMPS:
28.FIRE ALARM: ❑YES ❑NO
2931 DO NOT APPLY TO NEW SINGLE FAMILY,MULTI-FAMILY AND ROOM ADDITIONS
29.SMOKE DETECTORS: NUMBER:
30.RECEPTACLES: 0-30 AMPS: 31-100 AMPS: OVER 100 AMPS:
31.SWITCHES: 0-30 AMPS: 31-100 AMPS: OVER 100 AMPS:
32.AIR CONDITIONING:
#OF UNITS: COMP. MOTOR HP RATING: AMPS: HEAT KW:
#OF UNITS: COMP. MOTOR HP RATING: AMPS: HEAT KW:
33.MOTORS:
NUMBER: VOLTAGE: HP: KVA:
NUMBER: VOLTAGE: HP: KVA:
34.TRANSFORMERS:
UNDER 60OV: NUMBER: KVA:
OVER 60OV: NUMBER: KVA:
35.MISCELANEOUS REPAIRS:
DESCRIBE IN DETAIL: Cef sul pv;1,65 LrOost AA1+,L1 .tv WtAlt4_l d
Eled Permit Application 2010
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�{ CITY OF ATLANTIC BEACH
�~ (OWNER / BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF YOU MAY BUILD OR IMPROVE A ONE—OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
If. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV, PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN"OCCUPATIONAL LICENSE"IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
Ll pQ
ADDRE S PHONE NUMBER
t4ey4� ew
PRINT NAME
SIGN A URE
DATE
Before me this day of friV. 20 11 in the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of '� County of.Jb"*x_C
IDa
❑Personally Known
dudIdenication .`f v poDEOR�H
a,WHIT E
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MY COMMISSION#DD 6341LIM
,
^/n- � C�- �� �,> ',: PIRES,May 21, 11 1.
Notary Signature:`/�?�"'"�c `� ThNNot9ryPUbAcUtttlerv�M' l
M-
F:BLDG/Owner-Builder Affadavit;REVISED: 4/16/2009