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Permit Elec Temp Pole 373 12th St 2012 ILA w l,`j f1 CITY OF ATLANTIC BEACH j 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00001746 Date 11/28/12 Property Address . . . . . . 373 12TH ST Application type description ELECTRIC ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc TEMPORARY POWER POLE TP01 ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ DODARO, NICHOLAS & CATHY OWNER 373 12TH STREET ATLANTIC BEACH FL 322335537 ---------------------------------------------------------------------------- Permit . . . . . . ELECTRICAL PERMIT Additional desc . . TEMP POWER POLE TP01 Permit Fee . . . . 90 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 5/27/13 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE ELEC DCA SURCHARGE 2 . 00 STATE ELEC 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 4 . 00 4 . 00 . 00 . 00 Grand Total 94 . 00 94 . 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 zZ 2 Ph(904) 247-588226 Fax (904) 247-5845 JOB ADDRESS' J J a� f s+ ( AQ / PERMIT# JEA INFORMATION REQUIRED ON ALL PERMITS (O AMPS —2-4 VOLTS PHASE i P O I VALUE OF WORK$ NEW SERVICE Overhead ❑ Underground ❑T Underground up Pole Residential'(Main) Service 0-100 amps 101-150amps 151-200amps amps # of Meters Commercial (Main) Service 0-100 amps 101-150amps 151-200amps amps CT Service amps Conductor Type Size Multi-Family(Main)Service ]00 amps 101-150amps 151-200amps amps # of Unit Meters emporary Pole amps SERVICE UPGRADE I 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-l 00amps 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 I '.Transformers KVA Motors hp FIRE ALARM SYSTEM (Requires 3 sets of plans) Qty volts/amps VALUE OF WORK$ REPAIRS/MISCELLANEOUS Replace Burnt/Damaged Meter Can Safety Inspection Panel Change OH 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. /Property Owners Name Phone Number Electrical Company Office Phone Fax Co. Address: City State Zip .'Print). State Certification/Registration# Re efore me this day o 0 /Z M cpMMISSION#EE 057349 PIR:S.May 21,2015 ? `= TW NotmPublic Undervmters 1 nature of Notary Public '�eF�•• g Y � �. �S- 3-7 0 &776 CITY OF ATLANTIC BEACH � OWNER / BUILDER AFFIDAVIT 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 A ONE-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. THE 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. III. 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN-OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY' OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR, TELEPHONE THE BUILDING DEPARTMENT(247-5826) IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. (C�� -3 z2,3.3 PA E NUMBER ADDRESS eeiqT[4� (_30002a PRAT NAME / N DATE(L2— [/ T Before me this A day of Q�/ 20 12M the county of Duval,State of Florida,has personally appeared herin by himself 1 herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of -q&��ounty of pMpNDAYrH11E ❑Personally Known � jpN#EE 057349 M'f, Yj L 3 U 7 d 7 7 '�'"�" C0""R g:Mayes 20nder + �$prnduced Identfication- :�'i P► B 'ers //` ' Bondedl Ndarf Notary Signature: F:BLDG/o�er-Builder Affadavit;REVISED: 4/16/2009