Laurel Way 1484CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number 10-00000619 Date 6/08/10
Property Address 1484 LAUREL WAY
Application type description WELL PERMIT
Property Zoning TO BE UPDATED
Application valuation 0
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Application desc
NEW WELL
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Owner
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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 ELEC TO WELL
Permit Fee 90.00 Plan Check Fee .00
Issue Date Valuation 0
Expiration Date 12j05/10
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Special Notes and Comments
Seperate permit required for electrical
connection/wiring to new pumps
Maintain proper distance from sewer lateral.
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 FLORIDA
BUILDING CODES.
ELECTRICAL PERNIIT APPLICATION
Jos ADDRESS' ~~0 `~ ~fI-
~L
#~
NEW SERVICE ^ Overhead ^ Underground ^ Underground up Pole
[~AResidential (Main). Service
1~l0-100 amps ^ 101-150amps ^ 151-200amps D amps # of Meters
^Commercial (Main) Service
^0-100 amps ^ 101-150amps ^ 151-200amps ^ amps ^CT Service _
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
AIC Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
amps
OTHER ELECTRICAL PROJECTS
^ Swimming Pool ^ Sign ^ Smoke Detectors Qty ^ Transformers KVA ^ Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans & Fire Alarm Checklist)
Qty volts/amps
REPAIRSINII S CELLANE OU S
^ Replace Burnt/Damaged Meter Can
VALUE OF WORg $
^ Safety Inspection ^ Panel Change ^ OH to UG
l~ Other: ~ X i ~lT/~-,1 ~ F .~.~ V ~ ` T f _ ~. s o_i .. -r~ a/ 6+ ~' & ~ li,: L ~
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
GonStrl1Ct10n.
Properly Owners Name ~ /A n u 2. ~~ ~c t-o k 1 k Phone Number 9 ~ Y -3 ~ 2 - f~s5 6
Electrical Company
gone Fax
Co. Address: ~__, State _
License Holder (Print): State Certification/Registration #
1+~®teariz~d ~i~~a~z~~le a~'~~~c~r~ ~ ~
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845
Zip
,~ /r...~
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~c •..;"r CITY OF ATLANTIC BEACH
::~"} ®WNER /BUILDER AFFIDAVIT
~'•' ~,tt~~'
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. TIID 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.
Ill. 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 1F ,A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT (247-5826) IF IN DOUBT.
V. ACKNOWLEDGEMENT; 1 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.
~'~ ~~ ~~~~L- AIL. ~G_ll_~_;~2233
ADDRESS
PRINT
Before me this ~ da~YOf l J/L~ / l ~
Duval, State of FI da, has personally appeared herin I
all statements and declarations are accurate.
Notary Public at Large, State of County
^ Pe Known
duced Identifyt
Notary
~in the county of
iself 1 hen3elf a d affirms that
In
PHONE NUMBER
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F:BLDG/Owner Builder APfadavi~