Permit Well 781 Jasmine 2010CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number 10-00000933 Date 8/03/10
Property Address 781 JASMINE ST
Application type description WELL PERMIT
Property Zoning TO BE UPDATED
Application valuation 0
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Application desc
WELL NOT DONE PERMIT EXPIRED
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Owner
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CAUSEY
781 JASMINE STREET
ATLANTIC BEACH FL 32233
Contractor
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WILLIAMS WELL DRILLING INC
P. O. BOX 330567
ATLANTIC BEACH FL 32233
(904) 241-8489
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Permit ELECTRICAL PERMIT
Additional desc .
Permit Fee 90.00 Plan Check Fee .00
Issue Date Valuation 0
Expiration Date 1/30/11
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Special Notes and Comments
Seperate permit required for electrical
connection/wiring to new pumps
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- -------
Permit Fee Total
Plan Check Total
Grand Total
90.00 90.00 .00 .00
.00 .00 .00 .00
90.00 90.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORll)A
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph (~04) 247-5 6 Fax (904) 247-5845 ~ ~ 9.3.3
JOB ADDRESS.
NEW SERVICE ^Overhead ^ Underground ^ Underground up Pole
^ Residential (Main) Service
D 0-100 amps ^ 101-150amps D 151-200amps ^ amps # of Meters
^Commercial (Main) Service
^0-100 amps ^101-150amps ^151-200amps ^ amps ^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.)
^ 100 amps ^ 150amps ^ 200amps ^ amps ^ CT 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 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
0 Swimming Pool ^ Sign ^ Smoke Detectors Qty ^ Transformers KVA ^ Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans & Fire Alarm Checklist)
Qty volts/amps VALUE OF WORK $
REPAIRS/NIISCELLANEOUS
^ Replace Burnt/Damaged eter Can ^ Safety~pection ^ Panel Change ^ OH to UG
0 Other: G~
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 too v~ the provisions of any other state or local law regulation construction or the performance of
construction.
Property Owners Name iC ~~ s~ \ ~-`°~; ~ Phone Number ~ C~ ~ ~~1 ~~~ t(~
Electrical Company Office Phone Fax
Co. Address: City ~'~~'~ State ~ Zip ~
License Holder (Print)• ^^ State Certification/Registration #
Notarized Signature o
oEaoFw+ n. wwrlE '
~~~'~ 1 ~bbs~a~, and subscribed before ~s ~= .. day f ~ ;~L'
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"-r'. `~~~~1' 2011 ~G%4.-kiL,
9onded thru N ry PubNC Uncle 8
~'~t'rh•' ture of Notary Public
20J~
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®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 AONE - 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; (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.
ADDRESS ., PNONE NUMBER
PRINT E _
._..._.....-,. ~~~ ~,~ ~J
~~~St~GNA URE
DATE
Before me this ~`--day of ~-- , 20 /~ in the county of
Duval, State of Florida, has personally app ed herin by himself I herself and affirms that
all statements and declarations are tru an accurate. ~~
Notary Public at Large, State of 7~, County of
^ Personally Known /7~, ~ ~s~~ / `~ '~ ~ ~~ - ~ ~ ~ ~. ~, ~,.~rqv p~,;,, , pE~~ a ~~
~Frotluced Identification - ! %( l._ d'Z xiµ" -`~; MYCOMMISSIQN # pp g~I26
/ ~ EXPIRES. May 21, 2011
/~/ ?~ ~j / / `~~ ~~Rf ~F4 • a 9ontled'Chru Notary Pubs Undenvrltero
Notary Signatur G ~~~ ~~ (~G
F:BLDG/Owner-Builder Affadavit; REVISED: 4/] 6/2009