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705 Sailfish Dr 2015 elec - 11 SS\ CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 9 ELECTRICAL PERMIT MUST CALL BY 4PM FOR NE)(T DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 15-ELEC-442 Job Type: ELECTRIC ONLY Description: WWO ELECTRIC 67 OUTLETS Estimated Value: Issue Date: 3/2/2015 Expiration Date: 8/29/2015 PROPERTY ADDRESS: Address: 705 SAILFISH DR RE Number: 171229-0000 PROPERTY OWNER: Name: FEDERAL NATIONAL MORT. ASSOC, Address: 705 SAILFISH DR GENERAL CONTRACTOR INFORMATION: Name: MILLENNIUM ELECTRICAL CONTRAT Address: 6380 PHILLIPS HWY QA CHARLES MICHAEL EURILLO Phone: FEES: State Elec DBPR Surcharge $2.00 State Elec DCA Surcharge $2.00 Electrical Heat $4.00 AC Circuits $10.00 Switch Outlets $60.00 Lighting Outlets, Including Fixtures $18.00 Trade Permit Base Fee $110.00 Total Payments: $206.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. ELECTRICAL PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd, Atlantic Beach, FL 32233 5�c" Ph(904) 247-5826 Fax (904) 247-5845 JOBADDRESS: 70-115- PERMIT# JEA INFORMATION REQUIRED ON ALL PERMITS 06) AMPS 2 �O VOLTS PHASE VALUE OF WORK$ NEW SERVICE 0 Overhead F-1 Underground Underground up Pole Residential(Main) Service 0-100 amps -101-150amps 151-200amps —amps #of Meters Commercial(Main)- Service -,CT Service amps :10-100 amps 101-150amps 151-200amps L ________amps Conductor Type Size Multi-Family(Main) Servi ze 1-0-100 amps 101-150amps 151-200amps —amps #of Unit Meters Temporary Pole —amps SERVICE UPGRADE 1-1 amps CT Service anips NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.) I 100 amps -1 150amps —amps ADDITIONS,REMODEL5,REPAIRS,BUILD-OUTS,ACCESSORY STIR 1015 Outlets/Switches: 0-30amps 31-100amps & %b q Appliances: 0-30amps �3_3 1-1 00amps S A/C Circuits: ___A_0-60amps 61-1 00amps Heat Circuits: # circuits @__C kw Number of Lighting Outlets, Including Fixtures: OTHER ELECTRICAL PROJECTS 0 Swinuning Pool . Sign -__�Smoke Detectors__Qty i Transformers FIRE ALARM SYSTEM (Requires 3 sets of plans) Qty_volts/amps REPAIRS/MISCELLANEOUS Replace Burnt/Damaged Meter Can Safety Inspection —Panel �Ag Other: s suspended Permit becomes void if work does not commence within a six month period or work i orabandon.ed 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. Q 1. ry Property Owners Name R_ Phone Number (j �,o 7_631-7f Electrical Company Y7,it'W tvt CA- dz' Office Phone ria�_ Zip Co.Address: A City State FL oelly ly? License Holder (Print): Ck"'10 A, Ckv-, 7d State Certification/Registration# Notarized Signature ofLicense Holder 2 '�"'t2ua" UNDA T.HMDY Sworn and subscribed before�me this of MY COMMISSION I EE 100125 EXPIRES:June 5,2015 Signature of Notary Public OM B=W 7h Bu*Way SwAm STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC130 49 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED k:,-, I Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 21 [Nil EURILLO, CHARLES MICHAEL I N� MILLENNIUM ELECTRICAL�CONTRACTORS LLC 6384 PHILLIPS HIGHWAY CKSONVILLE FL 32216 ISSUED: 06/04/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1406040001866 F_.7TE(..IDDfYYYY) ACC)R" CERTIFICATE OF LIABILITY INSURANCE 2/27/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). IOIT '�CT Brian Turner PRODUCER NAM . Hazel Partners LLC PHONE 904-201-1216 904-239-3136 _WC,No Ext), 610 M a rket Street E-MAIL .brian.turner aze pa nerslic.com Saint Augustine FL 32095 -ADD INSURER(S)AFFORDING COVERAGE NAIC 0 INSURERA:Essex Insurance Company 39020 INSURED MILLELE-01 INSURER B:BERKSHIRE HATHAWAY LIFE INS CO NE 62345 Millennium Electrical Contractors, LLC INSURER C:BERKSHIRE HATHAWAY LIFE INS CO NE 62345 6384 Phillips Hwy INSURER D:MERCURY IND CO OF AMER 11201 Jacksonville FL 32216 INSURE�E: INSURER F: COVERAGES CERTIFICATE NUMBER:437434752 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSIR X E7BR POLICY EFF LIMITS LTR TYPE OF INSURANCE l.TD . POLICY NUMBER IMIMIDDIYYYYI A X COMMERCIAL GENERAL LIABILITY Y Y 1021363 2/27/2015 2/27/2016 EACH OCCURRENCE $1,000,000 MA E TO RENTED CLAIMS-MADE FXI OCCUR PREMISES(Ea occurrence) $100,000 M ED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000.000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY El Ro- F-1 LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: SPEcT $ C17VMR=G1_E LIMIT $1 D AUTOMOBILE LIABILITY Y Y BA0900000008054 2/27/2015 2/27/2016 (Ea accident) '000,000 BODILY INJURY(Per person) $ X ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per acddent) $ AUTOS AUTOS PROPERTY DAMAGE $ NON-OWNED (Per accidenq X HIREDAUTOS AUTOS Uninsured Motorists $1,000,000 C UMBRELLA UAB Ix X OCCUR MIWC688140 2/27/2015 27/2016 EACH OCCURRENCE $2,000,000 EXCESS LIAB I CLAIMS-MADE AGGREGATE $2.000,000 DED �x I RE ENTION$0 Follow Form OTH- $GL,EL AL Tr ER B WORKERS COMPENSATION MIWC688140 Z/27/2015 27/2016 X STETRTUTE AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT $1,000,000 ANY PROPRIETORtPARTNERIEXECUTIVE F`N] NIA OFFICERIMEMBEIR EXCLUDE E.L.DISEASE-EA EMPLOYE�$1,000,000 (Mandatory In NH) "jes6idesTnbe under E.L.DISEASE-POLICY LIMIT 1$1,000,000 D S IF 'ON OF OPERATIONS below DESCRIPT10N OF OPERATIONS I LOCATIONS/VEHICLES ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Electrical Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Atlantic Beach ACCORDANCE WITH THE POLICY PROVISIONS. 800 Seminole Road Atlantic Beach FL 32233 AUTHORIZED REPRESENTATIVE .V�_T- .00 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD