810 HIBISCUS ST - SOLR18-0002 (SMALL VERSION) J 1 rJ
CITY OF ATLANTIC BEACH
i,-;•;--. ..--, 800 SEMINOLE ROAD
K ATLANTIC BEACH, FL 32233
'Atm 9/ INSPECTION PHONE LINE 247-5814
ELECTRICAL SOLAR PANEL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: SOLR18-0002
Description: Solar Photo Voltaic System
Estimated Value: 18000
Issue Date: 8/13/2018
Expiration Date: 2/9/2019
PROPERTY ADDRESS:
Address: 810 HIBISCUS ST
RE Number: 170945 1110
PROPERTY OWNER:
Name: RHODES DONALD B
Address: 810 HIBISCUS ST
ATLANTIC BEACH, FL 32233-2544
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: All American Solar LLC
Address: 1060 E Industrial Dr STE A
Orange City, FL 32763
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$7,500.
�, .t, Building Permit Application �te12/8/17
a City of Atlantic Beach
VOW, 800 Seminole Road,Atlantic Beach,FL 32233
QPh e:( )247-5826 Fax:(904)247-5845 ( 1tFC" 036I
[�
Job Address: V 1 0 I-11 1215 CV) Permit Number: �""'�'
Legal Description S'(C I.../�. a RE# /909
95 1/10
Valuation of Work(Replacement Cost)$ 4 0 0 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move •-u• 'ooI Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial •esidenti.
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
90 'gam L, C'1APC 9/Siw /hov�e
phV)t°
Florida Product Approval" for multiple products use product approval form
Property Owner Infor .tion �(,�Q� ( I(c L. 5 -
Name: �� hVs' t/ Address: 3J 0 /4) /
City /I[+r� 4C �l State Zip " Phone f1�1-J1)(5—
E-Mail - L ✓" 7q 611 02 a/ , G�)
Owner or Agent(f Agen , Power of Attorney or Ageficy Letter Required) f. ./ 1 �S
Contractor Information r �,—a, ,�/�
Name of Company: ,,'J is _r„0,4,_ L" Qualifying Agent: 19:6441 t/"�"1 t r" 'y
Address /Ub(; b iii sc. City b State Zip
nt
Office Phone Job Site/Coct Number
State Certification/Registration# C 1 C 569k, E-Mail s e� Al
'i y0...., r r U0
Architect Name&Phone# / /
Engineer's Name&Phone# Jt-W .P rre S 7 S 31 I 1 q
9 1
Workers Compensation /
xempt nsurer/Lease Employees/Expiration Date
Application is hereby made to obtain a permit to do ork and installations as indicated. I certify 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 the laws regulationg
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc.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.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
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.
(Signature of Owner or Agent) (Signature of Contractor)
(including contractor)
Signed and sworn to(•r affirmed)before a t,is d. If Signed nd sworn to(or affirm•• before me his day of
ilif
.•a . _ MY BSN ADAMS
„ or. mi • '��_
#' COMMISS••
ic
'"?'wti EXPIRES September 07 �Qa ure o'Notary) ture o 'EMS
. ADAMSI4Q71] -5� nowfbridnr,R s.rv�u,nom My COMISSIONArFF915794
[ ] ersonally Known OA [ Personally Known OR :' .-^ _,.;Produced Identification/' I , I ]Produced Identificationa.�;; EXPIRSeptember 07 2019
Type of Identification: 1"li P tt t. LI a,WA Type of Identification: 1407i 39°0'53 Flondallota yS.'rh,•cem
` � ei. AUG 8 2018 ,- CITY OF ATLANTIC BEACH
S80 Seminole Road
. "� Atlantic Beach,Florida 32233
REVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS
Date _d !° Revision to Issued Permit Corrections to Comments /Permit# SOC-Q-i g
Project Address O 10Hic91-c-cus Sf
Contractor/Contact Name !'1")1 /V))L!Cu h 010'1)P- 6e l La q h)$
Phone ({01 ,07-y03 Email / ivicJ, t//6 /'/'linty IcDhr 1/11-03N
Description of Proposed Revision/Corrections: Permit Fee Due$ —d "
Z �q fro i- -Pt Cko
tt Y' �A , C
/ a A 4 I (00 Oita
Additional Increase in Building Value $ W7 Additional S.F.
By signing below,I (.�'''"� , ' 606 r affirm the Revision is inclusive of the proposed changes.
(pted name) ¢ Q
Signature of Contrac • Agen Contrac . I sign if increase in valuation) Date
(Office Use Only)
Approved Denied Not Applicable to Department
Revision/Plan Review Comments
Department Review Required:
Building
Planning &Zoning ni Reviewed By
Tree Administrator
Public Works
Public Utilities P- /0 —1 c8
Public Safety Date
Fire Services
JEA Application for Interconnection of Distributed Generation System
Less than or Equal to 100 kW
IMPORTANT: Interconnection of a distributed generation system and/or energy storage system to JEA's distribution grid requires JEA's
Application Pre-Approval prior to the start of the Installation,and Installed System Approval prior to the start of its operation.Approval
for interconnection to JEA's distribution grid requires the following:
1) JEA must receive and approve all required documents listed in Documentation(Section 5).
2) The distributed generation system and/or energy storage system must pass the JEA on-site inspection.
Customer should review the JEA Distributed Generation Policy prior to submitting this application.Customer is responsible for any costs
that may be incurred with the services that required the utilization of additional JEA engineers.
1. JEA CUSTOMER INFORMATION
Account Holder Name: Donald B Rhodes JEA Account#: 92415 34200
Service Address: 810 Hibiscus St
City: Atlantic Beach State: FL Zip: 32233 Account is: it Residential 0 Commercial
Phone#: 904-866-1615 Other#: Email: thegnsebastian@gmail.com
2. GENERATION SYSTEM INFORMATION(For multiple generations/storages,submit application for each individually)
New Generation System? ❑Yes 0 No(Skip to Section 3)
Generation source: 0 Solar(PV) ❑Wind ❑610-mass 0 Other:
Manufacturer Gross Output Power Rating of System(kWx): 5.85 Number of Solar Panels: 20
Panel Manufacturer: Q cells Q Plus L-G4.2 325 Watt Inverter Manufacturer: Enphase I Q 6+
Number of Inverters: 20 All Inverters UL 1741 SA Listed? ❑Yes 0 No
3. ENERGY STORAGE SYSTEM INFORMATION
Energy storage system(battery)included? ❑Yes 0 No(Skip to Section 4)
Manufacturer: Usable storage capacity: kWh Peak output: kW
Guaranteed lifetime cycles: Guaranteed lifetime years: Battery Chemistry:
Total Generation(s)and/or Storage(s)Gross Output: kWw:
4. CONTRACTOR INFORMATION
Installation Contractor: Steven Lorenz Florida License#: CVC56961
Address: 1060 E Industrial Dr Suite A City: Orange City State: FL Zip: 32763
Phone#: 386-218-6930 Fax#: Email:
Electric Contractor: Florida License#:
Address: City: State: Zip:
Phone#: Fax#: Email:
5. DOCUMENTATION(Initial to certify that documents are submitted together with this application)
(a) Required Application Pre-Approval documents to be submitted together with this application:
Application for Interconnection One-line electric diagram,if generation system includes energy storage system
(insert N/A,if not applicable)
Interconnection Agreement
IRS Form W-9 Energy storage system technical specification sheet(s)(insert N/A,if not applicable)
(b) Required Installed System Approval documents to be submitted before JEA on-site inspection:
Site survey clearly showing location of generation and/or battery system,inverter,disconnect switch(es)
Finalized Electric Permit
Inverter compliance with UL Standard 1741 and UL Standard 1741 SA
Completed and Signed System Installation and Inspection Checklist(Page 2)
By signing below,I hereby certify that I am the JEA Account Holder and that all the Information provided in this application is true and correct to the best
of my knowledge,that I have read and understand the JEA Distributed Generation Policy,that I have submitted with this application all the
required documentation listed in Section 5(a)and that I will submit all the required documentation listed In Section 5(b)prior to JEA on-site Inspection.
Signature: //01/1(4 Name(Print): o e 744 ✓ 6,40 Date: O
March 19,2018 Page 1 of 2