Permit Elec 5121 Polaris Ct 2012 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00001788 Date 12/11/12
Property Address . . . . . . 5121 POLARIS CT
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 8500
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Application desc
retile 2 baths/wdo in sunroom
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Owner Contractor
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NAVAL CONTINUING CARE NORTH RIVER BUILDING SOLUTIONS
RETIREMENT FOUNDATION, INC 6771 SHINDLER DR
1 FLEET LANDING BLVD JACKSONVILLE FL 32222
ATLANTIC BEACH FL 322334599 (904) 838-9179
--- Structure Information 000 000 RETILE 2 BATHS WDO REPAIR IN SUNROOM
Occupancy Type . . . . . . RESIDENTIAL
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Permit . . . . . . ELECTRICAL PERMIT
Additional desc RELOCATE 3 OUTLETS
Sub Contractor BARKOSKIE ELECTRICAL SERVICE,
Permit Fee . . . . 56 . 80 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 6/09/13
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Other Fees . . . . . . . . . STATE ELEC DCA SURCHARGE 2 . 00
STATE ELEC DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 56 . 80 56 . 80 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 60 . 80 60 . 80 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELEcTRIcAL PERAUT APPLi[CA-HON
CrrY OF ATLANnc]REAcH
100 Seminole Rd,Atlantic Beach,FL 32233
JOB ADDRFSS: Ph(904)247-5826 Fax(904)247-5845
hP Z-14-1Z-1 S e7-
ERMff# 12-1798
NEW SERVICE
00verhead Underground D Underground up Pol
DResidential(Main) Service e
no-100 amps D101-150amps D 151-200amps O.,amps # of Meters
"Commercial Main)Service
00-100 amps 0101-150amps 0 151-200amps O._amps OCT Service
Conductor Type size amp:
OMulti-Famfly(Main)Service
00-100 amps 0101-150amps 1115 1-200amps O_amps of Unit Meters
0 Temporary pole 0 _amps
SERVICE UPGRADE 0 amps 0 CT Service-amps
NEW FEEDER(ADDITIONS,ACCESSORy STRUCTURES ETC.),
0 100 amps 0 150anips D200amps D ...amps) OCT Service_amps
ADDMONS9 REMODELS�REPAIRS9 RUILD-OUTS'ACCESSORY STRUCTURES, ETC.
Outlet"/Swilhl: 0-3 0amps I-I 00amps
APPliances: 0-3 Oamps 3 1-I 00amps -101-200amps
A/C Circuits: -0-60amps ____61-100amps -101-200amps
Heat Circuits: # circuits
Number of Li
94ti'T Outlets, Including Fixtures:
OTBER ELECTRIC;AL PROJECTS
[3 Swimming Pool 0 Sign 0 Smoke Detectors_Qty 0 Transformers KVA Eimotors hl
FIRE ALARM SYSTEM (Requires 3 sets of play. &Fire Alarm Checklist)
Qty-volts/anips VALUE OF WORK$
REPAIRS/MISCELLANrEOUS
DR-eplace Bumt(Damaged Meter Can OSafety hWection OPanel Change 11014 to UG
90ther; 1?4�4-rE 6a rz-e--rs
Permit becomes Void if work does not commence within a six month
read this application and know the same to be true and correct period or work is suspended Or abandoned for six months. I herebY certifY that I have
specified or not The per=does not giv-anthorlty to V10 All Provisions of laws and ordinances governing this work will b complied with whether
late the Provisions of any other state or local law regulation constructi e
constructon. on or the Performance of
ProPerfy Owners Naine FDC-t�L*"j-D ( to e-,
Phone Number Z410
Electrical CompanY5��Z05/4.le Office phone 7-4 6 q 7 31 Fax 7,49 So t 7
CO-Address: q-15-3 5WE77e7LA16 city j -- -
License Holder(Print): .) (3 --State f�,-Zip 3 7,Z S-D
State Certification/Registration#ez-/5 Z�3 9-7
'VOtarXed Signature of
License Holder
�Ota-�Public,staic C�l Florida Sworn subscfibdb�f�re me this day of 20/0
riffany AugliSt
kA�C,0MMjSSi0n COD801149
0,2
06126512012 Signature of Notary Public
UV