1701 Selva Marina Dr 2013 Pool CITY OF ATLANTICBEACK,
800 SEMINOLE ROAD
j ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
�D I
Application Number . . . . . 13-00003633 Date 11/26/13
Property Address . . . . . . 1701 SELVA MARINA DR
Application type description SWIMMING POOL/SPA
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 43200
-----------------------------------------------
Application desc
INGROUND POOL
-----------------------------------------------
Owner Contractor
-----------
_ ------------------------
STER, JOHN W SUPERIOR DESIGN POOLS & SPA
1701 SELVA MARINA DR. 12489-3 SAN JOSE BLVD
ATLANTIC BEACH FL 322335617 JACKSONVILLE FL 32223
(904) 262-7946
----------------------------------------------
Permit . . . . . . SWIMMING POOL
Additional desc .
Permit Fee . . . . 270 . 00 Plan Check Fee 135 . 00
Issue Date . . . . Valuation . . . . 43200
Expiration Date . . 5/25/14
-----------------------------------------------
Special Notes and Comments
POOL - Wellpoint (if used) must discharge into vegetated
area 10 ' minimum from street or drainage feature (swale,
structure or lagoon) .
Full right-of-way restoration, including sod, is required.
Roll off container company must be on City approved list
and container cannot be placed on City Right-of-Way.
(Approved: Advanced Disposal, Realco, Shappelle ' s and Waste
Management . )
Full erosion control measures must be installed and
approved prior to beginning any earth disturbing
activities . Contact Public Works (247-5834) for Erosion
and Sediment Control Inspection prior to start of
construction.
---------------------
--------
Other Fees . . STATE DCA SURCHARGE 4 . 05
STATE DBPR SURCHARGE 4 . 05
Fee summary Charged Paid Credited Due
----- ---------- ----------
Permit Fee Total 270 . 00 270 . 00 . 00 . 00
Plan Check Total 135 . 00 135 . 00 . 00 . 00
Other Fee Total 8 . 10 8 . 10 . 00 . 00
Grand Total 413 . 10 413 . 10 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION D
CITY OF ATLANTIC BEACH
OPYFILE C800 Seminole Road, Atlantic Beach, FL 32233 NO 0 ZOJ
Office (904) 247-5826 Fax (904)247-5845 3
Job Address:
1 VT O 4SeAy o__ u Permit Number:
Legal Description Loo- S.eA\ja- V trcx Parcel #
Floor Area�o Sq. t. q'Pt
Valuation of Work$ L43, .-->C0— Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition ool/spa indow/door
Use of existing/proposed structure(s)(circle one): Commercial (
Resident'
If an existing structure,is a fire sprinkler system installed? (Circle on . es o N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: SvJ cr,, '--
Property Owner Information:
Name: o n Vim_ Address: O Se ova.. `' �-
City Gtr. 1�' C, State ip _Phone fRgN 1.C)
E-Mail or Fax# (Optional)
Contractor Information:
Company me: ,1 Qualifying. Agent:
Address: City Zip Zs�
Office Phone U to Job Site/Contact Number (QC?H) Fax# R
State Certification/Registration # S a5
Architect Name& Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Applicatio�,,8 hereby made to obtain a permittodo the work and instaltions asindicated. 1 certify that no work or installation has commenced prior to the
ssuance permit and that all work wtll be performed to meet the standardsofalllawsng construction in thisjurisdiction. This permit becomes null
d void iork is not commenced within six(6)months, or if constructn orwork is suspended or abandonedfor apertod of six 6)months at any time after
ork is cmenced. 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 hereby certify that I have read and examined thisapplication and know the same to be true and correct. All provisions of laws and ordinances governing this
type o 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 of any other federal,state, or local law regulating construction or the performance of construction.
Signature of Own Signature of Contractor
Print Name _ Print Name ,.1_"l0 'r��.. ................................................
_....._............
..... ._. e....... .......... ..... :.......... ......_-J... . 1r..:...S' 1
Sworn o and subscribed before me Sworn to and subscribed before me
this�Day of OCA Zr- 201` this 1 ay of rDc,4 Qr 20 t 3
Notary Public N 1CNZry-tW* ftfr06dda
YHEEI
c State of Florida Z Stept�pp�ll Re ed 01.26.10
N Mitchell ` My CMRnfl 10111MM254097
ion EE 215497 Exp W mi;6
5/2016 ,
Doc #
2C13074484, OR BK 16302 Page 1332, Number Pages: 2, Recorded
03/25/201,3 at 01:51 PM, Ronnie Fussell CLERK CIRCUIT COURT DWAL COUNT
RECdRDNG $18.50 DEED DOC ST $3570. 00
�v9y'Y.;.:.4U..k.y'M.M�2av!Y:WA�dFiM6YW':U
F
Prepared by: t FILE C
t:.
Elite Title&Escrow
236 Ponte Vedra Park Drive Ste 201
Ponte Vedra Beach,Florida 32082
File Number: 13-02-0074-PV
General Warranty Deed
leet Lnding Bd.,Atlanic
Made this March 13,2013 A.D.By Charles Laurence B .Stec and Wage BIueue�Ster,hose addhusbarnd ess is:4110 and wit�whoseapost office addresstis:
Beach,FL 32233.hereinafter called the nan >
to 1701 Selva Marina Drive,Atlantic Beach,Florida 32233,hereinafter called the grantee:
(`Nhcncvct used'herein the term"grantor"and"grantee"include ail the parties to this Instrument and the heirs,legal re PT
and assigns of
individuais, and the successors and assigns of corpnrations)
Witnesseth,that the grantor,for and in consideration of the sum of Five Hundred Ten Thousandnts,andbar00110 sells,aliens,
reby
dged,hereby
(5510,000.00)and outer valuable COs unto the considerations,receipt
all that certain land situatetineDu al County,Florida,viz:
remises,releases,conveys and confin i>y'
Lot 1,Block 10, Selva Marina Unit No. 5,according to the mapor y, Florida.lat thereof,as recorded in Plat Book
30,Page(s)29 and 29A,of the Public Records of Duval
Parcel ID Number:172013-0000
Together with all the tenements,hereditaments-and appurtenances thereto belonging or in anywise appertaining.
r
To Have and to hold, the same in fee simple forever. 1
cantor is lawfully seized of said land in fee simple;that the grantor y
l defend
And the Illy warrants the tit
grantor hereby covenants with said grantee that the g
has mood right and lawful authority to sell and convey said land:eerh and that sat the aid land hereb}is tfree of all encumbran est except ataxes ilaccrui g
the same against the lawful claims of all persons whomsoever;
subsequerit to Decembei 31,2012.
DEED Individual Warranty Deed-Legal on Pace
TREE & VEGETATION AFFIDANIT
City of Atlantic Beach FILE COPY
i �
Department of community Development
Planning&Zoning Division
k"I.-I
soo Seminole Road Atlantic Beath,FL 32233 PERMIT# 3
(P)904 247-5800 (F)904 247-5845
SECTION I-APPLICANT INFORMATION rZ— owner(s) f—, Legal Authorized Agent*
NAME OF APPUCANT
NAME OF COMPANY
ADDRESS OF COMPANY �k --ts'\J
PHONE VTI ELL (" �3EMAIL
----------
CONTRACTOR CERTIFICATION NUMBER C-0
ATLBCH BUSINESS TAX RECEIPT NUMBER
SECTION 11-SITE INFORMATION
STREET ADDRESS OF PROPERTY �C70\
Nam address hoS not been ossl9red to this property,contact the AS Building Deponent of M4)247-5826 to request an address,
LEGAL DESCRIPTION
LOT BLOCK VC> SUMVISION P
REAL ESTATE NJMBER \f1fo\C)�6-Cr�(ZOTOR PARCEL SIZE: a`3,D_F;Lo SOFT AC
RESIDENTIAL COMMERCIAL OTHER(SPECIFY)
I offltm that I hove reviewed the provisions of Chapter 23, 'Protection of Trees and Native Vegetation"of the Municipal Code of
Ordinances for the City of Atlantic Beach,FL and/or I have participated in a pre-opplicarion meeting with the Administrator of those
regulations. Subsequently,/Offirt'll that no regulated trees and no regulated vegetation will be damaged,destroyed andlor removed
from the above-described at adjacent properties in conjunction with this project.
W .L —0 SIGNATURE OF OWNER
SIG _ AOF OWJNR
W
t_
0 -3
U', o 2013by State of U-
Signed and sworn before me on thi2S ay of County of T)\AV.(A
Identification verified:
Oath sworn: r, Yes "a
ul)
JENNIFER WALKER Nota nature
MY COMMISSION#FF 011480
EXPIRES:April 2412017 My Commission expires:
• rs
V*Qd Thru Notary publir underwrte
*Idea bukPlInS
L/L d 50L29M6 << SIGS Li2
?Ipr"Iv A -V /3- ?6 3�
NOTICE OF COMMENCEMENT
y�• bfc tia.,-,�aett r.,:..y�,--Rt ,y a,�t"x...t�e mra,;st4•n.
�--�. Tax Folio No.
State of E
County of -�v'WaLA FILE COPY
t U
To Whom It May Concern: caw
y• 5.. t::.wt,t,ar.
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 COMMENCEWENT.
Legal Description of property being improved:
Address of property being improved: 11101
General description of improvements: G V4
�9w 3�...Q_ s � Address: f I0 S�1Y0.,
Owner \
Owner's interest in site of the improvement: Qd ��`� � Z M 13 l
Fee Simple Titleholder(if other than owner): U— \0--1 9-3 '' Sw
CkO
Name:
Contractor:GV •� {1 't��'�
Address Q `i 3S
`n'v Telephone No.: Fax No:
Y 1'
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 (l)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Si UV Date: 1`2013
Before me this 1 — da of Dc�l-cbe..r in the Coun�t of Duval,State
)f Florida,has personally appeared Marl 8 awn. 5-}e + 3 W• SAO-,-
Doc#2013285954,OR BK 16589 Page 1743, lotary Public at Large,State of Flo da,Coup ty of Duval. ,
Ay commission expires: �S�X\.o :�� 1•
Number Pages:1 or
Recorded 11107/2013 at 10:04 AM, 'ersonally Known:
Ronnie Fussell CLERK CIRCUIT COURT DUVAL 'roduced Identificatio
COUNTY Notary Public State d Flgida
RECORDING$10.00 Stephanie N Mitchell
MY Canmiaaion EE 215497
• `Expiros 0tN05f20�s` y
12'!489-3 San Jose Blvd.
Jacksonville, F132223
904-262-(946
904-262-?81 5
iu,tirtil,.superiordesignpools.com
supdespools@yahoo.com
Lie. (TC'05?252
November 612013
Job:
Ster Lot Coverage
1701 Selva Marina Drive Lot-22,950
Atlantic Beach, Fl 32233 House-49256
904-710-7932 Pool & Deck-1,690
Impervious-6,600
Occupancy Class:
Single Family Group R-3
FBC 2010
NEC 2008
Table of Contents
V
Pae 1- Cover Pae W x z
a
Page 2-Survey w/pool ® o 0 `'
Page 3-Survey w/pool & plumbing & e �` 0 O U L" z
gel N-- no A
Page 4-Plumbing & Deck Drawing QU
Lu
Page 5-Pool Drawing , Uj A a
Page 6-Pool Barrier s CLO e�d
V
Page 7-APSP Form 1 U)
Page 8-APSP Form 2 M :5 ca
2 w w x
0 p oa
Page 9-Filter Sheet CL -5
Page 10-Pump Sheet 0U) ZU U
Pae 11-Heater Sheet 4
Page � �
Page 12-Main Drain Sheet �
Page 13-Energy Eff. Form -- -
Page 14-Pool Engineering
-- -am ... vvv..VP1■1 . vvn v r- I yr
LOT 1 /�BLOCCKK MA
10 ACCORDING
n TO THE PLAT OF
AS RECORDED ELLAT BOOK 30 RNA UNLIT NO.
5
AGE(S) 29 AND 29A OF THE CURRENT
PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
JOHN W. STER AND MARY BLUE STER, SS��} C� Pevl(, ')C
CHICAGO TITLE INSURANCE COMPANY,
AND ELITE TITLE & ESCROW, INC. b,,rr v-
I
LOT 3
BLOCK 10 SELVA MARINA UNIT NO. 6 Poo( la a),
P.B. 34, PAGES 51, 51A do 51B
1/2• 0 S 12'03'23' E 153.86' (M) LOT 18 f
e' S 1 1'56'50" E 153.64' (R) BLOCK 10 Oct- P��1rl
1/2-
—xTcd SUBDIVISION BOUNDARY UNE Lo g�r
9.7 ,J
x (DS a�
�J' t s ON W
Po�lfi 4 —/6�pp
I 24.5'16 IV
J. b
1
v _Al— -� eye pc�,nr ,•CONbiETE. f
0.T — 1 :DRIVEWAY.
60.7' ► O
I
z BRICK .o • M n
STEP 1 STORY BRICK
m w
A/C
RESIDENCE 3 ;
1.INO. 1701 - N 1
O m O p
co
6. N
TL r c i .n0039.8' 26ri 15.5' 26.3'DV)
EY40' B.LOT 2BLOCK 10
vi c� P.T._BROICK 1/2LOT BLOCK
BEARING REFERENCE UNE
3/4' :•' P.C.
1/2
1.5' CURB ec GUTTER �
h
N 12'38'54" W 130.24' (R) � �44
R — 5779.58' L — 130.36'(M)
N 12'38'54" W 130.36' (M) , ^
SEL VA MARINA DRIVE
100' R11 ) \
8000 ZONE -X" . AREAS DETERMINED TO BE OUTSIDE THE 0.2% ANNUAL CHANCE FLOOD PLAIN /FLOOD ZONE "X (SHADED)" _ AREAS OF 0.2X ANNUAL CHANCE FLOW. AREAS(X Ix ANNUAL
CHANCE WTH AVERAGE DEPTHS OF LESS THAN 1 FOOT OR W1H ORANNACE AREAS LESS THAN 1 SQUARE MILE- AND AREAS PROTECTED BY LEV£ES FROM IXp�AANNNUALL CHANCE FLOOD.
LASSOCIATED
1. BEARINGS ARE BASED ON GEWERPUT 906KE 30. PAGE 29A _
2.STRUCTURE NO. 1701 SHOWN HEREON LIES WITHIN FLOW ZONE x
SURVEYORS INC. DEST DETERMINED FROM F.E.M.A. FLOOD MAPS PANEL NO. I ATE004 I7 le3. THIS IS A SURFACE SURVEY ONLY. THE EXTENT OF UNDERGROUND FOOTIN
LAND do ENGINEERING SURVEYS PIPES AND UTILITIES, IF ANY, NOT DETERMINED.
4.JURISDICTIONAL AND//OR ENVIRONMENTALLY SENSITIVE AREAS IF ANY, P3846 BLANDING BOULEVARD LOCATED BY THIS SURVEY.
JACKSONVILLE, FLORIDA 32210 5.THIS SURVEY BASED ON LEGAL DESCRIPTIONS FURNISHED. THE PUE
904-771-6468 RECORDS WERE NOT SEARCHED BY THIS SURVEYOR FOR EASEMENTS, TI
TIFICATE OF AUTHORIZATION N0. LB 0005488 COVENANTS, B.R.L'S RESTRICTIONS, CLOSURES, TAKINGS OR ORDINANCES, I
THERE COULD BE OTHER MATTERS OF RECORD THAT AFFECT THIS PAR(
6.UNLESS OTHERWISE STATED ALL IRON PIPES FOUND HAVE NO IDENTIFICAT
I HEREBY CERTIFY THIS SURVEY WAS DONE UNDER MY LEGEND/ABBREVIATIONS
DIRECT SUPERVISION AND MEETS THE MINIMUM TECHNICAL O SET IRON PIPE OR REBAR P.C. - POINT OF CURVE CH CHORD
STANDARDS FOR LAND SU N(; PURSUANT TO CHAPTER 5J-17.050 "ASSOC.SURVEY- OR L8.5488 P.T. - POINT OF TANGENCY (R) - RECORD
THROUGH 7.052, FLORI AD ISTRATIVE ODE, C PTER 472, F.S. • FOUND IRON PIN OR PIPE (IP) -O.U.-=OYM HEAD UTILITIES (M) - MEASUF
n ■ FOUND CONCRETE MONUMENT (C.M.) FIRE HYDRANT (C) _ ��
�Vu X_ CROSS CUT OR DRILL HOLE CONIC. - CONCRETE R. - RADIUS
BY: _ O.R.B.-OFFICIAL RECORD BOOK ASC - AIR CONDITIONER L - ARC LEN(
CH LE B.
HA E FLORIDA C TIFICATE N0. 3771 O.R.V.-OFFICIAL RECORD VOLUME ® - WATER METER PHONE RIS
(((((��� P.R.Mr PERMANENT REFERENCE MONUMENT P•EQ. — POOL EQUIPMENT —
CH LES L. STARLIN FLORIDA CERTIFICATE NO. 4579 B.R.L— BUILDING RESTRICTION LINE x—x CHAIN LINK FENCE R/W- RIGHT Of I
RAYMOND J. SCHAEFER FLORIDA CERTIFICATE NO. 6132 E.T. - ELECTRIC TRANSFORMER h PAD W—W WIRE FENCE B.T.— BUILDING
JOB N0. 60121 J.E.A.— JACKSONVILLE ELECTRIC AUTHORITY �IT 1�� — UTILITY PC
DATE 03/05/2013 C Ac R — COVENANTS do RESTRICTIONS ~' GUY ANKH(
SCALE: 1" = 30' DRAFTER S. G. H. P.C.C. - POINT OF COMPOUND CURVE BTN. - BETWEEN COVD — COVERI
P.R.C. — POINT OF REVERSE CURVE (E.T.) - EAVE RE E.B.-ELECTRIC E
NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER
. . ■
�1 r Duk
LOT n1 BLOCK 10 ACCORDING TO THE PLAT OF
�AS RECORDED EPLAT A OKMARINA UNET NO.
5
PAGE(S) 29 AND 29A OF THE CURRENT
PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
JOHN W. STER AND MARY BLUE STER, Uev)(C ')C
CHICAGO TITLE INSURANCE COMPANY,.
AND ELITE TITLE & ESCROW, INC. �"� 64/�' � C�o1✓'O
LOT 3 SELVA MARINA UNIT NO. 6 Poo /a alit ss /�✓
BLACK 10 P.B. 34, PAGES 51, SIA do 518
I LOT 18
09 S 12103'23' E 153.86' (M) 4�N r1
1/2- qe BLOCK 10
S 1 1'56'50" E 153.64 (R) ��`�- P 1/2-
N n
SUBDIVISION BOUNDARY U
x 9.7' Pill
x at
(3�� v 26.r
D I 4.5' Q
CA .CONbli
sl in
40.7' 1 ! :DRIVEWAY. .ct
Y ^ 60.7' . o
BRICKCC�CGI1/ QLkl-(f\ Sk;rhn,t( •,. 5-1
• �•� o
STEP 1 STORY BRICK n
W w Pic RESIDENCE
3 ; v
NO. 1701 , -
= n Q
in N w O g
14 O m r- S O
to 0o
n O in M n O
9.6' ^ CA O
zo 0 18.5' N N 15.5' '� 00
39.8' 26.1' vi r 15.5' 26.3'
COPD
nLE
z SA
ENTRY
LOT 2 40' B.R.L
BLOCK 10
oi 39P.T.
BRICK _I ��
LOT 1
ST�EC � COLUMNS 1�2
BLOCK 10 `' ( )
. ,
BEARING REFERENCE UNE
' P.C. p9
1.5' CURB d< GUTTER
N 12'38'54" W 130.24' (R) x-
R — 5779.58' L — 130.36'(M)
N 12'38'54 W 130.36' (M)
SEL VA MARINA DR/VE
FLOOD ZONE "X" - AREAS DETERMINED TO BE OUTSIDE THE 0.2%ANNUAL GLANCE FLOOD PLAIN /FLOOD ZONE -x (SHADED)- - AREAS OF 02%ANNUAL CH CE ROOD AREAS OF' Ix ARNUAL
GLANCE WTH A1hRACE DEPTHS OF LESS THAN 1 FOOT OR tM1H DRAINAGE AREAS LESS THAN 1 SQUARE VrF• AND AREAS PROTECTED BY LEVEES FROM ix ANNUAL CHANCE FLOOD.
Ft E Y 0 R GENERALP��E�
J S 1. BEARINGS ARE BASED ON PUT K PAGE 29A
2.STRUCTURE NO. 1701 SHOVA HEREON UES 1MTHIN FLOOD ZONE x A'
BEST DETERMINED FROM F.E.M.A. FLOOD MAPS PANEL NO.I AT o4/t 7/t9e9
As OCIATED SURVEYORS INC. 3. THIS IS A SURFACE SURVEY ONLY. THE EXTENT OF UNDERGROUND FOOTINGS
w LAND & ENGINEERING SURVEYS PIPES AND UTIUTIES, IF ANY, NOT DETERMINED.
►- 3846 BLANDING BOULEVARD 4.JURISDICTIONAL AND/LOCATED BY THIS SURY.OR ENVIRONMENTALLY SENSITIVE AREAS IF ANY, NOI
JACKSONVILLE, FLORIDA 32210 5.THIS SURVEY BASED ON LEGAL DESCRIPTIONS FURNISHED. THE PUBLI(
904-771-6468 RECORDS WERE NOT SEARCHED BY THIS SURVEYOR FOR EASEMENTS, TITLE
J O CERTIFICATE OF AUTHORIZATION NOLB 0005488 COVENANTS, B.R.L'S RESTRICTIONS, CLOSURES, TAKINGS OR ORDINANCES, ETC
.
S S V THERE COULD BE OTHER MATTERS OF RECORD THAT AFFECT THIS PARCEL.
6.UNLESS OTHERWISE STATED ALL IRON PIPES FOUND HAVE NO IDENTIFICATION
I HEREBY CERTIFY THIS SURVEY WAS DONE UNDER MY LEQEWD/ASMEVIAYIOWs
DIRECT SUPERVISION AND MEETS THE MINIMUM TECHNICAL 0 SET IRON PIPE OR REBAR P.C. - POINT OF CURVE CH - CHORD
STANDARDS FOR LAND SU 14(; PURSUANT TO CHAPTER 5J-17.050 "ASSOC.SURVEY- OR LB.5488 P.T. - POINT OF TANGENCY (R) - RECORD
THROUGH 7.052, FLORI ADA�NI�TK ODE, C PTER 472, F.S. 0 FOUND IRON PIN OR PIPE (IP) -O.U.--OVER HEAD UTIUTIES (M) - MEASURED
//// . ■ FOUND CONCRETE MONUMENT (C.M.) V - FIRE HYDRANT (C) - COWU1ED DAT
X - CROSS CUT OR DRILL HOLE CONC. - CONCRETE R. -RADIUS
BY: _ O.R.B.-OFFICIAL RECORD BOOK ASC - NR CONDITIONER L - ARC LENGTH
CH I- B. HATC EFLORIDA C TIFICATE NO. 3771 O.R.V.-OFFICIAL RECORD VOLUME ® - ►'NATER METER PHONE RISER
P.R.M.-PERMANENT REFERENCE MONUMENT P.EO. - POOL. EQUIPMENT -
CH LES L. STARLINGFLORIDA ERTIFICATE NO. 4579 O.R.L.— BUILDING RESTRICTION UNE x—x CHAIN LINK FENCE R/*- RT OF WAY
RAYMOND J. SCHAEFER FLORIDA CERTIFICATE NO. 6132 E.T. - ELECTRIC TRANSFORMER & PAD W—W WINE FENCE B.T.- BUILDING nE
J.E.A.— JACKSONVILLE ELECTRIC AUTHORITY Ute-WOW FENCE UTILITY POLE
JOB NO. 60121 DATE 03/05/2013 C k R — COVENANTS h RESTRICTIONS -1-1-IRON FENCE GUY ANCHOR
SCALE: 1" = 30' DRAFTER S. G. H. P.R.C. - POINT OFCREVERSE CUPOUND RVE (E.T.) -BEAV£ TIE ETWEEN E BY-ELECTRO C Box
NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER
-` J
SUPERIOR DESIGN LS & SPAS, INC. ,
12489-3 SAN JOSE BLVD. DATE
JACKSONVILLE, FLORIDA 32223 CALCAAATM BY�
(904) 262-SWIM (7946) FAX (904) 262-7815 CHECKED BY 71 19- -/f J,�) DATE
I
SME
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SUPERIOR DESIGN POOLS & SPAS, INC. SH �_l
12489-3 SAN JOSE BLVD. CALCULATM DATE
JACKSONVILLE, FLORIDA 32223
(904) 262-SWIM (7946) FAX (904) 262-7815 CHECKM BY 7/ 7 OATE
SCALE -Tre- P-O A C s
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L46
f
m --Vl- G-�
12489-3 San Jose Blvd.
Jacksonville, Fl 32223
904-262-7946
904-262-7815
www.superiordesignpools.com
sypdespools@vahoo.com
Lic. # CPC057252
Safety Device
Pool Barrier- Child safety fence to go around the pool it
complies with Res. Section 403.2.17.1-17.3 FBC. Please
see plans for location.
OW
�► The Association of
Pool& Spa Professionals'
ANSVAPSPACC 15 ENERGY EFFICIENCY COMPLIANCE INFORMATION FOR RESIDTIAL SWIM G ROOLS
PROJECT NAME: �� �\ - CONTRACTOR NAME pOOls& S c"
AND ADDRESS AND ADDRESS:
O Se0v ( ak;�_0r. - ase Blvd.
\tl
Q�c-�1 - 4
OWNE C to-ii TO�P`NOONE: ^�� DATE11h k
This Information sheet was prepared by Me APSP-1S Residential Swimming Pool and Spa Energy Efficiency Standard Writing Committee of the Association of Pool and Spa
Professionals(APSP). It Is not part of the American National Standard ANSI/APSP/ICC-15 2011 but Is Included for Information only.Contractors should acquire and comply
with the ANSI/APSP/ICC-15 2011 standard which can be purchased at www.apsp.org.
1. §5.2.1:Calculated pool volume Z oZ�S
a. Gallons: U,a\S ;or p!
-�� n L5 1• gallons —
b.Calculated Gallons: (surface area)X (average depth)X 7.48 (gal/f A3) -�—
2.§5.2.1:Calculated maximum filtration flow rate 2. gpm —
(Pool volume+360 or 36gpm whichever is larger)
3.§5.2.2:Auxiliary Pool Load: Yes, No?
(Enter the highest"auxiliary pool load"to be powered by the swimming pool filtration pump.Do notladd auxiliary 3. gpm —
pool load flow rates together,only the highest is used.) '
d
4. Calculated maximum flow rate 4. gpm —
(Item 2 or Item 3, whichever is larger.)
S.§5.5.1:Pipe sizing:
a.Minimum suction pipe diameter 5a. inches —
(Enter the smallest pipe size from Table 1 with a 6 fps flow capacity the some or more than item 4.) ^
b.Minimum suction branch pipe diameter Sb. (oC) Inches —
(Calculate:Item 4. (gpm)+Branch Pipes (quantity)=branch flow rate (gpm).
Enter the smallest pipe size from Table 1 with a 6 fps flow capacity the some or more than the calculated
suction branch flow rate.)
c.Minimum return pipe diameter 5c. Inches —
(Enter the smallest pipe size from Table 1 with a 8 fps flow capacity the some or more than item 4.)
d. Minimum return branch pipe diameter 5d. Inches —
(Calculate:Item 4. (gpm)_Branch Pipes (quantity)=branch flow rate (gpm).
Enter the smallest pipe size from Table 1 with a 8 fps flow capacity the same or more than the calculated
return branch flow rate.)
6.§5.4.1:Filter type and size:
a.Filter type: (Cartridge, DE,Sand) 6a. `r —
b.Minimum filter area6 6b. sq.ft. —
(Calculate:item 4. (gpm)+filter factor 3
Filter factors:Cartridge=0.375, Sand=15,Diatomaceous Earth=1
7. §5.4.2:Backwash valve: Yes, No? 7. Inches —
(When using a backwash valve,enter result of Item Sc or 1 Inches whichever Is larger)
Table 1 Pin"M Ix I r a.$- 1 a" 1 a.$- 4• 1 e" 1
Nominal GPM Q•fps 38 63 90 138 1 185 238 374 540
Nominal GPM a 6 fps 51 84 119 184 1 247 317 499 720
8.Pump selection:
45.3.2.1:Pools 17,000 gallons or less,select pump'from the database with a Curve-A ppm flow equal to Item 1 or less.
45,3.2.2:Pools 17,001 gallons or more,select pump'from the database with a Curve-C gpm flow equal to Item 2 or less. •Multl-
speed pumps must have one speed listed that satisfies this requirement.
a.Pump model 83
Sf 3a\S
b.Pump flow 8b.- / gpm
(§5.3.2.1,5.3.1.2:Applicable Curve A or C qpm flow listed In database)
4/5/12 ANSI/APSP/ICC-15 Standard Writing Committee Form 1 of 2
1 r
ANSI/APSP/ICC 15 ENERGY EFFICIENCY COMPLIANCE INFORMATION FOR RESIDENTIAL SWIMMING POOLS
Component Section Requirements Check
4.4.1.1 Heater has no pilot light
4.4.1.2 Readily accessible on-off switch mounted outside of the heater
Heaters No electric resistance heating unless for inground spa with tight fitting cover with R-6 insulation,
4.3.1.3
or for pool with 60%of documented pool heating from on-site solar or recovered energy.
4.3.2 Heater efficiency:gas/oil fired heater efficiency at least 78%, heat pump COP at least 4.0
5.1.1 Pool filter pump listed in database
S.3.1 Pool filter pump with total horsepower 1.0 or more is multi-speed
Multi-speed pump controller programmed to default to the filtration flow rate when no auxiliary
5.3.3 pool loads are operating within 24 hours and programmed with temporary override capability for
servicing.
Pool systems 5.3.4 Single-speed pump controller capable of operating pump during off-peak electric demand. J
5.5.2 Pipe before pump has at least 4 diameters of straight pipe.
System installed with solar,or setup for the future addition of solar heating equipment by
5.5.3 installing 18 inches of horizontal or vertical pipe after the filter and before a heater,or built-in or
built-up connections, or dedicated pipe to and from the pool. /
5.5.6 Directional inlets for mixing pool water. 5�
Y
1
4/5/12 ANSI/APSP/ICC-15 Standard writing Committee Form 2 of 2
Head Loss (Feet of Water)
2.31 Feet of Water = 1 PSI
O N A Ql 00 O N A 07 0o CO
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-4
I Hayward Industrial Drive
MAYWARlYpool Products Clemmons,NC 27012
A kayward Industries, Inc.Company 336-712-9900
www.haywardnet.com
CERTIFICATION OF COMPLIANCE
Contains: WG 1048E Description: 8" Round Suction Outlet Cover
Ratings: Floor: 125 GPM Wall: 72 GPM Open Area: 8.1 sa-in
Certified to Comply with Section 1404 of the Virginia Graeme Baker Act (VGB) Pool & Spa Safety Act
Test Results can be obtained from:www.Iiaywardnet.com and/or http://www.nsf.org/Certified/Pools/
Manufactured: Between October 2008 and December 2008, by Hayward Pool Products in Jiangsu Province,
China and Clemmons, NC Divisions of Hayward Industries, Inc. 620 Division Street, Elizabeth,NJ 07207,
Phone 908-355-7995
Date of Mfr: The Lot Number shown on the product label contains the Year& Month of manufacture. The
first number represents the year (ex 8 = 2008) and the second character the month (A=Jan, B=Feb, H=Aug, I is
skipped, J=Sep, etc)
Tested to ANSI/ASME 112.19.8-2007 (addendum 8a-2008) per Section 1404 of the Virginia Graeme Baker
Act (VGB) Pool & Spa Safety Act. Certified by NSF International, 789 N. Dixboro, Road, Ann Arbor, MI.
48105 1(800)-NSF-MARK.
Date of Installation: ISWGI O48COC
6"
SPACING BETWEEN
MOUNTING HOLES
USED ON FOLLOWING SERIES:
00 00 WG1030AVPAK2 SP1030AVPAK2
0000000 WG1048AVPAK2 SP1048AVPAK2
000000 WG1049AVPAK2 SP1049AVPAK2
07 3/4" INP 0000000
0000 0000 WG1051AVPAK2 SP1051AVPAK2
SUCTION OUTLET 100 '&00000 WG1052AVPAK2 SP1052AVPAK2
0000 000WG1053AVPAK2 SP1053AVPAK2
COVER WG1048E 00000
000000 WG1054AVPAK2 SP1054AVPAK2
0000 000 WG1153AVPAK2 SP1153AVPAK2
-WG1154AVPAK2 SP1154AVPAK2
���ourvE HAYWARUpw w
CCx4Trk'0LS One source. Every pool.
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2T
NOTICE OF COMMENCEMENT
State of Tax Folio No.
County of D wwo—,
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 COMMENCEWENT.
Legal Description of property being improved: Lam. {�j�cGk
Address of property being improved: 1 Ifl� 52��0., �,�r�, �� ��.` •r ,
General description of improvements:
Owner,k)(30 (VID- 3 Address:
Owner's interest in site of the improvement: 130 T?-`7 -7-7 (�g
Fee Simple Titleholder(if other than owner):
Name:
Contractors ,� r r1 m�y�S•,� S � .
t Address �bQJ �52 �V�• Qom.
to`-/"N Telephone No.: �q > 10c�.– "(4Fax No: lOa
r
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making
Name:
Address:
I
Phone No: o
Name of person within the State of Flor da, NnijouLf. e a y �on w om notices or other documents may be
served: Name: V
51TEry
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
Sign d : Date: 1 /111`z 013
Before me this 1 da of QC4-o%oAt.r in the Coun• of Duval,State
)f Florida,has personally appeared Ma+r1� 15 awn, SAs.r.r W SA-*- -
Doc#201 OR 8K 16589 Page 1743. dotary Public at Large,State of Flo 'da,Co ty of Duval. {�
Number Pages:1 4y commission expires: q Xb
Recorded 11107/2013 at 10:04 ANI, 'ersonall Known: eS I
Ronnie Fussell CLERK CIRCUIT COURT DUVAL 'roduced Identificatio or
COUNTY
RECORDING$10.00 Notary Public State of Florida
Stephanie N Mitchell
�.)
My Commission EE 215497
Expires 09/0512016
City of Atlantic Beach APPLICATION NUMBER
os Building Department (To be assigned by the Building Department.)
r 800 Seminole Road Q. ��d?�
9 Atlantic Beach, Florida 32233-5445 .7
.' Phone(904)247-5826 • Fax(904)247-5845
-Jt3 E-mail: building-dept@coab.us Date routed: �� 7
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 44 ���I�R. Q/'%J7�- t review required Yes No
Build'
Applicant: QQ� anning&tonin
istrator
Project: Poo Public Works
c Utilities
757 is y
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
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:
APPLICADON STATUS
Reviewing Department First Review: pproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING
ING
&ZONING Reviewed by: Date--//
Ay D
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 07/27/10
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road ' -
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
s
�• E-mail: building-dept@coab.us Date routed: �� 7
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: / /D a��/V�- r�/Ar���' t review required Yes o
p Y
Build
Applicant: QQ� annin &Zonin
/ istrator
L
Project: /� QD ublic Works
c Utilities
u is e y
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Dateof Permit Verified By
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: Approved. []Denied.
(Circle one.) Comments:
BUILDIN f
PLANNING &ZONING Reviewed by: Date.
TREE ADMIN. Second Review: ❑Approved as revised. ❑De ed.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. []Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
City of Atlantic Beach $- APPLICATION NUMBER
Building Department VE
° J p ` (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445 NOV ® 7 2013
Phone(904)247-5826 • Fax(904)247-5845
_�t3 E-mail: building-dept@coab.us J Date routed: �� 7
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I !4 I XfIVOL A4/7�` A--f4 rtrmKit review required Yes No
Build'
Applicant: 7>040/ annin &Zonin
istrator
Project: /� 00 [� ublic Works
c Utilities
u is y
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
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. ❑Denied.
(Circle one.) Comments. ((((
BUILDING
PLANNING&ZONING
Reviewed by: CA— Date:—//—F-/-3
TREEADMIN. Second Review: []Denied.❑Approved as revised.
WORKS Comments:
C TILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
Yt�y�w;y City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445 d
Phone(904)247-5826 - Fax(904)247-58 j V 7 ZW3
,,;119% E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I �4 I J'61VA. A4/74-4- r' t review required Yes No
Buildi
Applicant: Qa� annin &Zonin
istrator
Project: J7 00 1,15ublic Works
c Utilities
u is e y
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
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: ❑Approved. enied.
(Circle one.) Comments:
BUILDINGS C✓��1�-�"�
PLANNING &ZONING Reviewed by: Date: l Z
TREE ADMIN.
Second Review: XApproved as revised. ❑De ed.
PUBLIC WORKS Comments:
PUBLIC UTILITIES FIZZ �I
PUBLIC SAFETY Reviewed by:AL___LDate: l
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
3witmrning Pool Energy Efficiency C011111pilance informatlon
NONE: These Requirements Apply ONLY to t)e Filtration Pump
A>tiSi/APSP/!CCAS 2012
Flow c4acidations
-�od ���� � + �0 = �g�xn -tl�ie W� caia�d flow rate
for pools under 13,000 gels. the cWlcvleted fkrw rate or aro 9► o greater the ftttration stow rale
=
d
is there an Aw Bary load on he Wastion pump? Yes No
if so, what Is the caia>fated auxaary flow rate�_ gpm
=low Rate (low speed) 1 �gpm ® /���rpm
um suction i
size @ 6 fps M• Minmction side branch pipe size @ 6 fps in.
Minimum suction aide pipe size @ 8 fps o'? in.
Minimum return side Pipe she @ 8 fps in. Minimum return side brand► pipe
ermine Fuer Size:
Fa0 37 D E(2.0) 0 Sand(t5)
aocs(GPMrSF2 : �'�( �
D5�Rw stm Fro sari ►r+m.,a►bed
pump Controls /
�iln-afion pump has --a auxiliary load — standard time clock
ittration pump with auxiliary load _,Control model for low speed default within 24 hr.
4 -D"i�
Heater Model �a j
:wcy as Neater efficienrating (No Pilot Light)
Aeat Pump efficiency C.O.P.
ANSI 5 & ANSI 7 Compliance Work Sheet
Dere�Sled TDR
I. Dtstenoe fran pool b pLsnp V ieet 7 /_
2 F*Aw bas On s�pis)a a ld pipe per,OL 9M S- E'J from pipe tow�iric�on bss dsart)
3_ Ffi*n in On FAn i*ti trb*0 per t R Q —gm' - (�v.pip.t idos bee
TWhF4*q
Firer t dealer bis b TDM
Die iced TDM4.
_
I / O� _ �• 4N ofi+arloeeea
soar� Rtww ��1
�rr� R � �•+
i
WAh pW4 io be kxh hD bW veb*a s •r=L St �� c� Sy*m Fbw Rate.
b be k%h b kW�Y® �p f'»MWL Rt ' gpm Sya+em PON�
6M"b be kfctl b beep VQb*Q `� 4A rrw- at (� Syaiem Roy f?ale
ump Seiectlon as Listed on Curve A or C (&de one)
�/ Maximum Flow Rate gpm
Fi�a/orl pur7�l ���C.t\� �-�`-'��
s MaY,Drain Cover ! oY QC
(wr.a Lm4
De+tiam fire Nm bw and Two of Required h-Mm SuCbon Outlets:
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CITY OF ATLANTIC BEACH
i 800 SEMINOLE ROAD
j ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
r ; ' �:�
Application Number . . 13-00003633 Date 12/12/13
Property Address . . . . . . 1701 SELVA MARINA DR
Application type description SWIMMING POOL/SPA
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 43200
----------------------------------------------------------
Application desc
INGROUND POOL
----------------------------------------------------------
Owner Contractor
----------------
------------------------
STER, JOHN W SUPERIOR DESIGN POOLS & SPA
1701 SELVA MARINA DR. 12489-3 SAN JOSE BLVD
ATLANTIC BEACH FL 322335617 JACKSONVILLE FL 32223
(904) 262-7946
----------------------------------------------------------------------------
Permit . . . . . . ELECTRICAL PERMIT
Additional desc . .
Sub Contractor . . DAVID PRUETTES ELECTRICAL SVC.
Permit Fee 95 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 6/10/14
--------------------------------------------------
Special Notes and Comments
POOL - Wellpoint (if used) must discharge into vegetated
area 10 ' minimum from street or drainage feature (swale,
structure or lagoon) .
Full right-of-way restoration, including sod, is required.
Roll off container company must be on City approved list
and container cannot be placed on City Right-of-Way.
(Approved: Advanced Disposal, Realco, Shappelle ' s and Waste
Management . )
Full erosion control measures must be installed and
approved prior to beginning any earth disturbing
activities . Contact Public Works (247-5834) for Erosion
and Sediment Control Inspection prior to start of
construction.
---------------------
---------------------------
Other Fees . . . . . . . . . STATE ELEC DCA SURCHARGE 2 . 00
STATE ELEC DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----- ---------- -
Permit Fee Total 95 . 00 95 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
PERMIT ISGWFIHIldiElFOIS IIN ACCORDANCE W11"AgLOCITY OF ATL9L*FI@(hEACH ORDINANC&AND THE FLORIDV
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach,FL 32233 3 3?
t-7 Ph� a
(A904)247-5826 Fax(904)247-5845
JOB ADDRESS: ( D I Ua mar- /L/,-- -D(- PERMIT# 3 33
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE
VALUE OF WORK$
NEW SERVICE ❑ Overhead ❑ Underground ❑1 Underground up Pole
Residential(Main)Service
0-100 amps C-101-150amps 151-200amps [J amps #of Meters
Commercial(Main)Service
_0-100 amps 101-150amps :-:151-200amps amps CT Service amps
Conductor Type Size
Multi-Family(Main)Service
C 0-100 amps :101-1 S Oamps 151-200amps amps #of Unit Meters
Temporary Pole amps
SERVICE UPGRADE amps CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
C 100 amps ❑150amps 200amps 7 amps CT 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 ECTRICAL PROJECTS
wimming Pool Sign Smoke Detectors_Qty C[Transformers KVA :'Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK S
REPAIRS/MISCELLANEOUS
'.--,Safety Inspection is Panel Change : OH to UG
Replace Burnt/Damaged Meter Can
_:.';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 ::55+e r Phone Number
Electrical Companyl,)OU i d l (t.tL S �( i�(�.� SW_61wC_0ffice Phone Faxa-7a
Co. Address:01, -$ ar��►d J _ _Stater Zip3��
License Holder(Print): V 1 GP `
�AC fication/Registration# (%C_0002-923
Notarized Signature of License Holder
Sworn and subscribed before me this _�day of 20 t
. KAREN EWING
� COMMISSbN#EE174M Signature of Notary Public (� k4 0'N
r •r,"r Expr&S May 21.2016
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