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Permit RA Glass Encl 147 Belvedere St 2012 r CITY OF ATLANTIC BEACH Vis) 800 SEMINOLE ROAD J ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 jilt Application Number . . . . . 12-00001201 ', Date 9/19/12 Property Address . . . . . . 147 BELVEDERE ST Application type description RESIDENTIAL ',ADDITION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 23270 ---------------------------------------------------------- Application desc glass enclosure -------------------------------------------------------------- Owner Contractor ------------------------ --------------- RING JESSICA U WESLEYS PATIO ROOMS 147 BELVEDERE ST 3545 -1 ST JOHNS BLUFF ROAD ATLANTIC BEACH FL 32233 SUITE 345 JACKSONVILLE FL 32224 (904) 626-5850 -- Structure Information 000 000 GLASS ENCLOSURE Construction Type . . . . . TYPE 5-A Occupancy Type . . . . . . RESIDENTIAL Flood Zone . . . . . . . . ZONE X ---------------------------------------------------------------------------- Permit . . . . . . RESIDENTIAL ADDITION Additional desc . . Permit Fee . . . . 170 . 00 Plan Check Fee 85 . 00 Issue Date . . . . Valuation . . . . 23270 Expiration Date . . 3/18/13 ---------------------------------------------------------------------------- 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 REQUIRED SIDE YARD SETBACKS ARE 15 ' COMBINED/5 ' MINIMUM PER SIDE. ACCORDING TO THE SUBMITTED SURVEY,', THE SOUTH SIDE YARD MEASURES 12 . 7 ' (12 ' 8 .4") AND THE NORTH SIDE YARD MEASURES 9 . 4 ' (9 ' 4 . 811 ) , FOR A COMBINED TOTAL OF 2211 . 211 . ACCORDING TO SUBMITTED PLANS, A GLASS ENCLOSURE IS PROPOSED TO BE LOCATED IN THE SOUTH SIDE YARD AND EXTEND 7 . 9 ' , THEREBY REDUCING THE SOUTH SIDE YARD TO 4 . 8 ' (419 . 611 ) , WHICH IS 2 .4" LESS THAN THE REQUIRED MINIMUM PER SIDE. ADDITIONALLY, THE COMBINED REQUIRED SIDE YARDS IS REDUCED TO 14 . 2 ' (1412 .41- ) , WHICH IS 9 . 6" LESS THAN THE REQUIRED MINIMUM COMBINED. HOWEVER, AN ADMINISTRATIVE WAIVER IS PERMIT ISPEMy9SMB E1NFWROIMN00WEM ACIT)T10(R VHEN'RUjjLTkTdftBRD5MFW�� THE FLORIDA BUILDING CODES. s CITY OF ATLANTIC BEACH s) 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 r X13 Page 2 Application Number . . . . . 12-00001201, Date 9/19/12 ----------------------------------------------- ---------------------------- Special Notes and Comments (151 ) , AND IS THEREFORE GRANTED. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 55 STATE DBPR SURCHARGE 2 . 55 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ------ ---------- Permit Fee Total 170 . 00 170 . 00 . 00 . 00 Plan Check Total 85 . 00 85 . 00 . 00 . 00 Other Fee Total 5 . 10 5 . 10 . 00 . 00 Grand Total 260 . 10 260 . 10 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. a�ct.td'�'iairs BUILDING PERMIT APPLICA'T'ION . CITY OF ATLANTIC BEACI� COPY 800 Seminole Road Atlantic Beach FL 32233. FILE Office (904)247-5826 Fax(904) 247-5845 `- k . WWI Job Address: Zq7 ��L- rJ�2� 5 _P'Frmit Number: Ap— 0OZ Legal Description SAG 141 /Z Parcel# Floor Area ot so t. S Ft Valuation of Work$ a 3, 2-70-- Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Additio Alteration Repair Move: Demolition pool/spa window/door Use of existing/proposed structure(s) circle one):. Co'mercial �eN. 6i r.�►_ nor.�'r /(oIf an existing structure,is a fire sprin er system )installed. (Circle one) <�-� Florida Product Approval # X4,41 �Z/y`Kl For multiple products use product app- royal Corm Describe in detail the type of work to be performed: .+2_ ox" b 1 a/— Property Owner Information: Name: SSild �I tj(r Address: Z 4'7 b-lA City id j 60tTie lkf1- StateG�Zip Phone &25 E-Mail or Fax#(Optional) Contractor Information: Company Name: Q Qualifying Agent:, 0,4 :r/> tQ wEsC�y Address: r� < fX L City TAS—'� State jG Zip ,, 5Q� _,5' Office Phone --p Job Site/Contact Number Fax# DE�3o State Certification/Registration# sec I yy5-7e. Architect Name& Phone# Engineer's Name & Phone# Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address Application is hereby made to obtain a permit to do the work n d installations as indicated 1 certify that no work or installation has commenced prior to the issuance 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 Wulf and void if work is not commenced within six(ti)months, or if construction or work is suspended or abandoned for a�period of six 16)months at any time after work is commenced. /understand that separate permits must be secured for Electrical Work, Plurrtbing,Signs, Wells, Pools, urrtaces, Boilers, Healers. 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. 1 hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions ofany other federal,state, or local lav regulating construction or the performance ofconstruction. Signature of Owner • Signature of Contractor Print Name .l. a....../� a:Y1.. . .............~..................................... Print Name L1 R (�t/F . r t subsc ' efore _, Sw a d subs rt rtfod be thi 20 t s a of 2 , 6 Nofary u My Comm.Expires oy 16,2014 _� .° NotaryPublic-State Florida Commission#EE 42659 M Comm. �� y Q mm. No RtAvMtg 1.26.10 ,,off Commission#EE 42659 DO NOT WRITE BELOW- .OFFICE USE ONLY -Applicable Codes: 2U10 FLORIDA BUILDING CODE Review Result (circle on Approved Disapproved Approved w/ Conditions Review Initials/Date: Development Size Habitable Space Non-Habitable Impervious area Miscellaneous Information Occupancy Group Type of Construction Number of Stories Zoning District Max. Occupancy Load Fire Sprinklers Required Flood Zone Conditions/Comments: FILE COP'S YY 4:.tp!a,a+;ykT(T`.�ilQ("� :"Itl✓'[.f i^.N�b'a'.'F.'v �i4 7'+1.+. 9{_i ��t li',y, ',p I�IIPIIp-aA1RpMA. �Aar.IWY .W*P»II••�pW�pw' 4�.Yp�,Yii MIAP SHOWING 15OU iNt�� R 3URVO V( OF LOT 599 AOCORDiNG To THE PLAT OF AS REI::C►RAEQIN PLAT BOOK 11)PUBLIC RECORDS OF � THE CURRENT COUNTY. ELORiDA. CElt't'll:':':'.3I7 TG: 1:15EICA xa:rc, OLD REPUBLIC NANICNAI, 'PITLE 'INSURANCE [OK:A@ZY, KEITFI WATSON Tl'rjrL SX,' ll CFS, TWCJ, ANI) CUA:iX4n vt s'1 C0A4PAVY. (250' reliv ED4E OF PAVEM NT ,-90.G>0' (R) 49 3c7' fi�J J/2" :50.06' `M) �/�'» jV0.00l Mir- VINA ',12.'7'"o _i A•4' ...L'C1vJ 1.5 6 B.9' 4CIN L 0. ' is d3�IdC. 5ivop T N";o W. 147 x `'- 4 YG °i.15 QA 9.0 _moi ;�X � � I_t)T 599 LOT 598 Q 00 N s• 0.4-\u r+k,� �� ,' r 1120 o1v 112- ti«C 4' W,1NAIL 3�22' (Ad) LOT 8161?. Lt'' (rwf LOT 614 T E;q 4; irw�a�ssrna�3s es.:.�ps..p....n g1ANCE�11N•AM#=wo W U='ALAN 1 FM Qt DRAO�i AN"LIM WWII 90U E m14io fZ AND/{RBAS 67 [ OM tlrYft66i' FROM -X ANTU, gFAM1[ 9F flr IINAIA. JRv YAR S 1. A?0L E S ARE Smo" o" surmy A A... 2.S'Ti1'7L'W N@ It?MW HElt al UES U114IN JUM 7ME X , PAEL N0?-DA1011 �llialffAE® SURVEYORS INC. 3,BTHES IDSEEARSD AAR0SY7.LONFLLQYDHI1f �M . UN0 Foo-PNOS. _ NOTICE OF COMMENCEMENT " -` ' il r POP State of Tax Folio No.I County of To Whom It May Concern: The 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 NOTICE OF COMMENCEMENT. Legal Description of property being improved: 1 Sof ,SICG1101-i Address of property being improved: /Z/7 8,rk-E✓,)A& 67 4.,m j-i C �Gf� 3 ��3 General description of improvements: GLASS Owner: J�S$�Gd ��/� _ Address:�yT / L. .?1')�/� !� •`14L Owner's interest in site of the improvement: Fee Simple Titleholder(if other than owner): Name: /n Contractor:_ Ji'f� Li Al 5/l y 5 A6/t ID I UC,-A 5 L1✓C Address: X375 Telephone No.:S'<,'f� d 3GY� Fax No: - 3d Surety(if any) Address: Amount of Bond$ Telephone No: Fax No: Name and address of any person making a loan for the construction of the improvements Name: Address: Phone 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: Telephone No: Fax No: In 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. (Fill in at Owner's option) Name: 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 different date is specified): THIS SPACE FOR RECORDER'S USE ONLY OWNER Signed: X Date: w �� Before me this day of he County of D val,State Of Florida,has persona e _ Doc#2012195939,OR BK 16065 Page 1640, Notary Public at Lar ate F r County of Number Pages: 1 My commission exp'res: Recorded 09111/2012 at 03:22 PM, Personally Known: or JIM FULLER CLERK CIRCUIT COURT DUVAL Produced Identificat =• • Notar Pn COUNTY �."� ","pr Comm*Expires NO 14 RECORDING$10A0 '�:; «d:�•r Commission#EE / D� HOMEOWNER SUNROOM ENCLOSURE AFFIDAVIT Sep 00 The purpose of this document is to make you aware of any limitations in the enclosure to bein er �rat y residence. The table below, Sunroom and Screen Enclosure Requirements provides a b d .otn he us sunroom category requirements. There may be restrictions on the use of your present home de the ory of sunroom you are installing. The property owner is hereby notified that should they make change a sun which could include, but not be limited to, addition of any form of temperature',control system or remova e doorstwindows separating the sunroom from the host structure,the room may become non-compliant with re uirements as mandated by the Florida Building Code,the Florida Model Energy Code and State Statutes. OWNER I have read this complete form and understand I am receiving a Category ff Sunroom.(I-V) Printed Name lf `� I i Cil � Address 114 Signed: Date: Before day of in the County of Duval,State of Florida,has personally appeared herein by himself/herself and affirms all stateme d t ns n are true d accurate. Notary Public at Large,State of County of MARIA A.KINU o� V ppS��y Personalty Known(]or Produced[ entification Eli °�' NotaryNotaty Public-State of Florida ID Type — 1G► Sunro m and ree 1 ul n#EE 4263,1 M11 pftmm Fwpvfms may 11A01114 59 Category I II 11 IV V Habitable Space No No Yes Yes Foundation Walls<200pif Walls<200pif Walls<200pif can Walls<200pif Walls<200pif can can have 8"W can have 8"W have 8"W x1 2"D can have have 8"Wx12"D x12"D ftg or 3- x12"D ftg or 3- ftg or 3-1/2" slab if 8"Wx12"D ftg ftg OR have site 1/2"slab if no 1/2"slab if no no concentrated OR have site specific concentrated concentrated load>7501b Oft specific engineering load>7501b OR load>7501b OR have site specific engineering have site specific have site specific engineering engineering engineering Existing exterior GFCI outlet Relocate or add additional outlet to exterior if enclosed Exit Lighting Not Required Required Required j Required Required Interior Electric Not Required Not Required Required Required Required Outlets Emergency Egress from Egress and Exit Egress and Exit Egress and Egress and Exit Escape exist. structure must meet code must meet code. Exit must meet must meet code. Openings allowed if open to code. atmosphere and has screen door leading away from residence. Misc.Window Host structure Windows must Windows may be Host structure Host structure and Door windows/doors be removable fixed or removable. windows& windows&doors Requirements shall not be Host structure Host structure doors shall not may be removed. removed. windows/doors windows and be removed. Forced entry, air shall not be doors shall not be Forced entry, leakage and water removed. removed. Forced air leakage penetration entry, air leakage and water requirements and water penetration apply. penetration requirements requirements apply. apply. Wind Borne Required, can be on host structure, if built under existing Debris Opening Not Required Not Required roof Protection Energy Sheets Not Required Not Required Not Requiretl Required Required AFFIDAVIT FOR ATTACHING A NEW STRUCTURE TO AN EXISTING STRUCTURE TO: Building Inspection Division,City of Jacksonville,214 North Hogan Street Home Owner: fs S Ce Name 1! 7 A14 Street Address Q IL fj i C- 13c 3 az 3 :i City. State and Zip Code n Contractor: �A✓�►� l�Jf s!f`! S ��i/y f`po/11S 1 — Permit Number As the Contractor for the proposed new structure located at the above address,I have personally viewed with the above named home owner those portions of the existing structure'on which portions of the proposed new structure are to be attached for structural support.I am confident that the drawings and details included with this permit application depict the existing conditions of the host structure,and the members of the existing structure upon which the new structure are to be attached are sound with no rot or deterioration The home owner has been advised by me that,in my best judgment based on experience and knowledge of structural adequacy,the members of the existing structure upon which the new structure are to be attached are sound with no rot or deterioration and will support all structural loads and forces imposed on them. By signing below,I hereby declare that I will hold the City of Jacksonville harmless and release it from any responsibility and liability for any adverse consequences or failures resulting from this work,and further that I will not initiate,execute or enjoin any legal action against the City of Jacksonville for such consequences or failures. A copy of this document will be recorded as an official record with the Building Inspection Division permit history so that any and all future buyers/owners of this property may be made aware of the status of work pe rmed this structure, Signed Date/ / _ Before me this day of In the County of Duval,State of Florida,has personally appeared herein by himself/herself and -Mfiqns all statements and declaratio a true and accurate. No Pu lic fit Large, State of Personally Known or Produce I MARIA A.KING ID Type Notar Public-State of F ri .y My Comm.Expires Nov 16,2014 F I'. ' Commission#EE 42659 City of Atlantic Beach APPLICATION NUMBER " Building Department (To be assigned by the Building Department.) r 800 Seminole Road /Z _ 12- 0 Atlantic Beach, Florida 32233-5445 Phone(904) 247-5826 - Fax(904)247-5845 Q L x U3,11 E-mail: building-dept@coab.us Date routed: City web-site: http://wvvw.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Department review required Yes o uildi Applicant: F� S D �40 ,-Planning&Zonin Tree Administrator Project: /� SS 6a � Public Works Public Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Recleipt Date of Permit Verified By ( ✓ Florida Dept.of Environmental Protection /v 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: proved. [:]Denied. (Circle one.) Comments: C!BU!lLDIN PLANNING&ZONING Reviewed by: Date: l / r 2- TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07127/10 City of Atlantic Beach APPLICATION NUMBER �• " � Building Department (To be assigned by the Building Department.) r i 800 Seminole Road 12- - 12- 0 / Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 Z x E-mail: building-dept@coab.us Date routed: / Cityweb-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 7C S De ldai ment review required Yes No nnin &Zonin Applicant: 4_5 G Tree Administrator Project: .S L n 1Zf Public Works Public utilities Public Safety Fire Services s,— fee r '� Dept Signature %(•� Review $ p 9 - dL/ Other Agency Review or Permit Required Review or Receiptof Permit Verified By Date �1 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: APPLI,QATION STATUS Reviewing Department First Review: Approved. E]Denied. (Circle one.) Comments: q"Aw BUILDING (/' KING &ZONING Reviewed b : Date: M / 20' v TREE ADMIN. FlApp Second Review: roved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07127110 II'm 9/12/12 PLAN REVIEW C a:?F CTIC NS RE= PALS 1 CITY OF ATLANTIC BEACH 800 c E MLE RMD ATLANTIC BEAM FL 32233 APPLICATION NBR 12-00001201 ADEPESS . . . . . . 147 BELV= ST APPLICATIC N MME 9/11/12 APPLSCATTCN TYPE RFSIM TTIAL ADDTTICN CUAER . . . . . . . P r3 JESSICA U 147 BELVF= ST ATLANTIC BEACH FL 32233 (CNTRD= . . . . . WESLEYS PATIO ECXMS 3545-1 ST MENS BLUFF RMD SUITE 345 JAQ 3a,Tv EI FL 32224 PUDGY M*E: PLAt14IrIC & ZUTUE MT'E ACTIC N ACITON BY 9/12/12 APPFG= ERS H UL RDjITl£2ED SIDE `YARD SETBACKS ARE 15' CSMBINED/5' MIINIIKE E'ER SIDE. AlJ=DU TO THE 9-UTITED SURVEY, THE 9".iJTH SII YARD MEASURES 12.7'(12'8.4") AND THE NTdH SIDE YARD MEASURES 9.4' (9'4.8"), RR A CSNIBINFD'ISL OF 2211.21'. A DAC To al ILTTED PLANS, A CLASS FNaOSURE IS FRDFOSED To BE UCCA= IN THE 3aJIH SIDE YARD AND EXTIIQD 7.91, THF FEBy REDUCING THE SjM SIDE )PPD TO 4.8' (4'9.6"), WHICH IS 2.4" LESS THAN THE FDI T=NIINIMUA PEEL SIDE. ADDITIaIALLY, THE Caffi=REQUIRED SIDE YARDS IS REDI= TO 14.2' (1412.4"), WHICH IS 9.6" LESS THAN THE REUUIF2ED MU, M[.M =INED. HCAEVER, AN AINIINISMATIVE WAIVER IS PERCSSIBLE FCR UP TO 50 (9") OF THE RE0UIRED SIANIIARD (15'), AND IS TfEFEKPE MPI\ .D. CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD r ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 F� Application Number . . . . . 12-00001554 Date 10/23/12 Property Address . . . . . . 147 BELVEDERE ST Application type description ELECTRIC ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ----------------------------------- Application desc Electrical for Screened Enclosure --------------------------------- Owner Contractor --------------- -------------- ---------- RING JESSICA U ELECTRIC PLUS 147 BELVEDERE ST 5358 LOSCO ROAD ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32257 ----------- ---------------------------------------------------------------- Permit . . . . . . ELECTRICAL PERMIT Additional desc OUTLETS/SWITCHES FOR ENCLOSURE . 00 Permit Fee 58 . 00 Plan Check Fee Valuation Issue Date Expiration Date . . 4/21/13 ------------------------ --------- Other Fees STATE ELEC DCA SURCHARGE 2 . 00 STATE ELEC DBPR SURCHARGE 2 . 00 _ ________ --- Fee summary Charged Paid Credited Due _ _ ---------- ----- . -- ----- ---------- - . 00 Permit Fee Total 58 . 00 58 . 00 . 00 . 00 Plan Check Total • 00 . 00 Other Fee Total 4 . 00 4 . 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. ELECTRICAL PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd, Atlantic Beach, FL 32233 Ph(904) 247-5826 Fax(904)247-5845 JOB ADDRESS: I 1J e 1y c A e t �5+ PERMIT# JEA INFORMATION REQUIRED ON ALL PERMITS a UU AMPS CLIC: VOLTS PHASE � VAL UE OF WORK$ I G NEW SERVICE ❑ Overhead 199underground ❑T Underground up Pole ❑Residential(Main) Service [10-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Meters ❑Commercial(Main)Service 00-100 amps El101-150amps El151-200amps F amps OCT Service amps Conductor Type Size ❑Multi-Family(Main)Service 00-100 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 OCT Service amps ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC. Outlets/Switches: _.Z0-30amps 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 ❑Smoke Detectors_Qty ❑Transformers KVA ❑Motors hp FIRE ALARM SYSTEM (Requires 3 sets of plans) VALUE OF WORK$ Qty volts/amps REPAIRS/MISCELLANEOUS ❑Replace Burnt/Damaged Meter Can [I Safety Inspection ❑Panel Change ❑OH to UG ❑Other: C }rl r � Sege L 11 C I a S v f-e 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. n GG Property Owners Name Q "� Phone Number ��bd� ax Electrical Company �l 2e�r C vS �n e Offi-c-e Phone( Co.Address: C>S�C� Y�Ot` City, \�.t�C State Zipy 1- ER, License Holder(Print): %„\ a ref State ertific tion/Registration#�33— Notarized Signature of License Holder DONNA L BAKU Sworn and subscribed before me this 2- r dAy of QC-h b er 20 12 e.: r MV COMMISSION K DD 853524 EXPIRES:Match 30,2013 Signature of Notary Public UZI Bonded Thru Notary Public Underwriters > ■