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392 7th St 2014 Covered Porch CITY OF ATLANTIC BEACH j 800 SEMINOLE ROAD J ,R> ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 ��J13�1�• Application Number . . . . . 14-00000194 Date 2/20/14 Property Address . . . . . . 392 7TH ST Application type description RESIDENTIAL ADDITION Property Zoning . . . . . . . RES SF DISTRICT Application valuation . . . . 13400 ---------------------------------------------------------------------------- Application desc covered porch ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ HARVEY SHORTELL TRUST KEITH SHEETS-REMODELING PROS 392 7TH STREET 2763 MANDERIAN MEADOWS ATLANTIC BEACH FL 322335434 JACKSONVILLE FL 32223 (904) 545-4638 --- Structure Information 000 000 COVERED PORCH Construction Type . . . . . TYPE 5-B Occupancy Type . . . . . . RESIDENTIAL Flood Zone . . . . . . . . ZONE X ---------------------------------------------------------------------------- Permit . . . . . . RESIDENTIAL ADDITION Additional desc . . Permit Fee . . . . 120 . 00 Plan Check Fee 60 . 00 Issue Date . . . . Valuation . . . . 13400 Expiration Date . . 8/19/14 ---------------------------------------------------------------------------- Special Notes and Comments 2010 FLORIDA BUILDING CODE, 2008 NATIONAL ELECTRIC CODE ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 120 . 00 120 . 00 . 00 . 00 Plan Check Total 60 . 00 60 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 184 . 00 184 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. s .51 M10 City of Atlantic Beach MBER I Building Department 800 Seminole Road Em ing Department.) Atlantic Beach, Florida 32233-5445 �Phone(904)247-5826 • Fax(904)247-5845 E-mail: building-dept@coab.us City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: / 2- 77NSr aEtwent review required Ye No 44-1 Buildin Applicant: ' 'Sheer g &Zonin {p Tree Administrator Project: ,Q V Gly-�,� �Q� C Public Works Public Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified B Date 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: proved. ❑Denied (Circle one.) Comments: QBUILDING PLANNING & ZONING Reviewed by: � _ Date:o2 TREE ADMIN. Second Review: ❑Approved as revised. ❑ nied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: devised 05/14/09 CITY OF ATLANTIC BEACH .- t ��.. Building Department - Sid 800 Seminole Road Atlantic Beach,Florida 32233 (904)247-5800 PLAN REVIEW COMMENTS Permit Application # Property Address: 3 alai f � Applicant: �� -e -/l Project: �ilf rC�o� mor c`-r-r This permit application has been: Approved Reviewed and the following items need attention: /v Please re-submit your application when these items have been completed. Reviewed By: . Date: 2�/i,+ /,2a1y' BUILDING PERMIT APPLICATION F y $ CITY OF ATLANTIC BEACH ILEC 0 00 Seminole Road, Atlantic Beach FL 32233 D t � � <.•�•+�►••►•,� Office(904) 247-5826 Fax (904)247-5845 FEg 0 7 14 Job Address: 392 7t" St. Atlantic Beach, FL Permit Number: 13. 9y IAT Lot 4 and the West 22 Feet of Lot 5, except the Southerly 5 feet of Lots 4 an , BOWERY'S REPEAT a subdivision according to the plat thereof recorded at Plat Book 20 page 22 of the Public Records of Duval County, FAL Parcel# Fl oor reao Sq.Ft. S Ft Valuation of Work$ 13,400 Proposed Work heated/cooled non- heated/cooled Alteration Class of Work (circle one): New Addition Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s)((circle one): Commercial esidential If an existing structure,is a fire sprinkler system installed?(Circle one s o N/A Florida Product Approval # For multiple products use product approval form Describe in detail the type of work to be performed: Covered Porch-Design,_ Engineering and construction including roof. Property Owner Information: Name: Verne Shorten Address: 3927 th St Atlantic Beach FL City Atlantic Beach State FL_Zip 32233 Phone 609-651-7627 E-Mail or Fax#(Optional) vshortell(a,gmail.com Contractor Infor a ion: &APWJqjIris Company Name: � Qualifying Agent::Keith Sheets Address: 2763 Mandarin Meadows City Jacks nville State FL Zip 32223 Office Phone 904 545-4638 Job Site/Contact Number Fax#904 260-6526 State Certification/Registration#_CBC 1252347 Architect Name& Phone# vwy 2,17 6,e Zb Engineer's Name& Phone# Fee Simple Title Holder Name and Address Bonding Company Name and Address - Mortgage Lender Name and Address NA Application is hereby made to obtain a permit to do the work d installations as indicated. I cert thn-no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards oJall laws regulating const action i»this jurisdiction. This permit becomes j mll and void f work is not commenced within six(6)months, or if construction or work u ended or abandoned for a period of six(6)months at any time after work is commenced. I understand that separate permits must be secured for Eledrica[Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters. Tanks and.9ir 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 this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this tvpe of work will be complied with whether specified herein or not. The granting of a permit does nor presume to give authority to violate or cancel the provisions of any other federal,stale,or local taw regulating construction or the performance of construction. Signature of Owner l x �' -� N�W Signature of Contractor Print Name Verne Shortell Print Name -- __ Sworn to and subsc ibed before me Sworn to and subs:ribed before me this Day of 20 this Day o. _.. 20 �f"Aq U -1,j*-- NotaryPublic ��+ =Of otary u tc Notary PCommiRevised 01.26.10 My comm. 4 ri�=Lvf,J City of Atlantic Beach APPLICATION NUMBER �S Building Department ` 800 Seminole Road (To be assigned by the Building Department.) Atlantic Beach, Florida 32233-5445 H Phone(904)247-5826 • Fax(904) 247-5845 / "L oil E-mail: building-dept@coab.us Date routed: CP /� !�L City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: —312— 77N f q review required Yes No Apartment ldin Applicant: /�A 3/ I g &Zonin Tree A ministrator Project: ,d V��E,D �Q� C Public Works Public Utilities Public Safety Fire Services Review fee $ Dept Signature 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: APPLICATI N STATUS Reviewing Department First Review: pproved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed b Y: Daterk TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date.- FIRE ate:FIRE SERVICES Third Review: ❑Approved as revised. [-]Denied. Comments: Reviewed by: Date: Revised 05/14/09 BUILDING PERMIT APPLICATION _ CITY OF ATLANTIC BEACH D 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 1 FEB 0 7"N14 Job Address: 392 7th St, Atlantic Beach, FL Permit Number: Legal Description Lot 4 and the West 22 Feet of Lot 5, except the Southerly 5 feet of Lots 4 an �13WERY O 'S REPLAT a subdivision according to the plat thereof recorded at Plat Book 20 page 22 of the Public Records of Duval County, ff Parcel # Floor Area o Sq.Ft. Sq.Ft Valuation of Work$ 13,400 Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa NNindow/door Use of existing/proposed structure(s)(circle one): Commercial ;siiential If an existing structure, is a fire sprinkler system installed? (Circle one): s o N/A Florida Product Approval # For multiple products use product approval orm Describe in detail the tyl2e of work to beperformed: Covered Porch- Design, Engineering and construction including roo . Property Owner Information: Name: Verne Shortell Address: 3927 1h St, Atlantic Beach, FL City Atlantic Beach State FL_Zip 32233 Phone 609-651-7627 E-Mail or Fax# (Optional) vshortellagmail.com Contractor Infor a ion: TrroS Company Name: &1V 5 6 u�h Qualifying Agent: Keith Sheets Address: 2763 Mandarin Meadows rk-,Yinville State FL Zip 32223 Office Phone 904 545-4638 Job Site/Contact Number Fax#904 260-6526 State Certification/Registration# CBC 1252347 Architect Name & Phone # 6 e Engineer's Name& Phone# Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address NA Application is hereby made to obtain a permit to do the workd installations as indicated. I cert 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 null and void tf work is not commenced within six(6f months, or if construction or work is suspended or abandoned for a period of six(6)months at any time after work is commenced I understand that separate permits must be secured for Eledrical 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 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 sped ed 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 Owner '/a�� Signature of Contractor Print Name Verne Shortell Print Name Sworn to and subsc ibed before me Sworn to and subscribed before me this Day of 20 Iq this Day of 20 4u Notary Public y+ �TNotary G.MITCHEC otary Public ifff, Public,State of Florida ommission#DD981686 Revised 01.26.10 mm.expires June 25,2014 U. .j.,�, JL .�;. t-10-3vD rL DESIGN & CONSULTING ENGINEER 9219 CYPRESS GREEN DR, STE. #10 JACKSONVILLE, FL 32256 Ph/Fax: (904) 737-6876/737-2385 �, Pro'ect# oZ o � ELfi 2 CITY OF ATLANTIC BEACH BUILDING DEPARTMENT WIND LOAD BASED ON THE FLORIDA BUILDING CODE 2010 RESIDENTIAL, FIG. R301.2(4), THIS SITE IS IN THE 3jZ MPH ZONE. PER ASCE 7-10 METHOD 1, THE IMPORTANCE FACTOR IS � I ,a , THE RISK ' CATEGORY IS II, AND THE EXPOSURE CATEGORY 'C , FOR AN ENCLOSED BUILDING. ROOF ANGLE A = tan -1 MEAN ROOF HT HEIGHT & EXPOSURE ADJUSTMENT COEFFICIENT = . ww ROOF LOAD FLOOR LOAD L.L. X20 P.S.F. L.L. 4 0 P.S.F. D.L. 17 P S F D.L. ✓'7 P.S.F. T.L. 37 P.S.F. T.L. P.S.F. GADX.lWWW0RW0X%5%An ARMC REACH RC RoWelnAL"jo,dx N c �2x�S �D —----- ..... - - -- - _._ ---- - - -- ---- �- 2 6T Ct a T-1 9o' ly 370 z --- - ez r 2-_ �?� --- (� �'S% - - ---- ------- i � _ 3� 2Rf Feb 20 14 02:36p Remodeling Pros 9042606526 p.1 NOTICE OF COMMENCE,._ F:4T -19 State of Florida County of,Duval d _ FILE COPY To Whom It May Concern: The undersigned hereby informs you that improvement will be made to certain real property, the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT d rn accordance with Section 7I�of Legal Description of property being improved. Lot 4 and the West 22 Feet of Lot 5, except the Southerly 5 feet of Lots 4 and 5, BOWERY'S REPLAT, a subdivision according to the plat thereof recorded at Pat Book 20 page 22 of the Pubic Records of Duval Address of property being improved: 392 71h St tlanttie Beach, FL General description of improvements:_ Covered Porch- Design Engineering and,- coon includirxl roof Owner: Verne ShoReli Address: 392 71h St, Atlsr:ic Be---a�F� Owner's interest in site of the improvement: Fee Simple Titleholder(if other than owner): / Dec#2014038641,OR f3K 15095 Page 887, Number Pages:1 Name: Recorded 0212012014 at 12:40 PWA, —' Ronnie Fusself CLERK CfRCUI' Contractor: Keith Sheets COUNTY CGURT CUVAL I R-ECORDING 510.00 ' Address: 2763 Mandarin Meadows ,JacksonviIle,FL 32223 Telephone No.: 904 545-463$ Fax No: 904 260-6526 Surety(if any) Address: c. Amount of Bond S Telephone'_N�o: 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 Lire State of FIor.ta. other than himself,designated by owner ups , whom notices or other doctunents may be served: Name: Address: Telephone No: _ Fax No: In addition to himself, owner designates the following person to receive a copy of Lienors Notice as provided in Section 713-06(2)(b),Florida Statues- (Fill ' Owner's option) Name: r' Address: Telephone No: Fax No: Expiration date of Notice of Commencement (the expiration date is one(1)year from the dale of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ON-Ly OWNER M � A JOSEPH r SANTORA Signed: Before me this Date: qy day of Notary Put t--slate of Florida �. in the County of Duval.State Of Florida,has personally appeared A:,_ . ; My Comm.Expires Feb 1 5 2015 to Public at Large,State of flori a.t 'unto of Duval. Commission # EE 5456E I ry' O"``i`� Bonded Through National Nolaty Assn. II commission expires: ,,•••, ,v crsonally Known: or— Produced Idcntifieation: U 1. Description,of p op�rt ee eseri Wpetty ddress i available): pQ S 6'1 c:�1 �ion f CK OneSOL If Ilii' 2. Gg era Description Qf i rovemen a. o ,: `, r� (eCkq e-VXL)' Q Ca) a F- 3. Owner Information: j, j qU a)Name and Address: 1 ch ois f, 5h 1(.x.1 1 tS i 3a. nigj w l' S t _1t-�1 3)1'33 m o n b)Interest in property: F l a[I esie Q ace- o v� c)Name and address of simple titleh er(if other than owner): 0 o w O^N J .7. �a� F, 4. Contractor Information; ,r}R ` ' T h o 104 z a)Name and Addres : ul �tttivl 6, ; to K; Ma V1 qj 0lU &t-eve 11VAI W- ,.1(kt f� .'�ij � �a�LL b)Phone Number: 'I 4- - ft o o C=o c n ami oOw 5. Surety Information: C z tr M v o_ a)Name and Address: b)Phone Number: c)Amount of Bond:$ 6. Lender Information: a)Name and Address: b)Phone Number: 7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as provided by 713.13(l)(a)7,Florida Statutes: a)Name and Address b)Phone Numbers of Designated Person: 8. In addition to himselfiherself,Owner designates of to receive a copy of the Liertor's Notice as provided in Section 713.13(1)(b),Florida Statutes. a)Name and Address: b)Phone Number of person or entity designated by owner: 9 Expiration date of Notice of Commencement(The expiration date is one(1)year from the date of Recording unless a different date is specified: WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. The foregoing instrument was acknowledged before me this,/-!—? day of 20 I'd NO P BLIC, TEOR�DA Print Name: `�h f t` E L �t AM t d�" '60 w; L GRN4H03+ 15 d Ju#XPersonally Known ❑ Identification/'Type: '' �� r^. o.F^.• ��4xervote�s Verification pursuant to Section 92.525,Florida Statutes.Under penalties of perjury,I declare tti'afT' ve read the foregoing and that the facts stated in it are true to the best of my knowledge belief. J),, e, 5,SU�� Sig of Property Owner Revised I0i1/2009 6'd Z0ZE-9VC-V06 Suetun^eN 841 d604,0 t L OZ Qe=1 �--.NOTICE OF COMMENCEMENT Permit No. Tax Folio No. State of Florida,County of Duval THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement. d Mar 04 14 10:42a Remodeling Pros 9042606526 p•1 NOTICE OF COMMEN_CE_ I- ,iT State of Florida K Vo. 0 County of!Daus] a f FILE C To Whom It May Concern: +'�:..r . .r+e° •+••r�� ' .s•.�-Y.Mr'1l•��w.t••.may.�r-••s'-...M�I♦r".i The undersigned hereby informs you that improvements will be made to certain real property; and in accordance with Section 7I3 of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT. Legal Description of property being improved: Lot 4 and the West 22 Feet of Lot 5, except the Southerly 5 feet of Lots 4 and 5, BOWERY'S REPLAT, a subdivision according to the plat thereof recorded at P'.1it Book 20 page 22 of the Public Records of Duval Address of property being improved: 392 7s' St.Aftntic Beach. FL General description of improvements: Covered Porch- Design Engineering and - instruction including roof Owner: Veme Shottell Address: 392 7a'St. Atlas _ic Beach. FL 01,vner's interest in site of the improvement: Doc#2014o3a641,OR SK 166% Page 887, Fee Simple Titleholder(if other than owner): Nur ber Pages: 1 Recorded Cr220!2014 at 12:40 POA. Name: Ronnie Fussell CLERK CIRCUIT COURT DUVAL Contractor: Keith Sheets COUNTYRECORDING$10.00 Address: 2763 Mandarin Meadows,Jacksonville,FL 32223 _ Telephone No.: 904 545-4638 Fax No: _904 260-6526 Surety (if any) Address: Amount of Bond S Telephone No: Fax No: Name and address of any person making a loan for the construction of the improvements Name: i`- Address: ' Phone No: Fax No: Name of person within the State of Floryda, other than himself, designated by owner up, . 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 Lienor's Notice as pro,6ded in Section 713.06(2)(b),Florida Statues. (Fill wner's option) Name: Address: •/ Telephone No: Fax No: ENpiration 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 4 Signed: Date: - ,r SEpH F. SO4TORA r3efore me this day of C-A-4L _in the County of Duva.State Notar Public•Slate of Flux+ a Of Florida,has personally appeared , `, . IJIy Camm Ea{fires Feb 1 B,2C1 I� ry Public at Large,State of Florida.r unto of Duval. Comn+issio�3t Iazfi Assn- I ) y commission expires: "f n, Bonded Th O.0 CLI " ,1 ersonally Known: or CL Produced Identification: L ,I �y�. G� a-./ �3 } CITY OF ATLANTIC BEACH s f 800 SEMINOLE ROAD s) ATLANTIC BEACH,FL 32233 J �� INSPECTION PHONE LINE 247-5814 lb V, Application Number 14-00000194 Date 3/12/14 392 7TH ST Property Address . . . . . . Application type description RESIDENTIAL ADDITION Property Zoning . . . . . . . RES SF DISTRICT Application valuation . . . . 13400 ---------------------------- Application desc covered porch ---------------------------- Contractor Owner ------------------- HARVEY SHORTELL TRUST KEITH SHEETS-REMODELING PRO 392 7TH STREET 2763 MANDERIAN MEADOWS FL 32223 ATLANTIC BEACH FL 322335434 (904)CKSO JACKSONVILLE E 4638 Structure Information 000 000 COVERED PORCH Construction Type . . . . . TYPE 5-B Occupancy Type . . . . . . RESIDENTIAL Flood Zone . . . . . ZONE X ----- -----Permit . ELECTRICAL PERMIT Additional desc Sub Contractor LIMBAUGH ELECTRICAL CONTRAC . 00 Permit Fee 59 . 20 Plan Check Fee 0 Valuation . Issue Date • • • ' 9/08/14 Expiration Date . ------------------------- Special Notes and Comments 2010 FLORIDA BUILDING CODE, 2008 NATIONAI ELECTRIC CODE--------------- ----------- 2 . 00 Other Fees STATE ELEC DCA SURCHARGE 2 , 00 STATE ELEC DBPR SURCHARGE ----------------- --------------------------------- Char ed Paid Credited Fee summary g -----u---- . 00 Permit Fee Total 59 . 20 59 . 20 . 00 . 00 . 00 Plan Check Total . 00 4 . 00 . 00 . 00 Other Fee Total 4 . 00 00 . 00 Grand Total 63 . 20 63 . 20 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 / r Ph(904)247-5826 Fax(904) 247-5845 PENT Sfi JOB ADDRESS: VOLTS PHASE ,IEA INFORMATION REQUIRED ON ALL PERMITS — 'MPS — VALUE OF WORK$ E] Underground D Underground up Pole NEW SERVICE ❑ Overhead # of Meters ❑Residential(Main) Service 0151-200amps O__amps 00-100 amps 0101-150amps P❑ s OCT Service am CCommercial(Main) Service 0151-200amps _-- amps ❑0-100 amps ❑101-150amps Size Conductor Type # of Unit Meters ❑Multi-Family(Ma i 0101-150amps ❑151-200amps ❑ amps Do-100 amps ❑Temporary Pole O__amps 0 amps El CT Service__amps SERVICE UPGRADE --- STRUCTURES,ETC.) ADDITIONS,ACCESSORY 0C Service amps NEW FIJEDhR( ❑200amps O___amps ❑l00 amps 0150amps ETC. 31-100amps 101-200atnps ADDITIONS,REMODEL ,REPAIRS,BUILD-OUTS, ACCESSORY STRUCTURE 00 am s AD �- 0-30amps ---- Outlets/Switches: 31-100amps 10] 2 P 0-30amps _,_--61-100amps Appliances: --0-60amps A/C Circuits: # circuits @__kw Heat Circuits: Number of Lighting Outlets, Including Fixtures: OTHER ELECTRICAL PROJECTS ❑Transformers ICVA ❑Motors hp 7 Swimming Pool ❑ Sign []Smoke Detectors_Qh' FIRE ALARM SYSTEM (Requires 3 sets of plans) VALUE OF-WORK Qt volts/amps gFp AyRS/1VIISCELLANEOUS ❑Safe Inspection ❑Panel Change OOH to UG OReplace Burnt/Damaged Meter Can �' ❑Other: lied with whether ed or ned for Permit becomes void if work does not commence within a six month period or work is suspe�nances governing ng this�work�whll be complied py certify erfo mance of e read this application and know the same to be true and correct. All provisions of laws e or permit does not give authority to violate the provisions of any other state or local law regulation construction ort e p specified or not. Thep construction. Number Owners Name (Fax ` Property t �. �1 ►�rC1� e Prf 1 CC✓ t e F� _---- ne Electrical Company City - Lip •Z2C Co. Address: State Certification/Registration o0 License Holder (Print): LLOULL!£09ej1dx y io o0 w Notarized Signature of License Folder 3 .(L, a eg1 Before me thi d Publi Signature of Not h