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Permit Well 1044 Stocks St 2010 fs, CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5826 Application Number 10- 00000638 Date 4/15/11 Property Address 1044 STOCKS ST Application type description WELL PERMIT Property Zoning RES SF DISTRICT Application valuation . . . 0 Application desc NEW WELL Owner Contractor THIS ADDRESS DUPLICATED -SEE PARTRIDGE WELL DRILLING CO. LOCATION 13648 Q /A:DONAL PARTRIDGE JR. 4744 COLLINS RD. ORANGE PARK FL 32073 (904) 269 -1333 Permit ELECTRICAL PERMIT Additional desc . Permit Fee . . . 59.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 10/12/11 Special Notes and Comments Seperate permit required for electrical connection /wiring to new pumps A reduced pressure zone backflow preventer must be installed if irrigation will be provided or if there is a private well on the property. Backflow preventer must be tested by a certified tester and a copy of the results sent to Public Utilities. Other Fees STATE ELEC DCA SURCHARGE 2.00 STATE ELEC DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 59.00 59.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 63.00 63.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL 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_,1247-5845 JOB ADDRESS: /C/ cigi PERMIT # JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE VALUE OF WORK $ NEW SERVICE ❑ Overhead ❑ Underground ❑1 Underground up Pole ❑Residential (Main) Service ❑ 0 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps # of Meters Commercial (Main) Service 00 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps El CT Service amps Conductor Type Size Multi- Family (Main) Service ❑ 0 -100 amps ❑ 101 150amps ❑ 151- 200amps ❑ amps # of Unit Meters ❑ Temporary Pole ❑ amps SERVICE UPGRADE ❑ amps ❑ CT Service amps NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.) [1100 amps ❑ 150amps 200amps ❑ amps ECT Service amps ADDITIONS, REMODELS, REPAIRS, BUILD -OUTS, ACCESSORY STRUCTURES, ETC. Outlets /Switches: 0 -3 Damps 31- 100amps 101- 200amps Appliances: 0- 30amps 31- 100amps 101- 200amps A/C Circuits: 0- 60amps 61- 100amps Heat Circuits: # circuits @ kw Number of Lighting Outlets, Including Fixtures: OTHER ELECTRICAL PROJECTS ❑ Swimming Pool ❑ Sign ❑ Smoke Detectors Qty ❑Transformers KVA II Motors hp FIRE ALARM SYSTEM (Requires 3 sets of plans & Fire Alarm Checklist) Qty volts /amps VALUE OF WORK $ REPAIRS/MISCELLANEOUS ❑Replace Burnt/Damaged Meter Can ❑ Safety Inspection ❑Pane r hang ❑ OH to UG i / X Other: r f L,L)E Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. ereby 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 I--, Phone Number e59-/02 7 Electrical Company Office Phone Fax Co. Address: City State Zip License Holder (Print): \ . 1 State Certification/Registrati• • 1 Notarized 1. ? , , �q ��+ lder l I � LAir"' :. • ` hri; r © I I #DD 634126 I I EXPIRES: May 21, 2011 ;01.0' Bonded Thru Notary ublit UndarWefa and subscribed before 1 t 's day off , 20 Signature of Notary Public 1.-tV1 % CITY OF ATLANTIC BEACH 9' ®WNER / 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. II. 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. i D4u cam s S c 7 5 /c 7a ADDRESS PHONE NUMBER L PRINT NAM/ Olko / fr‘'' ci/j.67// PIM DATE ef•= s � .ay of , 20 in the county of Duval, State of Florida, has personally appeared herin by himself / herself and affirms that all statements and declarations are ttru� accurate. ,l /�� Notary Public at Large, State of / County of ` / f /" r-- 0 Personally Known r ; :.. 3 ,3 0 Produced Identification - S v ` t/ 6 * r %�� F MY �d� 4y'.�1T�� • � 'p Bonded tl 7hr XP/ RE 1 5SM8 21 ©p 63412 . 4 N ote 2011 Notary Signature: � /v` G`�/` ryp b Urrderv F:/BLDG /Owner - Builder Affadavit; REVISED: 4/16/2009