Permit Sign & Elec 27 Seminole 2011 \ . CITY OF ATLANTIC BEACH
"
4 Alk 5. s, 800 SEMINOLE ROAD
" I :4 ATLANTIC BEACH, FL 32233
.
INSPECTION PHONE LINE 247 -5826
x3! 9
Application Number 11- 00001529 Date 2/22/11
Property Address 27 SEMINOLE RD
Application type description SIGN PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
sign w/ elec
Owner Contractor
BUDNIK AND D ELECTRICIAL CONTR
6703 LAURINA PL
JACKSONVILLE FL 32216
Permit ELECTRICAL PERMIT
Additional desc .
Permit Fee . . . 90.00 Plan Check Fee .00
Issue Date Valuation . . . . 0
Expiration Date . . 8/21/11
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
FLORIDA FIRE PREVENTION CODE
NATIONAL ELECTRIC CODE
Other Fees STATE DCA SURCHARGE 2.00
STATE ELEC DCA SURCHARGE 2.00
STATE ELEC DBPR SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 90.00 90.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 8.00 8.00 .00 .00
Grand Total 98.00 98.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
''? .L �
y �' s CITY OF ATLANTIC BEACH
.; ` s 800 SEMINOLE ROAD
J 11 - X ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
.0 1319/'
Application Number . . . . . 11- 00001529 Date 2/22/11
Property Address 27 SEMINOLE RD
Application type description SIGN PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
sign w/ elec
Owner Contractor
BUDNIK AND D ELECTRICIAL CONTR
6703 LAURINA PL
JACKSONVILLE FL 32216
Permit SIGN PERMIT
Additional desc .
Permit Fee . . . 65.00 Plan Check Fee .00
Issue Date Valuation . . . . 0
Expiration Date . . 8/21/11
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
FLORIDA FIRE PREVENTION CODE
NATIONAL ELECTRIC CODE
Fee summary Charged Paid Credited Due
Permit Fee Total 65.00 65.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 65.00 65.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
r s!.vr „ City of Atlantic Beach APPLICATION NUMBER
1 Building Department
X. } 800 Seminole Road (To be assigned by the Building Department.)
n r Atlantic Beach, Florida 32233 -5445 `Z
Phone (904) 247 -5826 • Fax (904) 247 -5845
»ott 5%' E -mail: building- dept @coab.us Date routed: //_51//
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /7 d j" a e Department review required Yes No
/� cNi ), 4-7--)b Buil l/
Applicant: anning & Zoning
((-, c 1're rnis rator
Project: c7 9 iv b G 1� / i�, Public Works
Public Utilities
Public Safety
�y + Fire Services
R vICGwfee $ 1Y0 y4 De +i a d4. JM ¢ V4
Jf:.��+snx ��A���II '�1 ; �✓. Y.F j t .0 `�� J 4 ,.
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: Approved. LDenied.
(Circle one.) Comments:
BUILDI
PLANNING & ZONING
Reviewed by: 1771 Date: 0 —
TREE ADMIN. Second Review: Approved as revised. ❑D vied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
City of Atlantic Beach
Buildin Department
r , , g APPLICATION NUMBER
800 Seminole Road (To be assigned by the Building Department.)
Atlantic Beach, Florida 32233 -5445
Phone (904) 247 -5826 • Fax (904) 247 -5845
� )» E -mail: building-dept@coab.us
City web -site: http: / /wwww.coab.us Date routed:
APPLICATION REVIEW AND TRACKING FORM
Property Address: _ c" J j a � � D- 'art ent review required q Yes No
B uil•'n
Applicant: O'/Vj b 2 i/� ` an
anning & Zoning j
� Tree rnis rator
Project: cc7 ' ' - Public Works
Public Utilities
Public Safety
Fire Services
: •,H.4 Dep5Sgnat"u
Other Agency Review or Permit Required Review or Receipt
of Permit Verified By Date
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: (Approved.
(Circle one.) Comments: Denied.
omments: ' n
BUILDING
��lQ(/1S G�- tee ,,� 4-267)] ANNING & ZONI S t � � , a '�t`' -Ce SLO
Reviewed by: �/ — Ih Date: , 6 72»/
TREE ADMIN. /
Second Review: Approved as revised. ❑Denied.
PUBLIC WORKS Comm :RE ' ED
PUBLIC UTILITIES G
PUBLIC SAFETY Reviewed by: 2 i
���� Date: � /2,0 1
FIRE SERVICES Third Review:
(Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
5
s BIDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: 2 7 $ ein/ /10 le
Permit Number: /1 — /5
Legal Description Parcel #
Valuation of Work $ Floor Area of Sq.Ft. Sq.Ft
5-69 Proposed Work heated /cooled n heated/cooled _
Class of Work (circle one): New A.,°• • Alter 1 @ 7. T ations Repair Move Demolition 3 1/spa window /do o
Use of existing /proposed structures) ) (circle one): Ccommesz Residential JAN 0 5 2011
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /.
Florida Product Approval # 9
For multiple products use product approva orb BY /
Describe in detail the type of work to be performed: ' I " i /ace z// /z //'M . ..5 r t. .
/ At i. - 44/ /a/ ,41 ii 5 .iti - o
Property Owner Information: - � AV S'r `if4/9 yr ,Q �64 )
Name: 1 I 1 ��/ ! s I rs /
/ ow Address:
City , 4. , ate - Zip ,o ( Phone ,----- 1
/. Ai % _ . /1rear *
E -Mail or Fax # (Optional)
Contractor Information:
AP
Address: Name, o /t1 . . AO 17 -2 li
Qua g Agent: /U ,4 /jm B4' c//C
s s: 6 703 1_0,11 I
Office Phone ! j � % Job S'te/ Co City ir State 1 Zip, iCl
ntact ber Fax #
State Certificatio " egistration # ;e / f j - 2
Architect Name & Phone # _
Engineer's Name & Phone #
'Tee Simple Title Holder Name and Address
3onding Company Name and Address
Vlortgage Lender Name and Address
1pplication is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
ssuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
ind void f work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a eriod of six _(6) months at any time after
vork is commenced I understand that separate permits must be secured for Electricar Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters,
ranks and Air Conditioners, etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
hereby certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
pe of work will be complied with whether specd herein or not. The granting of a permit does not presume to give authority to violate or cancel the
°ovisions of any other federal, state, or local law regulating construction or the performance of construction.
24
ignature of Owner /� 4
Signatm e of Contractor .� �%
tint Name L. V v tok R \t Ali P
'� Print Name � � -)( / U jl/�l�
worth - • . scr� . b -fore me
us / i �a fro r , -- -._ _. _=..: before me
_ 4 r c 1 R CODES i� . i . � ` i C / 2Q1 Pu .lio , . ' ; OF A T LANTIC 'O w:. it ! , ‘-- t � � . _ , � „
' r~ 1 -.: - Jary 14, ; ' y ITS FOR ADIIPtle& ,, . lc
- . ,
I ?� e i
t ry Pubic Und' 1. ' 1 ' REMENTS AND
I
s CONDITIONS. e{ise • ` 1 q ! 0�
REVIEWED BY:
DATE: 0 "'/ <. u
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233 ; _
Ph (904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: 2 7 dirn t- 2l1//° r , W g a,e, � PERMIT # l / /5,) 9
NEW SERVICE El Overhead ❑ Underground El Underground up Pole .
❑Residential (Main) Service
90 -100 amps ❑ 101 150amps ❑ 151 200amps ❑ amps # of Meters
❑ Commercial (Main) Service -
00-100 amps 0101- 150amps ❑ 151- 200amps ❑ amps OCT 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 0200amps ❑ amps OCT Service amps
ADDITIONS, REMODEL, 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.P OJECTS
❑ Swimming Pool f5" 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/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change 0 O to UG
❑ Other:
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
construction. rr y �/, r�
Property Owners Name �/� ae �e e Phone Numbe / j" l Z 413 7 /3
Electrical Company brzedivi lZ a vei &/'✓' /v Office Phone _ q 11 V SV 736
Co. Address: 6 7c 9 Laze22. /A/a. tot- Cit ,e State P( Zip °Z2-a
License Holder (Print): M A X / ill ,8i-( ii. / le State Certification/Registration # -/Z (5 3g
Notarized Signature of License Holder Jam.., /r ' `:
Sworn' and subscribed before me this r v, s ay o . m:•r'R»mi 2€ J_
,� * � ., "r, M. ISS •N . ID 957760
' , ;;!, ' '.: IR E • bras ;Kam,_ l
Signature of Notary Public \-,, �r.; o� � :
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