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2239 Barefoot Trace Permit Well 2011 CITY OF ATLANTIC BEACH .-, . 800 SEMINOLE ROAD =} ATLANTIC BEACH, FL 32233 d ' INSPECTION PHONE LINE 247 -5826 -�JJ31 Application Number 11- 00001863 Date 4/08/11 Property Address 2239 BAREFOOT TRAC Application type description WELL PERMIT Property Zoning TO BE UPDATED Application valuation . 0 Application desc new well Owner Contractor HANSON, JIM AND JANET WILLIAMS WELL DRILLING INC 2239 BAREFOOT TRACE P. O. BOX 330567 ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (904) 241 -8489 Permit WELL PERMIT Additional desc . Permit Fee . . . 75.00 Plan Check Fee . . .00 Issue Date • • • • Valuation . . . . 0 Expiration Date . . 10/05/11 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 is 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. Backflow preventer to be installed on the customer's side of the meter, on City water service. Other Fees STATE DCA SURCHARGE 2.00 STATE DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 75.00 75.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 79.00 79.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH WELL PERMIT APPLICATION /�� Date C Owner's Name: \T/ 17,0,# T p Address: ^ pC `� he � o �� Well Address (if different than above): Well Location on Property (i.e. northeast corner, etc.) ovi ( Well Installation Contractor: 60////141 G-! / Pt. i7( "', • Contractor License No.: 6 'Vl 7 Phone;p 3 FAX: Contractor Address: 1, , � a Jr e �1 �� Check Use of Well: Domestic Irrigation Y Other Estimated- Well Depth/ g& Casing Depth /2 S Screen Interval from(Acto 7 Casing Well Diameter: g Material Is address currently connected to the City water system? 3• Is address currently connected to the City sewer system? y f Has a Well Permit been obtained from the City of Jacksonville ?X&Permit # Does the well require a permit from the St. Johns River Water Management District? (Not required for wells under 2- inches diameter installed by resident or wells under 6- inches diameter if installed by licensed well contractor). / If permit is required, note Permit Number and attach a copy. NOTE: WHENA WELL IS INSTALLED ON YOUR PROPERTY, YOU MUST INSTALL A REDUCED PRESSURE ZONE TYPE BACKFLOW PREVENTER ON THE CITY WATER SERVICE, ON THE CUSTOMER'S SIDE OF THE METER. THE BACFFLOW PREVENTER MUST BE TESTED BYA CERTIFIED TESTER AND A COPY OF THE RESULTS SENT TO THE PUBLIC UTILITIES DEPARTMENT. ILE COPN �,t=- IN :rr City of Atlantic Beach APPLICATION NUMBER �' "� Building D epartment y' (T be assigned by the Building Dep art me n t .) 1,. � .Y Ail 800 S eminole Road - � ' Atlantic Beach, Florida 32233 -5445 V Ph one (904) 247 -5826 Fax (904) 24 -5845 Q �� /ft 9:� E-mail: building- dept @coab.u Da ro uted City web -site: http: / /www.coab.us APPLICATION REVIEW AND CKING FORM Property Address: ' a 3 f ,)� riNl, Departm ent review required Yes No J Bui Applicant: Z{)/////c )(2 nn & �1 / `', Tree Pla Adm ning Project: vim log. �• P orks Public Utilities c Safety Fire Services 7 "" aY, arts .c e)� '.a r ti i 3nr ",, .., L ,,, a ^r" .. ., r Revlew:Efee $ 'K 4" ` i. .�s� ,1 ;,,G �. Dep lg na re �y . +l ,, i. °, �, j;i Sf 7 Other Agency Review or Permit Required Review or R Date of Permit Verified eceipt B y 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: pproved. DDenied. (Circle one.) Comments: // 1 BUILDING PLANNING & ZONING Reviewed by: Date: -�� TREE ADMIN. Second Review: Approved as revised. ['Denied. P :%'WORK Comments: y" 414711:01g° P B r S • FETY Reviewed by: Date: FIRE SERVICES Third Review: _Approved as revised. Denied. Comments: Reviewed by: Date: Revised 05/14/09 ri �' 4 CITY OF ATLANTIC BEACH $ .9 800 SEMINOLE ROAD . ma J 7 ATLANTIC BEACH, FL 32233 {J . INSPECTION PHONE LINE 247 -5826 y131 9 Application Number 11- 00001863 Date 4/11/11 Property Address 2 239 BAREFOOT TRAC Application type description WELL PERMIT Property Zoning TO BE UPDATED Application valuation . . . 0 Application desc new well Owner Contractor HANSON, JIM AND JANET WILLIAMS WELL DRILLING INC 2239 BAREFOOT TRACE P. O. BOX 330567 ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (904) 241 -8489 Permit ELECTRICAL PERMIT Additional desc . WIRE FOR WELL Sub Contractor . LIMBAUGH ELECTRICAL CONTRAC Permit Fee . . . 55.60 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 10/08/11 Special Notes and Comments Seperate permit required for electrical connection /wiring to new pum A reduced pressure zone backf preventer must be installed if irrigation is 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. Backflow preventer to be installed on the customer's side of the meter, on City water service. Other Fees STATE ELEC DCA SURCHARGE 2.00 STATE ELEC DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 55.60 55.60 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 59.60 59.60 .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 (904) 247 -5826 1 Fax (904) 247 -5845 K6t, JOB ADDRESS: • ( C -�( >'� C. ~e- PERMIT # 1 l' JEA INFORMATION REQUIRED ON ALL PERMIT() AMPS' 2.4-/ CJiOLTS , PHASE VALUE OF WORK $ �fQ NEW SERVICE ❑ Overhead ❑ Underground ❑J Underground up Pole :Reside) 1 (Main) Service 00 -10( ps ❑ 101- 150amps ❑ 151- 200amps ❑ amps # of Meters ❑ Comm al (Main) Service 00 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps OCT Service amps Conductor Type Size Multi- Family (Main) Service C0 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps # of Unit Meters uTemporary Pole ❑ amps SERVICE UPGRADE ❑ amps ❑ CT Service amps NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.) ❑ 100 amps ❑ 150amps 0200amps E amps OCT 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 'Swimming Pool ❑ Sign ESmoke 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 CJ OH to UG they: w 4 _ t 2-CD 0 • -_ 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 construction. u Property Owners Name — 1L Y Hal `S(1 Phone Number ,� Electrical CompanyLl rYi K 1 1 E t'c*r 1 CCU.I Co + e Phone 1 2 - 41 - � x Co. Address: 42 L f -� h r City AF 10 (1 i c • :l : F License Holder (Print): 4 / [if • ( ! 1 I State Certification/Registr 3002296 Notarized Signature of License Holder WI f ' ' Notary Puolic State f U L Sworn and subs ?? . � � •� o ri - ��.y 20 1 o. �a E.. , /11'o� •• - ACTING Signature of No r 1. ,; 1