1099 CORNELL ERES18-0245 'A' CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
-5814
INSPECTION PHONE LINE 247
ELECTRICAL RESIDENTIAL -
MUST CALL BY 4PM FOR NE)lT DAY INSPECTION: 247-S814
PERMIT INFORMATION'.
PERMIT NO: ERES1M245
De�scription: 5 OUTLETS
Estimated Value: 20
issue Date: 7/30/2018
Expiration Date: 1/26/2019
PROPERTY ADDRESS.
Address: i Ogg CORNELL LN
RE Number: 1775450010
PROPERTY OWNER:
Name: DAVID LEE ALMOND
Address: 1099 CORNELL LN
ATLANTIC BEACH, FL 32233
Name.
Address:
Phone:
Name:
Address:
Phone:
PERMIT INFORMAT[ON:
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,them 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 aizencies,or federal agencies.
* A notice of Commencerieut 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$7,500.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach,Fl,32233
Ph(904)247-5826 Fax(904)247-5845 C—� izC—S, 1101-b-z4s
JOB ADDRESS: 112 ZEN�Z - _PERr*ffr#
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS —VOLTS —PHASE
VALUE OF WORK$-92L't0--
NEW SERVICE 0 Overhead El Underground ED Underground up Pole
ofiesidesistfid(Main)Service
00-100 amps 0101-150arrips 0 151-200arrips 0—arrips #of Meters
oCommercial(Main)Service
[10-100 amps E1101-150imps 0 151-200anyps 0_amps [ICTService_amps
Conductor Type Size—
DMulti-Fandly(Main)Service
00-100 arrips 0101-150amis 0 151-200amps 11—--arrips #of Unit Meters
OTepaporary Pole 11----amPs
SFkWl��UPE �E] ��[]
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
0100amps 11150amps [1200=ps D---amps DCT Service_amps
ADDITIONS,REMODELS REPAIRS,BUELD-OUTS,ACCESSORY STRUCTURES,ETC'
C:5 Outlets/Switches;42EO-30amps 31-100amps —101-200amps
Appliances: ____fl-30amps 31-100amps 101-200hrimps
A/C Circuits: —0-60amps 61-100amps
Heat Circuits: #circuits g __kw
Number of Lighting outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
ciSurimming Pool DSign 0 Smoke Detectors—Qty oTmaaio=er;_KVA DMotors_hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty—volts/amps— VALUE OF WORK
REpAntSWISCELLANEOUS
DReplace Burat/Damaged Meterr Can 0 Safety Inspection OPanel Change DOH to UG
00ther:
Pernrit becornes vid ifwad:do.not ,,mmea within a six ormth period or=auspetuledorabaralloneritOrsixonalths I hereby certify that I have
read this application and know the sarne to betrue and correct Allprovisions and ordinances governing this work will be ,ophod with whether
ap.ifiodornot The pennit du�a not give,authority to violate the provisions ofarty,other state or local law regulation tonstruction or the perforarance of
construction.
PropertyOwnersName L)4vj,(Zj )q/m n"L�' PhoneN=ber
Electoral Company Cj f'j e—r— Office Phone________Fax—
Co.Addrcm: , City State Zip
License Holder(Print): State Certi cation/Registration
No SPERGER Ider Q%A1
TOIR GI 20(
My COMMISSON#FF 924W Sworn and subscribed b a-4Q-4ay of
EXPIRE oc',raIi'mig
ic 0
R Signature of Notary P
CITY OF ATLANTIC BEACH
(OWNER / BUILDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES. PART I 'CONSTRUCTION
CONTRACTING"REQUIRES OWNER I 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 ALILLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
—OR
allpULV
_IV THLfQNSjZjLCjj_QN_Qj%2LL YOU MAY BUILD OR IMPROVE A ONE
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF S25,01)(1.DO OR LESS. THE BUILDING
MU5_T F Yo R U 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
WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
IT FOR SALE OR LBASE, YOUR CONSTRUCTION MUST
"wk-A�NON AS YOUR CONTRACTOIL
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE ENMQYM_U_YQQ_—UA—VE
I[CENSES REOI ITRED By 3TATE LA3W kb�OTI Y R PAL LICENSINQ
ORDINANCE5,
11. INJURY LIABILITY; SINCE .31 MAy B ]A
OWNE LLmULI, F&IM Ili" RJU TO WORKERS THEY HIRE.
THE BUILDING DEPARTMENT SUGGESTS WORKERS 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 T T N T Mp Y
Lg_Ea DE A Y
CIRCUMSTANCES, OWNERS BERG SUi�TECT iO$5.000 PENALTY UNDER FLORIDA STATUTE NO.
E. THE OWNER SHOULD PHYSICALLY
455-228(l). AN 'OCCUPATIONAI I_1QUME'_&NQjADjQ_V6j1E
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.
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