334 4TH ST - PERMIT ERES18-0153 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
................
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-58 4
ELECTRICAL RESIDENTIAL -
MUST CALL BY 4113M FOR NE)(T DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: ERES18-0153
Description: 150 amps/120 volts/single phase-add outlet
Estimated Value: 80
Issue Date: 5/16/2018
Expiration Date: 11/12/2018
PROPERTY ADDRESS:
Address: 337 4TH ST
RE Number: 1698350000
PROPERTY OWNER:
Name: GOELZ LARKIN L
Address: 337 4TH ST
ATLANTIC BEACH, FIL 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 PERIMIT AppiicATION
CITY OF ATLANTIC BEACH
800 Seminole Rd. Atlantic:13each, FL 32233)
Ph (904)247-5826 Fax (904) 247-5845
JOB ADDRESS: gan PEWMIT
JEA LNIFORINLAXION'REQUIRED ON ALL PERNIITS ANIPS VOLTS PHASE
1,A L UE OF 111ORK
NEW SERVICE F-1 Overhead Underground FITUnderground.up Pole
Service
0-100 amps __101-15�)amps 151-200amps
#of Meters
(Al.ain)Service
0-1.00 amps 10 1-1_'�Oanips 151-200anips _--allips Service amps
Conductor Type Size
��...'_Kulti-Family t-Main) Senjee
100 amps 101-150amps 151-200arrips —amps of Unit Meters
Temporary Pole --,—amps
SERVICE UPGRADE anips CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
Service
7100amps -150arnps 72.0.0anips- amps amps
-ALDDITIONS,RETMODELS. RE-P_A,1RS.BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/S�witches: __j_0-3'0a111pS 31-100araps 101-200amps
Appliauces: 0-30amps .331-100amps -101-200amps
_AfC Circuits: 0-60ai-.Pps- 61-1 00amps
H eat Circuits: circuits @ kw
Number of Lia
hting Outlets,*Including Fixtures:
OTHE R ELECTRICAL PROJECTS
-_-Swirnming Pool -'- Sign 7.Smoke Detectors --Transformers KVA [F Motors 111)
FIREALAWNISYSTET4 (Requires 3 sets of plans)
Qty_volts,.11 arrips IIALLTEOr- TFORKS
REPAIRS[INIHSCELLANIEOUS
c 01-1 to UG
Replace Burnt/bamaoed Meter Can Safety Inspe tion Panel Chanae
Other:
P e
ennit becomes void if work does not comrnenee�vitbin asix pionth period or work is suspended or abandoned for six months. I herebv certify that.1 have
read tl iisapplication and kno%v 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 pennit does not
9"ve authority toviolate the provisions of any other state or local law regulation construction or the,performance of
comtruction.
Property Owners Name v� Phone Number no
A
Electrical Company Office Phone Fax
Co. Address: eA951 city StateFL- Zip &14-33
License Holder (Print): C-'\ State Certi.fication!Registration#
Alot'arized Si Holder AJ(A) Y10
jENNIFERJOHqSTON
fp
commissioN#GG 042984 Sworn and subscribedbef.-orergati-fis 1 (0 day of 20
ExPIRES:October 27,2020 rs
B.nded Tw NotarY Public Urllerwfile Signature of Notary Public
CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I "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 IM[PROVE A ONE—OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
INWROVE 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.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
Ill. 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(l). 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.
(go
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ADDRESS PHONE NUMBER
La?*jVL
P r TAE�����
S1yyT1j111__ DATE
Before me this I�0 day of 96L�-i 20 1�theco.nty.f
Duval,State of Florida,has personally appear&d he y tiim-self/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of County of
11 P onally Known JENA
IIFER JOHNSTON
I # 'T
My COMMISSION#GG 042984
EXPIRES:October 27,2020
ub.
uc. Bonded Thru Notary public Underwriters
6'>P.d d Idenfification- FLA-Y'v.Nm�s V�VkaAl
Notary Signature:
F,./BLDG/0mer-BuilderAffadaviVREVISED:4/16/2009
Cash Register Receipt Receipt Number
City of Atlantic Beach R5083
DESCRIPTION ACCOUNT QTY PAID
PerrnitTRAK -$59.60
'ERES18-0153 Address',337 4THSf A'PN': 169835 0000, $59.60
.ELECTRI AL $55.60
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
ELEC SWITCH AND RECEPTACLE OUTLETS 455-0000-322-1000 0 $0.60
STATE'SURCHARGES 4.00
STATE DBPR SURCHARGE 455-0000-208-0600 0 $2.00
STATE DCA SURCHARGE 45500002080700 0 $2.00
TOTAL FEES PAID BY RECEIPT: R5083 $59.60
Date Paid:Wednesday, May 16, 2018
Paid By: GOELZ LARKIN L
Cashier: BA
Pay Method: CREDIT CARD 5
Printed:Wednesday, May 16,2018.4:02 PM
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