770 TRITON RD - ELECTRIC \� j� CITY OF ATLANTIC BEACH
r 800 SEMINOLE ROAD
L.<11 --y
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ELECTRICAL RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: ERES18-0053
Description: 200 amps/240 volts/single-phase-elec for bathroom
Estimated Value: 0
Issue Date: 2/21/2018
Expiration Date: 8/20/2018
PROPERTY ADDRESS:
Address: 770 TRITON RD
RE Number: 171333 0000
PROPERTY OWNER:
Name: ROCKWOOD DAVID A
Address: 770 TRITON RD
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
,
Phone:
Name:
Address:
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU 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 RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions
applicable to this property that may be found in the public records of this county, and there may
be additional permits required from other governmental entities such as water management
districts, state agencies, or federal agencies.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH -CZ S(A—b O
800 Seminole Rd, Atlantic Beach, FL 32233 u a
Ph(904) 247-5826 Fax (904) 247-5845 1
JOB ADDRESS: -7 7 D --r-v---.-1-0,_ Ro 41- (Or cc.)- r L 3223 3 PERMIT# k
JEA INFORMATION REQUIRED ON ALL PERMITS 20 0 AMPS 2? b VOLTS I PHASE
VALUE OF WORK$
NEW SERVICE E Overhead n Underground U Underground up Pole
❑Residential(Main) Service
❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Meters
❑Commercial(Main) Service
00-100 amps ❑101-150amps ❑151-200amps El amps El CT Service amps
Conductor Type Size
El Multi-Family(Main)Service
II 0-100 amps ❑101-150amps ❑151-200amps El amps #of Unit Meters
El Temporary Pole El amps
SERVICE UPGRADE ❑ amps El CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps 0200amps ❑ amps OCT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: t-j 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 ELECTRICAL PROJECTS
E l Swimming Pool ❑ Sign ❑Smoke Detectors Qty ❑Transformers KVA ❑Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$ L1 rift
Q,0-0
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change ❑OH to UG
El 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
Properly Owners Name W tM - ..,._v .0 QOe) Phone Number `1U q—tfq c 3-r gFr
E e ritnccal Company 0 L.) tilE'- (r Office Phone Fax
Co.Address: City State Zip
License Holder(Print): :-.1)1,0t-v,L C9 0GC'<LL 0"6. 7 State Certification/Registration#
Notari e!. .'-�':-.--=-:•- ofnse ' older �C
-,----F, ;-4.,„- JENNIFER JO'NS
` ' :'` MY COMMISSION#GG 042984 (�/
i 02o Before me this day of F2- t,l Cv- 20 0
x. v ~` EXPIRES:October262
`a'�+'O= ru Notary Public Underwriters
�. a Bonded Signature of Notary Public 0
•j L%L`J j•
CITY OF ATLANTIC BEACH
IJ%WNER / 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.
3223 3
ADDRESS PHONE NUMBER
'D}018 oc,vO
PRINT NAME
IGNATURE """ �,,''' DATE
c
J Before me this a_t_day of 1 L0,/!l�11 A-C.y 20.13n the county of
Duval,State of Florida,has personally appeared erin by himself/herself and affirms that
all statements and declarations are true and accurate. �
Notary Public at Large,State of 1 ,County of L..(^�4�1vG1 I w= P%s•• JENNIFER JOHNSTON
MY COMMISSION#GG 042984
;Personally Known I r ¢ EXPIRES:October 27,2020
0 Produced Identification- ;' • Bonded Thru Notary Public Underwriters
Notary Signature: V
F:BLDG/Owner-Builder Affadavit; 4/I6/2009