Permit Bldg & Elec 5103 Polaris 2010 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00001205 Date 10/04/10
Property Address . . . . . . 5103 POLARIS CT
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 7000
----------------------------------------------------------------------------
Application desc
renovate bath/shower
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
PRESTIGE BUILDERS & REMODELERS
848 AILY CHURCH LANE
SEVIERVILLE TN 37876
(904) 662-1528
----------------------------------------------------------------------------
Permit . . . . . . I BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 85 . 00 Plan Check Fee 42 . 50
Issue Date . . . . Valuation . . . . 7000
Expiration Date . . 4/02/11
----------------------------------------------------------------------------
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONALELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 8S . 00 85 . 00 . 00 . 00
Plan Check Total 42 . 50 42 . 50 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 131 . 50 131 . 50 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Mau 11 10 12:30P
BUMI)ING ftRM1T APPLICATION
CITY OF ATLANTIC BEACH
900 Senfinole R04 Atknfic BeWA FL 32233
Office(904)247-5826 Fax(904)247-5945
Job Address: 5 1 t) PO L-P(R 1-1 CT .Permit Number: 0 5r-
Legid Desesiption-- A M E __, Parcel#
Floor Of Sq.Ft
Viduation of Work S -7 0 bb, Propand Work hiaft&weled non-heated/cooled
CIM of Work(cumle ome): New Addlijon Ahmhon (�� Mow Demolition pool/spa window/door
Uw of exisaw ro AM k
If an exisftgu=i"a ft=es*P1Wjsny xOne):inshi&COPM(M rialle
Florida Prodact Amoval# irdle NO
For muffiple proa-acts an preaud approval Form
De9cribe in detail the type of work to be petformed: LZ F t4 t)0 BTE- p)1)*TH
Ho [1)612
LI 1-4 G-&C-)M I)A� E dTU Q -4 i t45 T A L-L P,'q W R LL- 'RE-1Z0Q-1E F-L
Property Owner h1formation: w P-I N&
Name:-IACC-o F :-C)NL ft��f-1 L=ANb11-4&
City JAILPrN I(- P)E-OCO —StateFL ��)-33 Phone
F,Mafl or Fax#
Contractor W
.qKMjft:
Conq)any Name: -T i L,-c P)u i L-h F-f 2-5 QualifyingAgent- JUT-rF) CJ&]j--1,CC-P<-01,aq
Address: s2a5 ity �LETJA N c- E�rl�l-$taft V C Z 3��-
c _ 4
Of rice P&;n- 5Q, Job Site/ !j9pbcr J 0
Stale CertificgdonMggistration C r�) C o to Lf-0
Archited Name&Phone ),4 f r�
Engineces Name&Phone# hA
Fee Simple Tift 1161der Nme wd AWress r onny
Bonding Cmapany Name andAddrew _t!4,n�jc UUr I
Mortgage I.Ander Name and Addrew --)-,.4 D rA L,
CORD A M
0
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE
TO YOUR PROPERTY.]w You PaEND To OBTAIN FNAWNG ON
YOUR LENDER OR AN ATTORNEY BFFoRE RECORDING yo
COhWENCENIENT.
or tie
Signatum of Owner - L6--C�a- Sipatm of T�U_ C)\-�
Print Name - a-rog- -V I -Lic-cec,
L j5—�-� Print Name I Q
Sworn to and subscribed before me Sworn and subscr#W before me
tbm-4,�Day of C.1- � .20/40 Inf At , r%, , <4-
A-- .20
I at
Notary Public No
SFFPP
EUZASETH TESKE DA B 6.10
Nowy Pwic-Side of FWW REQuIREM]EN7S
My Comw EWra Aor S.2013 MONS.
cammuw#00 MM REVIEWRI)BY.
DAM
Doc;#2010229 768,OR 13K 16384 Page i4-3,
NOTICE OF COMMENCEMMNT Number Pages! I
Recorded I 0/01,'2oi oat 11:51 AM,
JIM FULLER CLERK CIRCUIT COURT DUVAL
COUNTY
PermitNo. A) — 4�t 0 5� RECORDING$10.00
Tax Folio No.
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property,and in accordance with Section
713.13 of the Florida Statutes,the following information is provided in this NOTICE OF COAUdENCEMMNT.
l.Description of property(legal description): PoLpp—t'i C--r ATI—atq1C 6EPiC14-4- r-
a)Street(job)Address: IS I P ID 1—R P—L5 C T 4 A-F t-ilat 1,411 c-- 6 E&C-a eL
2.General desc4tion of improvements: Q r-,NoQ rA—i F— 12SATIA r j,-,51AbLQErZ ANt., 6LANE-00M
3.Owner Information t> h L-
a)Name and address: W-CRE , ONO ELZf-I LbNbIPA& 6" 11 TI FL
b)Name and address of fee simple titl Ider(if other than owner)
c)Interest in property_ ME bIMPLE
4 Contractor Information
a)Name and address: Pp C6TI &t I L-be Q� C T 6'F N EP—1 V N E 4 F L
b)Telephone No.: qb4� (&a . 15;L--A Fax No.(Opt.)
S.Surety Information
a)Name and address: A
b)Amount of Bond:
c)Telephone No.: Fax No.(Opt.)
6.Lender
a)Name and address: No Ne
Phone No.
7.Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a)Name and address: NONE
b)Telephone No.: Fax No.(Opt.)
8.In addition to himself�owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.13(li(b),Florida Statutes:
a)Name and address:
b)Telephone No.: Fax No.(Opt.)
9.Expiration date of Notice of Commencement(the expiration date is one year from the date of recording unless a different date
is specified):
WARNING TO OWNER: ANY PAYMENTS NLADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMUNCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART L SECTION 713.13,
FLORIDA STATUTES,AND CAN RESULT IN YOUR PAYING TWICE FOR IM[PROVEMMNTS TO YOUR PROPERTY.
A NOTICE OF COMY[ENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COM31[ENCING WORK OR RECORDING YOUR NOTICE OF COM[MENCEMENT.
STATE OF FLORIDA
COUNTY OF PINELLAS 10.
Signatul;of r�Owner's–Authormed Officer/Dmztor/PartnerManager
A--
Print Name
The foregoing instrument was acknowledged before me this -A9, day of j U M C 20)b by
1 -11 j (type of authority,e.g.officer,trustee,
�-rs -k.-4 F 15 Is as N1 N GIC
attorney in fact)for (name of party on behalf of whom instrument was executed).
Personally Known.--t'�OR Produced Identification Notary Signature
Type of Identification Produced Name(print)
OR
Verification pursuant to Section 92.525,Florida Statutes.Under penalties of pejury,I declare that I have read the foregoing and that
the facts stated in it are e L.UL
-111 MAE 9,11A-SIVE",
Notary Public-State of Florida
FORWINOC,"sd2010 My Comm.Expires Apr 5,2013
rz gnatu-re ofNatural Signing(in line#10.)Above
gP Commission#DD 867829
Bonded Through National Notary Assn
APPENDIX 13-D'
FLOMA ENERGY EFIFICIENCY CODE FOR BUILDING CONSTRUCTION
FORM SING-04 PAOWMMM Limited Appikoficaus laniscirliplive,Method C SOUTH 18 9
Small Additions,Phencivedions&flediding System I
Corrioliancewillill,",I Cot Sub42opler 6 offt haft Energy FfkbFW Care my be dernordfrOd by the vuld Fam 600G-04 for adiltions,of 6M sWm fear or less,sillewinstalled components of
frianufacttired hernes,and movations to s*W red andtipia-tarrily nisiderwas.Mentodive rmftft are provided im Millions by vat of Fam 600044 or 6004-04-
PROJECTWW- fti.-Apnc-T MLMW. b!AIL-t--F-r--5
AND AODRESS:- C_ Pj E�pV 1j. pERWMNG CLIMATE
f CNVC*: ZONE. 7 E] 6 0 9
-;6 NO.:
OWNER: NCL-RE "WW 1,40,11 F21 �T I JURISOCTION I I I I I I I
SWiLL ADDITIONSM MSM RMODICES OW square feet or less ol coalitiaoW am),Prescnotive iewbeearile;in Tables 6G-L 6C-Z and 6C-3 apply only to the components of the addition,not to
ft*existrip bwkiw spata hialing,cooling,and madiff leading equipinert erj=M levois mug he met Only West opopment is installed speediiiailly,ID serve the additim or is being installed in
conjunction with the addition coistruction.Coloponeft separating uncoaddianarl spaces from conditioned spaces muld and Me prescribed ardainturn rnsulidion levels,RE)WATtONS(B"whal
buildings undarlift nedpolien costingi marar Vain=%of the assessed volin of ft hudding),Previliptim mininevairds in Tables,6C-1 and OC-2 apply Only to ft conriparrients and equipment being
renovated or reptocial.WAWACTURED HOMES MW BUILDINGS,Only,slit4i"bled canoponeift and ftizem am 1q,Ilas liew BUILDING SYSTEMS Goinpily when complete,new"ern is
installed.
pbase Prim CK
I. Renovatkark Addition,Nw Slieftairt or Manuftchared Hom I. a
--JAP-5
2. Single4anally,detached or Wailt4ge-Inirnity attached 2.
3. N MuNkille-liamilly,4W.of unilis covered by Oft stdrer"sion 3.
4.
4. Corrittilkindid go"am(swW IQ 5.
6. laredonainierit eave overhang f1l.)
0. Glass"Wad antic Single Pane Double Pane
&Clearr glass 6. _sq.11. sq.ft.
b�TM Mrn or solar smm 6111. sq.It. sq,11.
7.
7. percerd"m of gians,to floor %
S. Flom tyllis,wild irmillation:
a-Slab-on-Irade(R-jakirej So R= Un-ft.
b Wood,raised(FI-value) W R= sq,fL
a.Wood,common(R-WAM) ft R sq.M
d.Concrete,raised(R-iaalue) S& R= sq.ft.
e-Concrete,common"us) Ora. R= sq.ft.
9. Wall type and Witsullalloar
a- Ex:lefior, 1. Masonry(insulation Fl-value) 99-1 R=- sq.ft.
2. frame(insulation Fl-value) 984 R -A.-q- ---sq�ft�
b� A4acent 1. Mason(Insulation R-v�) 9b-1 R sq.ft.
Z Wood trame(insulation R-value) W2 R sq.It
c.Mamage Walls oil Mtd#ft Units*(Yes(ND) 9c.
10. Coiling type and irasulatiow.
a-Under attic(Insulation Ft-value) Ift R= j-5-.sq,
b-Single assembly(Intsulakin R-a;ue) lob. R sq.tt.
11. coos"svoinam-
(Types:central,room unit package temlinal A.C-,gas,existing,nom) to r4
12. Heating systwW SEEPJEEA-.
(Types:hag purnp,elm strip,natural gas,LP-gas,gas h,p,,room or PTAC, 12. Type. 14 F-fXj- PLtM t->Pu
NSPFICOPIAFUF-,. -�u
ffidsling,none) (z K
13. Air distrillaildon systern-
a-Bacidim damper or single package system'(Yes/No) l3a.
b Ducts m mamage weft adequately sealed*(YeslNo)
14, Hot ivadew systrury- 14. Typ,,
(Types:elec-,natural gas,ottwer,exis",none) EF-
Pertains to manufactured twmines;wiM sile-insitafted components. I
f hereby oe"thrittvi Diem and by the C.10W260"aw,in compliance with Review of plans and specifications covered by this cakolation indicates compliance with the PAXAb
the Roridzi Enamy Code Enemy cixle�Wore constrixtion is compieleiL this beilding will be inspected for compliancie Pt
a"tance,with Section 5U 9M FS
BKOINSOF"CIAL,_
I hereby certify buildi rida Enemy code
OWWR A&Wft r . .
FLORIDA SURDM CODE-8UKJDING 13-0.37
APPENDIX 13-0
Climate Zones 7,8,9
DIBLEOC-1: 1118111AMMIS F11111111311111111ALMMUM R.adLn*.KOWITIM 1811ARMUMMUMM ME-MMMICOMMMOF K4KWWMD HoM
toomm 11MINNUM INSTALLED
amo"TM DMALLED EFFICIENCY EFFMMMY
Concrete Block
Frame,2,xr jCrvdmdA$G -SpR SEER=mo SEER=
Frame,Z x er R-19 Single Phg. SEER=9J SEER=
C4mmon,Frame R-11 Room unk or PTAC EER �&5* EER =
conmm�mmixav
UndarAlfic R_30 Recut PAS"kmm ANY
Sh)*Assamftf�Enclosed Held Pumo-SM HSM=&S
HSPF=6.6
Frame wig Sirve pIq1
Male!Pans M13 Fk*mta*orPTHP Coe -2.7*
rVIs Assembir Open A-10 10
Cornmon,Frame R-11 0 Gas;relieved or priVene AFUE=,78 AFLJE
'ELL Fuel ON ARJE=18
Slab-on-grade 00 hft*num so
Bamed Wood R-11
Rarlsed Concrehe R-5 W
Common,Frame Will #_ Elecinic nedstexce EF=.W EF
V- Ges;nalural or LP EF=Z9 EF=—
In uncondkdoFodipme R-6 Filed oil EF=M EF.
In condboned "a minknurn
ME OC-2:PRESCMPM REQU11111911119M FM a=AMU IN ADOMM OKI See Tablee 134507-1 ABC,32 and 13-6MI ABC3_2
MS*Mm qlass Do ftor new allaiwed is salached by 4Ve,overhug lef1p,and sokiv beall VM coriffichent Maximum%=_Insindled%
GLASS TYPF-OVERHANG,AND SOLAR HEAT GAIN COEFFICIENT REOL1111RIED FOR GLASS PERCENTAGE ALLOWED
LIP TO 2D% UPTO30% UP TO 4G% UP TO 50%
SWOO Double SIMIle, Double Single Double SWVW Double-
OH_SHGC OH-CU40C am-SHOC OK43NM OH-SHOC 0141,040C 0H-SHGC OHSHGC
11-A7 V-78 Z--87 V_ 78 S-87 Z--78 V-�87 ZY-78
9-75 V-J5 0_61 2'--75 V .61 3_75 2-61
V-�57 V-57 U-44 7_57 V-44
9-AD V-39 It-35
01 30
Cwcertiled SH13ICkc1henriandacturar or tee ddatft S*Vle dear SHOC=Mdouble clear SHGC-.86,and*I*Unt SHGC A4
TABLE SC-3 MMMM REWREMEMS FOR ALL PACKAGES
C01101120"EM SECTX391 REQUNd3AEWrS CHECK
I!Xwwjdwlo&cmdm 60111 To be CmAked,gssllieaad�weagior-sb*pW or otheirmse,geallea
Exted"TroKhms&Doors 606.1 MMML 0-3 drrVsq.*,winclow arear.5 chrL%q.tt.door area,
sole,&Top PUMS M&I Sells plah-and penalrabom 1vough 113P Oates of ejftrkw waft must be sealed
"Moe"d Ljow" M&A TVP&PC rated wrM no pareivanons(two,afternobves Wkr&WQ
*~ory""M M6.1 Air barrier an perknene of flow cavity butween noors,
ExhmM Fame Orhouls!ft--ded to—nM-W Vsca shall t__dmWw!L s)MW br combustion climicas viM irdn"exhaust
dut-l"ork
Combuslien Haidleg MsA Combusfoon speoe and wells heaft systarne Must be 111411h-ftde combuslim air,exaW for*ad vow
weeler"lenders
G-*vft 0111110moCY N%*"mWft in Table 012A.ABC-IL?Swfthordoaftnmrmddm*brgakorsW-cbtora"
ftM)must be pvwded ENAM"Wal or buk-on beat trap mqWWJCK WgIllcal ppe fters
Sud no poem a spas ("?I SO"&hearted Pools:Meng ftwo covers(exoso sow himeaq pjwKmvmftW pool,must ham a pump Uraw C
POW handlers must he""**"=therinal oflickincy of 71M as sm a
Ned wMer Piques 8121 kwAmian Is required fog hot weam arcuie"syseana(txax*q heat recovery urft).
0 mull be moldicled in no ZS goorw par MWW af M PW
HVAC Dud CamdemMor, SM11 All dUCeS,ft-gs,—he"aWpinerd aW Plenum chambers SW be m-'-Iia*Mached,sealed,Insulated and
-houdlow&kahmpan installed in acconjamos Vdlh 11110 CAMW of Section 61G.1.Dtvft in adllim inest be hindeded to a folhimurn of R4
HVAC Corldnaft SIPI'I*readily ccessidn,ma"Und Or BUICIMUC theinIMM IN each syft,.
9ENERAL DIRIXTM:
1. On Table 14_ b'ft*ft W"alue otft*Aigftbft added to each MOWneid And the nfr"Ocy Of the"*OW MWWd-All ft M
M'nlmtn VWM kht CMVOMM and OSOMM 400 beft added nor mwmftd a"be left blank, "alans and dk*"Cft inSWW USt thent or OXCW the
2, ADDITIONSaWy Ddsomw the pwm4p urmnelles,to cohdiboned da"Manni ft adfton as toljrrws�TOW disamen Is
old hemasnod mal'Sla"Mid addl itby*OVWM hotel.Wheallimsele Ofall Qlmwmdows�skkV glass doors and glass door parle Doublethe
eubraln'd k"the I"glass ama-Dmile ft N*tftd OM am brial by fle MdnMk1VJonn*dfnI wor wafelas fasf be,'DgreMvvd or enclosed by ft MM"],a"amunt NW tD the Urfa!area of this glass may be
GM�Iffw Pmm~ftft w TaMe ric-i MUM*by 100 1 u r
Pt�sm'��Ww�by�mb"afWAI=("temdoubWo )wW#*. (OH) 0 90 tha POMM Bird the WSW gins Perveritage nde which you,
arid owthlina,the minnuum,sow mat iiii, allowed is am --t-1 0010601-kh a sour hog gain coff,,Wni(SHM)F.,
soffind-Ao""M'Wom and doors PMW'W-the n4KW Waft Of Via house aW being mrtswind m the_aMpro,oo ,,awe
tO comply with the overhang arld SOW hall Vas cudficlant guMVosft on T n"..Ole"rl�
able W2.Ail new gins in the emign amne mad Ille M%timMent%I ON of me options in ft giens percentage calege'v
YOU indicated-The evolving(OH)disurna,is parm,,diceled,heir,#0 taw at the
1. RENOVATIM oKy_p4placem"0M Mok 10"M ft follow*MW glass to a POW dfft*under the OuWMW Oft of the troufterIg.
a oo wtose ewenl edge done nor onend hnsw am a A km#w mw wMaMills,Any glass We aild solar IMM 9*0=dhdW way be need for QIMM am which are urder at least a 2-foel overt"
double-paw brined raf%W aWas 8�bei�q mnava ad that doner" rhm crft�'"ust ell sdtw-VI�PM triled,d,,W,.Vn,olw
4. 8UILDff4G SySTEM&Cum*when new$10,1,xadaund W sysmm MWW
5. Compleite the ptreons fe*wsted on#0 me ta at P"1
6 Read'Minimum Re'lleramente nor SiViAll AdMIM NM 6V,3.&M che*all jolscabje xxeffl�
,' Reno,sign junj dab ft Uvmp4,,,ff c,,,eft1k,,Wemnt on page I
13-D.38
FLORIDA BUILDING CODE-BUILDING
QL-Aill City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445 h -0
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: Z/
City web-site: hftp://Www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: J*�IdJ D921rtment review required Y No
�uiiding
Applicant: W66g-71 �7 L --Pfa�ng &Zoning
Tree Administrator
Project: ?JAI'd Public Works
Public Utilities
Public Safety
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: P�J/Approved. [:]Denied.
(Circle one.) Comments:
�BUILDIN6
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN. Second Review: FlApproved as revised. EID49ed.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: [-]Approved as revised. [-]Denied.
Comments:
Reviewed by: Date:
Revised 05114109
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00001205 Date 10/07/10
Property Address . . . . . . 5103 POLARIS CT
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 7000
----------------------------------------------------------------------------
Application desc
renovate bath/shower
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
PRESTIGE BUILDERS & REMODELERS
848 AILY CHURCH LANE
SEVIERVILLE TN 37876
(904) 662-1528
----------------------------------------------------------------------------
Permit . . . . . . ELECTRICAL PERMIT
Additional desc . .
Sub Contractor . . BARKOSKIE ELECTRICAL SERVICE,
Permit Fee . . . . 58 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 4/05/11
----------------------------------------------------------------------------
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONALELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE ELEC DCA SURCHARGE 2 . 00
STATE ELEC DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 58 . 00 58 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 62 . 00 62 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
I-AA Ut 1U U928a BARKOSKIE ELECTRIC (904)249-8017 P.1
ET,EcmucAL PERMT APPUCA-RON
CrrY OF ATLAN-nc Bi&AcH
800 Seminole Rd,Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845
'0
TOB ADDRxss:_-L-)_/ 41 a 67 PERMT
NEW SERVICE ElOverhead El Underground ED Underground up Pole
DResidentiaJ(Main) Service
00-100 amps 0101-150amps 0151-200amps 0- --.amps #of Meters
GCommercial(Main)Service
00-100 amps 0101-150amps 0151-200amps C1 amps OCT Service amp
Conductor Type size
OMulti:-Family(Main)Service
00-IOD amps 0101-150amps 0 151-200amps, 0—amps 4 of Unit Meters
OTemporary Pole 0 amps
SERVICE UPGRADE 0 am,n s- 0 CT Service anms
NEW FEEDER(ADDMONS,ACCESSORy STRUCTURES,ETC.)
0100amps 0150amps 0200amps 0 amps OCT Service amps
ADDMONS,REMODFJS REPAMS,BMD-OUTS,ACCMORY STRUCTURES,ETC.
Oude&Switches: :Y�10_30amps ________�j_j00arups 101-200amps
Appliances: 0-30amps 31-100amps —101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits-@____j'-W
Number of Lighting Outlets, Including Fixtures:
OTE(ER ELECTRICAL PROJECTS
OSvViMmiu9PooI OSiga 0 Smoke Detectors
_Qty OTransformers KVA OMotors
FIRE ALARM SYSTEM (Requires 3 sets of pbns&Fire Alarm ChecklW)
Qty volts/amps VALVE OF WORK S
REPAIRSIMMCELLANEOUS.
ORep1we Burntffiamaged Meter Can OSafety b1spection OPanel Change OOH to UG
gOther- - PLEY DEVIC
�L_A-Ct�_r _&-S k_� 20 r—
P,)ezm-*,t 1b, =1 void if work'does noat�Iomnmmence within a sk mowh puiDd or work is suspended or abandoned for six months. I hereby certify diat I have
read Ws spplication and know 1he snw to be true and cormcL An provisions of lam sad ordinanccs governing this worL-Will be complied withwhe&er
spocified or not The pmmmit does not give mothorhy to violaw ibc provisions of amy other staft or local law regulation coastruction or the periormncr of
construction.
Phone Number
Property Owners Name, LA�\)I ? N3_ r
Electrical Company K'C>5 K I L;-� CZ-�Fz_-M i c- Office Phone ZW(- 47 3/—Fax
Co.Addrew:.'9'�-3 sqz-f-�� 4viks- CAY State r-L- Zip�j7Z.Sz
License Hokler(Print):. - - I__ State Cerfification/Registration#
Notariked SignaWre ofLicense Holder
b6gre me ffis day of N.6ttj
S-worn and s"s
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