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338 2nd St 2014 Pool ±,JUN f ,C,� �' -'���s� CITY OF ATLANTIC BEACH j 800 SEMINOLE ROAD !J =� ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 0A Application Number . . . . . 14-00000713 Date 6/06/14 Property Address . . . . . . 338 2ND ST Application type description SWIMMING POOL/SPA Property Zoning . . . . . . . RES SF DISTRICT Application valuation . . . . 20000 ---------------------------------------------------------------------------- Application desc new pool ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ PATRICK, GRADY SCOTTS POOL SERVICE INC 10549 BURRIS DR ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32225 (904) 641-5999 ---------------------------------------------------------------------------- Permit . . . . . . SWIMMING POOL Additional desc . . Permit Fee . . . . 150 . 00 Plan Check Fee 75 . 00 Issue Date . . . . Valuation . . . . 20000 Expiration Date . . 12/03/14 ---------------------------------------------------------------------------- Special Notes and Comments Must clean dirt from street and right-of-way daily. Parking on site only. 2010 FLORIDA BUILDING CODE, 2008 NATIONAL ELECTRIC CODE REQUIRED INSPECTIONS : *POOL STEEL *ELECTRICAL GROUNDING AND BONDING *FINAL (PUMPS MUST BE RUNNING FOR FINAL) SWIMMING POOL SAFETY INSPECTION REQUIRED ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 25 ENG REV PRE APP > 3 HRS 25 . 00 STATE DBPR SURCHARGE 2 . 25 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 150 . 00 150 . 00 . 00 . 00 Plan Check Total 75 . 00 75 . 00 . 00 . 00 Other Fee Total 29 . 50 29 . 50 . 00 . 00 Grand Total 254 . 50 254 . 50 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 ` FILE C Office (904) 247-5826 Fax (904) 247-5845 Job Address: 33 00 �7'� Permit Number: . 71 Legal Description ,57E UE y Parcel# Valuation of Work$ Floor Area o q.Ft. �_ q. 't . /T OC/ Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s) circle one): Commercial Residential If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A Florida Product Approval# For multiple products use product approva orm Describe in detail the type of work to be performed:_ /A)( -RayAle 10m L Property Owner Information• Name: —A Address: 3_3`9 ;),UP 5777 City-A T4Afl`lG L State RGZip 3.223 Phone E-Mail or Fax#(Optional) Contractor Information: CONTRACTOR EMAIL ADDRESS: Company Name: SC oT5 L SaAV14_t- IAI& Qualifyin Agent: CTB/aAV,,u Address:) 6),5q 61, 9U2/r t Ap City ' A11-1, State-?SL4 _Zip 3:2225 Office Phone. 6 41 -5"19`j Job Site/Contact Number �_o 3.0`Z 3 Fax# y 1 326f7 State Certification/Registration# C PCQ I a 3 / Architect Name&Phone# Engineer's Name&Phone# Fee Simple Title Holder Name an ddress Bonding Company Name and A ress Mortgage Lender Name and A dress Application is hereby made to obtain a permit to do the work 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 laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a_period of six p) months at any time after work is commenced. I understand that separate permits must be secured or Electrical-Work,Plumbing,Signs, Wells,Pools, urnaces,Boilers,Heaters, Tanks and Air Conditioners,etc. 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. I he mt this application and know the same to be true and correct. All provisions of laws and ordinances governing this typ :�3yill be c �vheth specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the pro _,n ,may d k I�P� c w regulating construction or the EXPI S: tuber 2 4 ;f•� Bonded N ubfic SCOTT ARNOLD Wrie +_ MY COMMISSIgqO��rNp#EE 0216 Si ure o 2 ' de�Thrl(m=4 Print Name / 60--1 � .... rmt Name OH AI /E DL P _�.......... : '... 1 ........................................ .................................................. Before me Before me this R Da f 20 this a�D f /��/ Zp Notary Public Nota Public Revised 01.26.10 FILE COPY : ,' I/��ta�� sLK eta IZZY 41 N PaxS i mg qvL v c T S - COPY '. - Al .� r r r jZE IL a v - t o i s FIR Nz Z �'` � � .fit• �, � ,�, +wF � i' Zk i IL COPY °TWm: .N,A4,11`.M!•e.x i'Ya:'IV dl�� YtS:.•... Pool AT co� �u�2s COU 7-1 All O l,S To /do o L N,O 7-0 Sc2 Esti Eiv 6 X657 v� SCOTT'S POOL SEHwCE 10549 BURRIS OR. JAX FLA. 32225 CPpp15231 904-i41599p FILE COPS t r 1, .,.✓"''"-ate"`: ��;ar.�" ... - �._ - -Open Area=38J9in2 - -IAPMO Listed Flow Rates: 1)25506-320-010 Sump Body -For 2.5"plumbing using two outer ports= 2)26520-050-020 2"NPT Plug 308GPM(Floor)&212GPM(Wall) 3) 25506-320-030 Debris Guard Tor 2.5" plumbing using center port only= 4) 25506-320-020 32"Cover 200GPM(Floor)& 168GPM(Wall) 5) 61008-042-022 Screw -For 2"plumbing using two outer ports= 268GPM(Floor)& 192GPM(Wall) -For2"plumbing using center port only= - 184GPM(Floor)& 176GPM(Wall) La Part Numbers: 25506-320-000 32"Channel Drain w/Sump, White �� ! 25506-321-000 32"Channel Drain w/Sump,Gray t 25506-324-000 32"Channel Drain w/Sump,Black i 25506-327-000 32"Channel Drain w/Sump,Dark Gray 25506-329-000 32"Channel Drain w/Sump, Tan 25506-320-100 32"Channel Drain w/Frame, White I_, 25506-321-100 32"Channel Drain w/Frame,Gray 25506-324-100 32"Channel Drain w/Frame,Black 25506-327-100 32"Channel Drain w/Frame,Dark Gray 25506-329-100 32"Channel Drain w/Frame, Tan 1) 25506-320-110 Frame 2)25506-320-120 Frame Support 3)25506-320-020 32"Cover 4) 61008-042-022 Screw Custom Molded Products, Inc. Vim'' Toll Free:800.733.9060 or visit us online at www.c-m-p.com 'iso 900 Contact us for details about our complete line of pool,spa&whirlpool bath components!! 0211 In, P"vlill�, Clean & Clear or.. Cartridge WNWiClamp R access •r safe • • 7i Single-piece to cartridges •- • -• � polypropylene tank • i. • corrosion . 1 Easy access I Y2"drain plumbing for • x. Model Filter Vertical Filter Flow Rate GPM Turnover Capacity-Res.(Gallons) Number Area Sq.Ft. Clearance* Diameter Res.** Com. 8 hrs. 10 hrs. 12 hrs. CC 50 50 30" 15.5" 50 19 24,000 30,000 36,000 CC 75 75 39" 15.5" 75 28 36,000 45,000 54,000 CC 100 100 61" 15.5" 100 38 48,000 60,000 72,000 CC 150 150 76" 15.5" 150 56 72,000 90,000 108,000 CC 200 200 76" 15.5" 150 75 72,000 90,000 1 108,000 *Required clearance to remove filter elements. **Maximum flow rate. Carefree. . .by design Like all Pentair Water Pool and Spa'cartridge filters,the • 2"plumbing for maximum flow. Clean&Clear°filter features an easily-cleaned cartridge_ • Single piece base and body designed for maximum for the ultimate : `;arefree pool filtration.The fiberglass- durability. reinforced tank hale =s are secured with an innovative damp ring—just loosen the ring and remove the top half • One-year limited warranty. See warranty for details. for easy cartridge access and rinsing. Filter maintenance doesn't get any easierAvailable from: • I%2"drain and washout for quick and convenient maintenance and winterization. • Innovative lock-ring requires only half of a revolution for a safe,leak-proof seal. Pentair Pool Products® �- Because reliability matters most www.pentairpool.com Phone:800-831-7133 pumps/filters/heaters/heat pumps/automation/lighting/cleaners/sanitizers/water features/maintenance products 3/11 Part#PI-121 NSF @2011 Pentair Water Pool and Spa Inc.All rights reserved. s • Super, i • Perform. . S nce I � outfitting yourpool or looking for a superior replacement for aHayward"Super Pump�SuperFlo dropsi right • place with ease to minimize installation • expense. Heavy-duty motorfor • ng service life. !– Superior hydraulicdesign• body parts deliver super-cluiet operation. J The strong, silent type The SuperFlo®high performance pump meets all the criteria Performance Curves for a superior pool,spa or water feature pump. It's super FILE COPY 3450 RF"energy-efficient,super quiet and super easy to maintain. Plus, 35 110- —2'h HP High Speed _-- _ —2 HP High Speed it's designed with Innovative materials that will stand up to the — I'hHPHigh Speed ®,,...rw. *.s^�rra+.cs:..rawK.. — 1 HP High Speed most demanding installations and conditions. Whether you're _3h HP Hilo SMd HP High Veed choosing your first pump or replacing older technology, o 25 ;80 SuperFlo is definitely a super choice. ?s 20 �5 d • Self-priming for quick,easy start-up. °V is 1 40 • Speed I I5-volt or 230-volt models available. to Low] 1750RPM • 20 Performance and pressure tested to ensure superior quality. S 0 • UUCUUNSF certified. 20 40 60 80 100 120 140 160 U.S.Gallons per minute • One-year limited warranty. See warranty for details. s to Is 20 25 30 3s Cubic Meters per hour Available from: ' Pentair r Pool Products® ..' "` Because reliability matters most www.pentairpool.com Phone:800-831-7133 pumps/filters/heaters/heat pumps/automation/lighting/cleaners/sanitizers/water features/maintenance products 8/09 Part#PI-232 NSF ® Q ©2009 Pentair Water Pool and Spa,Inc.All rights reserved. —MT ; = FILE C 0 R-Yri:• .� ".� '•*;v»s:r�+rasTtik�+iaiia,:.Yraw�F�llr,a:..^ - " Easy to install or retrofit in even the tightest space - models 1 from 175M to 400M BTUs - all measure 211 x 21"W x 28"H 1 - Rotating digital display means more installation options 1 and easier access to view operating information 1 Rustproof, tough composite exterior for long life Available in natural gas and propane models. Pool Capacity in Galialss Pool Surface Area in Sq.Ft.at 5.5' Depth 5 85,210 97,383 121,729 146,075 194,766 2,069 2,3.64 2,955 3,546 4,727 10 42,605 48,691 60,864 73,037 97,383 1,034 1,182 1,478 1,773 2,364 15 28,403 32,461 40,576 48,692 64,922 690 788 985 1,182 1,576 20 21,303 24,346 30,433 36,519 48,691 517 591 739 887 1,182 25 17,042 19,477 24,346 29,216 38,953 414 473 591 710 945 30 14,201 16,230 20,288 24,345 32,461 345 394 493 591 788 35 12,173 13.912 17,390 20,868 27,824 296 338 423 507 675 40 10,651 12,173 15,216 18,260 24,346 259 295 369 443 591 Minutes for 307 Temperature Rise (Heater Input in 1000 BTU/HR) 175 21.0 31.0 40.0 50.0 61,0 71.0 81.0 91.0 102.0 200 18.0 27.0 35.0 44.0 53.0 62.0 71.0 80.0 89.0 %50H1 � 5.8 23.5 30.8 38.5 46.5 543 62.0 70.0 77.8 00 566.5 26.5 33.0 40.0 46.5 53.0 60.0 66.5 r -Y 1001-ID 9.0 13.0 !8.0 '.0 27.0 31.0 35.0 40.0 44.0 ,. .. -1 G. tlrN lj i.."Ci df IU Ui 11 U:Ue'U.�1.!ItM( It ir���r City of Atlantic Beach �� APPLICATION NUMBER Js 1 Building Department (To be assigned by the Building Department.) 800 Seminole Road713 Phone �r Atlantic Beach, Florida 32233-5445 7 Phone(904)247-5826 • Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: C:2h 0 .�-i( ADment review required Ye No Applicant: �Q�� �o a oni ratorProject: �() QG ublic Utilities Pu is a e y Fire Services Review fee $ Dept'Signature ..` : , rd,. Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: Q pproved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: 7 TREE ADMIN. Second Review: ❑Approved as revised. nDenqed. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. [-]Denied. Comments: Reviewed by: Date: Revised 05/14/09 i.tJ kjr City of Atlantic Beach APPLICATION NUMBER �1 fi Building Department (To be assigned by the Building Department.) 800 Seminole Road D �/ Atlantic Beach, Florida 32233-5445 7 Phone(904)247-5826 • Fax(904)247-5845 ,1�) E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: —?38 Q/70( D epadment review required Yes No Applicant: i('Q 7.r. 6 7_-0> Planning &Zoni / rator Project: 6L) Q6 C� Public Work ub is Utilities Pu M isa e y Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: ❑Approved. Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: / Date: -3—)(91V TREE ADMIN. Second Review: Wpproved as revised. ❑Denied. PUBLIC WORKS Comments: "1 PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date:/ FIRE SERVICES Third Review: []Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) I 800 Seminole Road 7/ Atlantic Beach, Florida 32233-5445 J Phone(904)247-5826 • Fax(904)247-5845 E-mail: building-dept@coab.us L Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: C /n 0► Sr P-epartment review required Yes No Applicant: �1Q 717-6 Q Planning & Zoni / rator Project: (,(� QG� Pub �E lic Work ublic Utilities Pu is a fey Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLI ION STATUS Reviewing Department First Review: pproved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: -42C_ Date: TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 I Np City of Atlantic Beach APPLICATION NUMBER `Js Building Department (To be assigned by the Building Department.) 800 Seminole Road O 7/3 Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Q,- /701 d'V D ment review required Yes No Applicant: �Q�� �o 0 Planning &Zoni Q G� Project: Public Work rator ublic Utilities Puis a e y Fire Services Review fee $ Dept Signature V 6k Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: Approved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: ❑Approved as revised. [—]Denied. E ORK Comments: C UTILITIE PUB E Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. []Denied. Comments: Reviewed by: Date: Revised 05/14/09 NOTICE OF COMMENCEME f (PREPARE IN DUPLICATE) Permit No. Tax Folio No. State of County of To whom it may concern: The undersigned hereby informs you that Improvements will be made to cr •i real property,and in accordance with Section 713 of the Florida Statutes,the following information ated In this NOTICE OF COMMENCEMENT. Legal description of property being improved: ✓I,&S/ _ -Or /l , X&%ea OF• , 02- 13 o ' f-.3 �4TGf�.i1J t�L Address of property being improved: 3 9 =^S A//1 7- __4T 1 L. JI1Y L C= J General description of improvements: //U�-ie(1 �.f/a /QDD L Owner J, �I` &A,419 y Address .� e2 u.p �57 4, T Ld,V Le .2�?33 Owner's interest in site of the improvement Fee Simple Titleholder(if oth owner) Name i Address U' Contractor Address 067 6 U s Phone No. gc5y fr 7 SC/ 9 Gj Fax No. Surety(if any) Address Amount of $ Phone No. Fax No. Name and address of any person making a loan for the construction of the improvers Name Address Phone No. Fax No. Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may be served: Name Address Phone No. Fax No. In addition to himself,owner designates the following person to receive a copy of the I ir's Notice as provided in Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option). Name Address Phone No. Fax No. Expiration date of Notice of Commencement(the expiration date is one(1)year from ate of recording unless a �\ different date is specified): THIS SPACE FOR RECORDER'S USE ONLY �+ /p OWNE• Signed: " L/ DATE q-1�jl7 Before thi day of in the County of ,State of Florida,has pe appeared Doc#2014116429,OR BK 16!91 Page 1942, herein by himself/herself and affirms that all staten.. Number Pages:1 are true and accurate l� Recorded 05,'27i;2014 at 08:10 AM, 1 900TTARNOW Ronnie Fussell CLERK CIRCUIT COURT DUVAL ! MY COMMISSION NEE021610 COUNTY EXPIRES:December 27,2014 RECORDING$10.00 r 6onW7brfNofaryPsbk� Notary Public at Large,Stat of o My commission expires: _ Personally Known or Produced Identification D m 0 D o C7 0 C/) m r� 0� i F o o T N (n D 0Z -Di O —I 000 :j � O pox m x �N j 0V) Z �'� o r N 00 • D D co X D o o O Z , --f � 0 0 (n N z ® 71 Z M '5.0' Ln D RAGE w -a 0 .1Al . • '. r' /1 )N: (10.19) p b, * '•• .` : • • ^ 0) r o 4 1 CONCRtTE DRIVE•'4 1 2 4 ; .t A, �,t„� O N n �- bd :RED :1 .c - • ►, .. o 1066)\'I PROPERTY U _`-A ONG-WALL -- - $ O O O —{ O _1 - �--1 36.1' C = M 217 O p r0 -{ MC -Ni m Orn Q d fri Nnz 'C D — !V a mos v �V 2 I , O L4OD m O l -� 0O V 1 = o o D �/0 0� O D *1 U) .. '" M 00• `'o c� �, O m 1xN g < r C r 1 1_ � K m yD m vt r z ---moo Z N �m C LrT- D , z o p z r � 0 co �€ pO ? M T I9 - _ " 0 *� D I i r n fTl O O O EAST COAST DRIVE (30' RIGHT OF WAY) Zc= z zxzm O mom ti r OZ . 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RES SF DISTRICT Application valuation . . . . 20000 -------------------------------------- Application desc new pool ------------------------------------- Owner Contractor ----------- ------------------------ PATRICK, GRADY SCOTTS POOL SERVICE INC 10549 BURRIS DR ATLANTIC BEACH FL 32233 (904)JACKSONVILLE FL 32225 -----Permit . . ELECTRICAL PERMIT Additional desc . . Sub Contractor . . DAVID PRUETTES ELECTRICAL SVC. . 00 Permit Fee . . . . 95 . 00 Plan Check Fee Issue Date Valuation . . . . 0 Expiration Date . . 12/24/14 ----------------------------------- Special Notes and Comments Must clean dirt from street and right-of-way daily. Parking on site only. 2010 FLORIDA BUILDING CODE, 2008 NATIONAL ELECTRIC CODE REQUIRED INSPECTIONS : *POOL STEEL *ELECTRICAL GROUNDING AND BONDING *FINAL (PUMPS MUST BE RUNNING FOR FINAL) SWIMMING POOL SAFETY INSPECTION REQUIRED _ _ ------ Other Fees STATE ELEC DCA SURCHARGE 2 . 00 STATE ELEC DBPR SURCHARGE 2 . 00 Fee summary Charged Paid Credited Due _ _ ---------- ---------. ----- ---------- - . 00 Permit Fee Total 95 . 00 95 . 00 00 . 00 Plan Check Total • 00 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 Grand Total 99 . 00 99 . 00 . 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 2 na CPh(904)247-5826 Fax(904)247-5845 JOB ADDRESS: t — c t_- PERMIT# l y=7 0JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE VALUE OF WORK$ NEW SERVICE ❑ Overhead ❑ Underground ❑1 Underground up Pole ❑Residential(Main)Service a 0-100 amps C�101-150amps (�151-200amps 0 amps #of Meters Commercial(Main)Service C0-100 amps 101-_A01 ❑151-200amps amps 'CT Service amps Conductor Type Size Multi-Family(Main)Service X70-100 amps n 101-150amps 151-200amps amps #of Unit Meters FiTemporary Pole [_--' amps SERVICE UPGRADE [.]—amps ��-CT Service amps NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.) A00 amps a 150amps 200amps amps CT Service amps ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC. Outlets/Switches: 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: OTHERY,tiCTRICAL PROJECTS _l Motors h wimming Pool [? Sign ❑Smoke Detectors_Qty CTransformers KVA p FIRE ALARM SYSTEM (Requires 3 sets of plans) VALUE OF WORK$ Qty volts/amps REPAIRS/MISCELLANEOUS Replace Burnt/Damaged Meter Can '-,Safety Inspection ❑Panel Change ,_j OH to UG 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. Property Owners Name - Phone Number Q ' f/ sLCS�/IL Office Phone �a- Faxo�7a'-1 � Electrical Company�i�%Gf'��� L IQ�'��� 2 Co. Address: �,� �n � �t� City Gc State PL Zip J��� License Holder(Print): fication/Registration# CMZ-� • Notarized Signature of License Holder :KAREN EWINt3 Sworn and subscribed before me s da ofd _20 • MY COMIMIBSION i EE174228 Signature of Notary Public • „ . ,, EXPIRE,!MiY 21.2018 3l�015!