1212 Jasmine St ERES21-0052 7 Fixtures "` ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
(-,----
y \' ERES21-0052
i� i' CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 3/5/2021
\ EXPIRES: 9/1/2021
- ATLANTIC BEACH, FL 32233
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
1212 JASMINE ST ELECTRICAL RESIDENTIAL ELECTRIC- 7 FIXTURES $0.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171020 0020 ATLANTIC BEACH SEC H
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
ROBERT& SHERRI 2208 MARSH POINT RD JACKSONVILLE FL
EMAHISER
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN
YOUR 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.
IST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
ELEC LIGHTING OUTLETS,INCLUDING FIXTURES 455-0000-322-1000 7 $4.20
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$63.20
Issued Date:3/5/2021 1 of 1
Y.t,e,:: w Electrical Permit Application JOB COPY nt-rtrrvmmnrrvn
HIGHLIGHTED IN
City of Atlantic Beach Building Department .. GRAY IS REQUIRED.
i`L
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826y4AJ� � Email: Building-Dept@coab.us PERMIT S: ERES21-0052
JOB ADDRESS: 101 - tr >/2 -5-1--; OH PROJECT VALUE$ /,O ' v
JEA INFORMATION REQUIRED ON ALL PERMITS: a AMPS \fours PHASE " ��
2- c !4�/ -(F,r (k//& L7
❑ NEW SERVICE: ID Overhead DUnderground ❑Underground up PleCol —t*oOS
ciesidential(Main)Service:
00-100 amps [' 101-150amps 1J151-200amps ❑ amps It of Meters
°Commercial (Main)Service:
00-100 amps 0101-150amps 0151-200amps Q amps OCT Service _ amps
Conductor Type Size
1:7Multi-Family(Main)Service:
❑0-100 amps 10101-1SDamps 0151-200amps ❑ amps II of Unit Meters________
n TEMPORARY POLE: amps
El SERVICE UPGRADE:❑ amps OCT Service amps
❑ NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
0100 amps 0150amps ❑200amps 0 amps 13:T Service amps
4DDITIONS, REMODELS, REPAIRS, BUILD OUTS, ACCESSORY STRUCTURES, ETC:
I
lJ Outlets/Switches: 0-30amps 31-100amps 101 200amps
Appliances: 0-30amps 31-100amps 101.200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: II circuits @ kw
Number of Lighting Outlets, Including Fixtures:
III OTHER ELECTRICAL PROJECTS:
❑Swimming Pool❑Sign ❑Smoke Detectors (Qty) ❑Transformers KVA OMotors HP
I I FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
-- REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection :Panel Change DOH to UG
Other: Updated 10/171I8
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 ive authority to violate the provisionspr/� of any other state or local law regulation constructiontr � ortheperformance of
Owner Name 6mA E g Phone Number: =-cha b/7LLRJOUfLQ_7
9I-°7L� x: r}5
Electrical Company: /?C�¢ Office Phone: Fax:
Co.Address: City: State: Zip:
License Holder: 11C/4x-- State Certification/Registration II:
Notarized Signature of License Holder ✓ /�{lltr� t.9
The foregoing instrument was acknowledged be a me thiV/f' day of rf..,4 ,20 li in the State of Florida,County of ,' .._, I___
.— ——— — — — — — — — —w Signature of Notary Public L _
I
1 ? :\ Hilary PublicA StaleofFlorida I [ ] Personally Known OR I�Produced Identification
A
commissioniHH087292 I Tunp of Irlontifiratinn• rt.,OL
•°...f`•-`r My Comm.Expires Jan 31,20Th
REEI
V VV 11=1 8.01.41141=8 /'11 I MOGI VII. J 0 B COPY H 7ennCVED
En!ter Johnston et 1:02 pm.Feb 17.2021
• City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 ERES21-0052
4. Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT SI: RES21-0057
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.
Il. 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. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPTL3COAB.US )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.
ob Address: ilD19 .i- & ('51 . ,,
)wner Name: e- ( 1.A.,ill Er104"t} C Phone Number: 9 4R-"—WO 'I S4
j� �
vlailing Address: 10 City: .6- Stater a Zip: 933
Notarized Signature of Owner / Q,[t19 5, LAM
"he(c egoing instrument was acknow •;ged bef me this /(D day of F hrt ct&I ,20_24 in the State of Florida, County
)f )4,k lad ) ....1
Signature of Notary Public (1)---•-,--
1INHAAKtMENKO [ ) Personally Known OR 1;‹,] Produced Identification
e Notary Public State of Florida I
I Commission 1 HH 007292
My Comm.Expires Jan 31,2025 I Type of Identification: F L L.
Updated 10/24/18