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Permit 1887 Beachside Ct 2012 US CITY OF ATLANTIC BEACH '� s) 800 SEMINOLE ROAD `�SaGaxL'�SU� l� ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00000676 Date 6/07/12 Property Address . . . . . . 1887 BEACHSIDE CT Application type description RESIDENTIAL ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 13000 --------------------------------------------- Application desc BATH REMODEL --------------------------------------------------- Owner Contractor ------------------------ ------------------------ BENNETT, DAVID C RJ VINAS CONSTRUCTION 1887 BEACHSIDE CT 2215 LAUGHING GULL CIR ATLANTIC BEACH FL 322335954 ATLANTIC BEACH FL 32233 (904) 514-4442 --- Structure Information 000 000 BATH REMODEL Occupancy Type . . . . . . RESIDENTIAL ------------------------------------------------------------------------ Permit . . . . . . PLUMBING PERMIT Additional desc RELOCATE 11 FIXTURES Sub Contractor PLUMBING BY JOSH Permit Fee . . . . 132 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 12/04/12 ---------------------------------------------------------------------------- Special Notes and Comments 2010 FLORIDA BUILDING CODE, 2008 NATIONAL ELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. WINDOW AND DOOR INSPECTION: *INSTALLATION INSTUCTIONS REQUIRED *ALL STICKERS ARE TO REMAIN ON THE WINDOWS *PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS * Provide a cover page, signed sealed plans for structural work to be done, standard paper size for plans . * ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00 STATE PLBG DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 132 . 00 132 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 136 . 00 136 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph(904) 247-5826 Fax (904) 247-5845 l '0_�O c�JOB ADDRESS: �_ PERMIT# NEW OR REPLACEMENT INSTALLATION: Project Value $ TYPE OF FIXTURETYPE OF FIXTURE QTY Bathtub ZE Septic Tank& Pit Clothes Washer Shower Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink �_ Toilet Hose Bibs Urinal Kitchen Sink Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory — Water Heater Other Fixtures Water Treating System RE-PIPE: TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY Bathtub Septic Tank& Pit Clothes Washer Shower Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet Hose Bibs Urinal Kitchen Sink Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory Water Heater Other Fixtures Water Treating System MISCELLANEOUS: ❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons(Requires 3 sets of plans) ❑ Lawn Sprinkler System-Number of Heads ❑ Well ** ** SJRWD Well m letion Form. Complete orm to submitted to the Buildi Dep men or final inspection.** a ❑ Other Permit becomes void if work does not commence within a six month period or work is suspended or abandoned r 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. Property Owners Name Phone Number Plumbing Company Office Phone Fax Co. Address: City State Zip License Holder(Print): /�C�ii-t/� 4� ° T State Certification/Registration# Notarized Si nature of License Holderzz� -' OHO AMANDA WH and subscribed befor e this da MY COMMISSION N EE 05 y 20 , ,a Bonded EXPIRES:NMa May 21,Und 1 ure of Notary Publ' v/,� �i I CITY OF ATLANTIC BEACH a 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number 12-00000676 Date 6 Property Address . . . . . . 1887 BEACHSIDE CT /07/12 Application type description RESIDENTIAL ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 13000 ---------------------------------------------------- Application desc BATH REMODEL -------------------------------------- Owner Contractor ------------------------ ------------------------ BENNETT, DAVID C RJ VINAS CONSTRUCTION 1887 BEACHSIDE CT 2215 LAUGHING GULL CIR ATLANTIC BEACH FL 322335954 ATLANTIC BEACH FL 32233 (904) 514-4442 --- Structure Information 000 000 BATH REMODEL Occupancy Type . . . . . . RESIDENTIAL -------------------------------------------- Permit RESIDENTIAL ALT/OTHER Additional desc . . Permit Fee . . . . 115 . 00 Plan Check Fee 57 . 50 Issue Date Valuation . . . . 13000 Expiration Date . . 12/04/12 ---------------------------------------- Special Notes and Comments 2010 FLORIDA BUILDING CODE, 2008 NATIONAL ELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. WINDOW AND DOOR INSPECTION: *INSTALLATION INSTUCTIONS REQUIRED *ALL STICKERS ARE TO REMAIN ON THE WINDOWS *PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS * Provide a cover page, signed sealed plans for structural work to be done, standard paper size for plans . * -------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ----------------------------------------------------------- Fee summary Charged Paid Credited Due ----------- ---------- ---------- ---------- ---------- Permit Fee Total 115 . 00 115 . 00 . 00 . 00 Plan Check Total 57 . 50 57 . 50 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 176 . 50 176 . 50 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 i (J Office (904) 247-5826 Fax (904) 247-5845 Job Address: 7 �� S��e ��— Permit Nu Legal Description 1 / �� LAG�slt Parcel# oor Area of q. t. t Valuation of Work$�� 4h� Proposed Work heated/cooled 3S non-heated/cooled �//'700:_ Class of Work(circle one): New AdditionAlteratio �RepaiMove Demolition pool/spa window/door Use of existing/proposed structures) (circle one): Commercial esidential If an existing structure,is a fire sprinkler evetam inetallarl? (Circle one): Florida Product Approval#_ For multiple products use prodr.,.ahpruval iorm Describe in detail the type of work to be performed: >'`e,1,,."PC_/ 0a 7� S" Property Owner Information: Name: .n ��! z ,n�J/ Address: l e�7 �o� City 4G .1 _,� State Zip �3Z z-3 Phone E-Mail or Fax#(Optional) Contractor Information: Company Name: T1/11 , s L L c_ Qualifyent: �`fi ,q.� �n/1� Address: L� i., Gu( in City X.1 State_( -�_ _Zip 32 Z 3 Office Phone / Z Job Site/Contactpub- Architect Number__ F& ` 19*1%Z._ Fax# State Certification/Registration# E d'ub Architect Name&Phone# Engineer's Name &Phone# ✓ �� 7 ior Fee Simple Title Holder Name and AddressBonding Company Name and Address ti,—Mortgage Lender Name and Address �///—Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permitZme—snu and void of work is not commenced within six(6)months, or if construction or work is suspended or abandoned for aperiod of six(6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools, Furnaces,Boilers,Heaters, Tanks 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. I here b certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type olYwork will be complied with whether sppeci ie d herein or not. The granting of a permit does not presume to gave authorityto violate or cancel the provisions of any other federal,state, or local! w regulatin con armance of construction. Signature of Owner Signature of Contractor Print Name .................. . ii.. Print Name .................. .................................. ......j ... ............................................ Swor and s cribed o ne S n a1 s cribed ore me t is Day 20 tl Day f 20 RL No XPI S:February 14,2014 C:OMMISSI 957760 'd h nd ru Notary Public Underwriters ' cc sr.+�ww.� INYllill =.','. :•: iF U 4,20 • +� of B .ed TRES:hnr Notary ublic UnderusV ed 01.26.10 F:<iziu'� MAY-31-2012 13:42 FROM: TO:92475e45 P:1/1 /_e' rmYT # l2 -- 7 NO ONWNC NT State of .. _ t io No. County of �1 F117L c0pr To Whom Tt May Concern: rile undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTIC OF COh�1MENC �, i,egal DescripVan of property being improved: Address of property being improved: General,description of improvements: v Owner: .'�� , lrl,"!I Address: Owner's interest in site of the improvement: Fee Simple Titleholder(if other than owner): Name: o Contractor: aD c Addrem:2 Telephone No.: FaxNo" Suzety(if any) Addrmas: Amount of Bond$ Telephone No: Fax No: — Name and address of any person making a loan for the construction of the improvements Number PaM:I OR��159 ie Page 1371, Recorded 05/3112012 at 01:45 PM, Name: �- JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY Addles: RECORDING$10.0o Flame No: Fax No: Name of person within the State of Florida, other than himself,designated by owner upon whom notices or other documents may be served: Name: — Address: Tclepbone No. Fax No: _ 1n addition to himself owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713,06(2)(b),Florida Statues. IFUI in at Owner's option) Naxnc• -z - ,Address` Telephone No: _ _ Fax No: Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a diYTcrent date is specified): THIS SPACE FOR RECORDER'S USE ONLY OWNER Signed:_ A. Date:_' Before nrC this day of 1 V in tfxa County lau ,Srste Of Florida,has parsouaily appeared ' _� Notary Public at Lar lorida,CountyDuv1 $HIRI EY L.G y on expi� - ill .,,: MYCOMMIS5 I• oma' -.r-or s EXPIRES:Febrd ti$Catl _ .^ 1t ?.?;\• Bonded Tj ractery nubile U rlerrrtites5 City of Atlantic Beach Building Department FDate PLICATION NUMBER 800 Seminole Road ned by the Building Department.) Atlantic Beach,Florida 32233-5445 �'Z _o� 7 Phone(904)247-5826 Fax(904)247-5845 �i E-mail: building-dept@coab.us d: City umb-site: I*P://wu+w.eoab.us APPLICATION REVIEW AND TRACKING FORM Property Address: -� h C: l De rtrne nt review wired Yes o Applicant: AL&dtng Planning&Zoning Tree Administrator Project: � Q k) Public Works Public Utilities n�Ti4 /]m � Public Safety Fire Services Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B 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: 6 APP ATION STATUS Reviewing Department First Review: pproved. (Circle one.) Comments: n I - /I P�s CO(/Pr �� C'n �•'�Pl�4.K PTO p-�! /LYS EF) S i r s S I PLANNING&ZONING Reviewed by: Date:$—/-/Z TREE ADMIN. Second Review: []Approved as revised. ❑ enied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Dom: FIRE SERVICES Third Review: []Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07/27/10 RJ Vinas Construction, LLC 2215 Laughing Gull Circle Atlantic Beach, FL 32233 am FILE COPT y 6/4/2012 we Mike Jones City of Atlantic Beach Building Department Summary: This project is the remodel of the upstairs bedrooms and bathrooms and adding a study/office. We are replacing one window to gain egress for a new bedroom placement. We are using an impact glass window.We are not moving any load bearing walls.We are moving one Shear wall.The engineering for the shear wall is attached.All the other walls are interior non load bearing. Address 1887 Beachside Court Occupancy Glass Single family:Group R-3 Building Code 2010 Florida Building Code Index of Documents !)Shop drawing of interior walls 2)Engineering letter for Shear wall Site Plan:This an interior remodel.A site plan is not required. Erosion and Sediment Control Plan:This is a interior remodel.An erosion and sediment plan is not required. Construction Site Management Plan:The dumpster will be provided by Shapell's.The dumpster will be stored in the driveway. The demolition will be interior wall only.The workers will park in the driveway. No Temporary fencing is required. Foundation, elevations and roof plans are not required. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph (904) 247-5826 Fax (904) 247-5845 JOB ADDRESS: O U 7 AOICI�/QL' C T PERMIT# NEW OR REPLACEMENT INSTALLATION: Project Value $ TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY Bathtub Septic Tank& Pit Clothes Washer �_ Shower Dishwasher Shower Pan T Drinking Fountain Slop Sink Floor Drain -�^ Three Compartment Sink Floor Sink , Toilet _ Hose Bibs ..y„! Urinal Kitchen Sink ,�„�� Vacuum Breakers Laundry Tray #+w. Water Connected Appliances Lavatory Water Heater Other Fixtures Water Treating System RE-PIPE: CO3 TYPE OF FIXTURE QT1 ® TYPE OF FIXTURE QTY Bathtub Septic Tank& Pit Clothes Washer Shower Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet Hose Bibs Urinal Kitchen Sink Vacuum Breakers I Laundry Tray Water Connected Appliances Lavatory Water Heater Other Fixtures Water Treating System MISCELLANEOUS: ❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons(Requi sets of plans) ❑ Lawn Sprinkler System-Number of Heads ❑ Well **SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.** ❑ 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 1 haveread 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. Property Owners Name ooe &-)w TT Phone Number 24g—3,3.3O Plumbing Company �..�1 nn Q Office Phone, ?-zS706 Fax Co. Address: 6 ice► A 11,/C City State ZiR3; License H O S e Certification/Registration 3os Notarized=,War MISSION 0579 �ad�der c Underwrite worn and subscribed before e thi day of 20 Signature of Notary Public x 'A+Ad!�Y�.C;IRak3su^.MiA;+ews:u,r.4�rr:c:reae'!eASkaran,,:. FILE COPYIta engineering company www,alfoengineedngco.com June 1,2012 Mr. David Bennett 10 l Orh Street Unit 54 Atlantic Beach,Florida 32233 Second Floor Shear Wall 1887 Beachside Court Atlantic Beach,Florida 32233 The 12'-4" 2nd floor north-south wall between the new "non-sleeping room" and the Guestroom (reference: Second Floor Remodel Plan for the Herring Residence, prepared by Alta Engineering Company, dated April 27,2012 shall be constructed as a shear wall as follows: 1. Sheath one side with 7/16" OSB nailed at 6" o.c. to each stud. Run boards horizontally.Cover with gypsum wall board on both sides. 2. But the double top plate of the new shear waif snug with the top plate of the south exterior wall. 3. Provide 2x6 flat blocking @ 16" o.c. to support the floor sheathing over which the new wall bears. Nail the shear wall sill plate to this blocking w(3) 16d nails @ each block. Secure the blocking to the adjacent trusses w/ scabs using (4) l Od nails to the underside of the truss top chord and to the blocking. 4. Provide(3)SP studs to serve as chords at each end of the new shear wall. 5. Anchor the studs at the south end of the wall to the top of the first floor south exterior CMU wall with a Simpson HD5A(or equivalent strap) using a 1/2" threaded rod with Hilt HY 150 epoxy(or equivalent) using a 6" embed into the CMU wall. (Install the anchor first and then install the studs.)As an alternate,you may use the straps described in item 6. 6. Anchor(2) of(3)studs at north end of the wall with(2)CS 16 straps that extend 16" onto the stud and 12" onto the face of the CMU wall below. Use 3/16" diameter 1-1/4" tapcons to secure the strap to the CMU wall. Add triangular blocking to support the span of the straps within the floor cavity. All fastening, anchorage or connections indicated above shall be installed in accordance with the manufacturer's instructions. Any fasteners, anchors or connections not explicitly described above shall be in accordance with the requirements of the 2010 Florida Building Code. alta enginearling company 6223 cherry lake drive north Jacksonville,florida 32258 904--880-0301 Bennet&Herring Residence June 1,2012 Letter Page 2 of 2 Thank you for the opportunity to provide our professional services. If you have any questions concerning this proposal, please do not hesitate to call. Sincerely, caltcDi engineering company certific, e of authorization No.29095 i cri/lz Brett Newkirk,RE Principal Engineer Licensed,Florida No.62476 Gmail-Herring Residence-ReModel-2nd floor shear wall notes. https:Hmail.google.com/mail/?ui=2&ik=634e67b9fb&view=pt&q=bre... GuAlRichard Vinas<richardvinas mail.com> .t Herring Residence - ReModel - 2nd floor shear wall notes. 1 message Brett Newkirk<brett@altaengineeringco.com> Tue, May 29, 2012 at 9:50 AM To: Richard Vinas<richardvinasc@gmail.com> Richard, Thanks for bringing the shear wall issue to my attention. In order to address, we will turn the common wall between the Guestroom and the"non-sleeping room into a shear wall as follows: 1. Sheath one side with 7/16" OSB nailed at 6"o.c. to each stud. Run boards horizontally. Cover with gypsum wall board. 2. Provide 2x6 flat blocking @ 16" o.c.to support the floor sheathing over which the new wall bears. Nail the shear wall sill plate to this blocking w(2) 16d nails @ each bock. Secure the blocking to the adjacent trusses w/ scabs using (4) 10d nails to the underside of the truss top chord and to the blocking. 3. Provide(3) SP studs at the end of the shear wall and anchor to the top of the south exterior CMU wall with a Simpson HDSA(or equivalent strap) using a'/2"threaded rod with Hilti HY 150 epoxy (or equivalent) using a 6" embed. (install the anchor first and then install the studs) 4. The end of the shear wall shall be 12'4"from the south wall. It will require anchorage to the top of the CMU wall. This will require cutting a hole in the existing floor or the ceiling below to facilitate access. 5. Provide(3) SP studs at the north end of the wall Secure these studs to the CMU wall below using (2) CS16 straps that extend 16"onto the stud and 12"onto the face of the CMU wall below. Use tapcons to secure the strap to the CMU wall. Add triangular blocking to support the span of the straps within the floor cavity. If you prefer, you may use the straps described for the north end on the south end as well. Hopefully this is not to confusing. Please email or call if you should have any questions. Thanks, Brett / Breff D. Newkirk, P.E. principal engineer alta engineering company www.altaengineeringco.com 6223 cherry lake drive north 1 of 2 5/31/2012 7:11 AM �X CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ;> ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00000683 Date 6/07/12 Property Address . . . . . . 1887 BEACHSIDE CT Application type description ELECTRIC ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc switches outlets ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ BENNETT, DAVID C E-4 ELECTRIC, INC. 1887 BEACHSIDE CT 1247 BOCA GRANDE AVE ATLANTIC BEACH FL 322335954 ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . ELECTRICAL PERMIT Additional desc . . Permit Fee . . . . 77 . 20 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 12/04/12 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE ELEC DCA SURCHARGE 2 . 00 STATE ELEC DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 77 . 20 77 . 20 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 81 . 20 81 . 20 . 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 Ph(904) 247-5826 Fax (904) 247-5845 JOB ADDRESS: ! 93W 7 PERMIT# JEA INFORMATION REQUIRED ON ALL PERMITS ,� AMPSJ 40 VOLTS t PHASE VAL UE OF WORK$ NEW SERVICE ❑ Overhead [9 underground ❑T Underground up Pole El Residential(Main) Service ❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Meters Commercial(Main) Service 00-100 amps ❑101-150amps ❑151-200amps ❑ amps 11 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: -)n_0-30amps 31-100amps 101-200amps Appliances: 7 0-30amps 31-100amps 101-200amps A/C Circuits: 0-60amps 61-100amps Heat Circuits: # circuits @ kw Number of Lighting Outlets, Including Fixtures: ALL OTHER ELECTRICAL PROJECTS [I 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/MISCELLANEOUS ❑Replace Burnt/Damaged Meter Can 1]Safety Inspection []Panel Change ElOH to UG ❑Other: LW d-,--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. Property Owners Name Phone Number � 1 `7 Electrical Company E rq tr 1ecft' C., 1'11c, Office Phone Fax Co.Address: 3 City State Zip 3 License Holder (Print): State Certification/Registration# 130'3"3 Notarized Simnature of License Holder SHIRLEY L. RAHil d subscribed fore e this f 20 February 1aca rnr,tiot8y pUaue u of Notary P ------