2317 FIDDLERS LN ERES21-0164 E_____
ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
ERES21-0164
CITY OF ATLANTIC BEACH ISSUED: 7/13/2021
800 SEMINOLE ROAD EXPIRES: 1/9/2022
ATLANTIC BEACH, FL 32233 1
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:
2317 FIDDLERS LN ELECTRICAL RESIDENTIAL ELECTRIC REMODEL 7 $1000.00
FIXTURES
TYPE OF REAL ESTATE ZONING: BUILDING USE ! SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169463 0122 OCEANWALK UNIT 01
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: i ADDRESS: CITY: STATE: ZIP:
RAINES DENNIS K 2317 FIDDLERS LN JACKSONVILLE FL 32233-4681
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.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
I
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:$63.20
Issued Date:7/13/2021 1 of 1
�,tine, Electrical Permit Application **ALL INFORMATION
HIGHLIGHTED IN
:A 341*- ,,,i City of Atlantic Beach Building Department GRAY IS REQUIRED.
Alg, 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: E. RE..( - ..)• (4
JOB ADDRESS: Z ) I l t C 8 de)--, (1 PROJECT VALUE$ 1 0 00
JEA INFORMATION REQUIRED ON ALL PERMITS: 2. ) AMPS1-7d VOLTS / PHASE
❑ NEW SERVICE: ❑ Overhead ❑Underground ❑Underground up Pole
❑Residential (Main)Service:
❑O-100 amps o101-150amps o151-200amps ❑ amps #of Meters
❑Commercial (Main)Service:
❑0-100 amps D101-150amps o151-200amps ❑ amps ❑CT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
❑0-100 amps o101-150amps 111151-200amps ❑ amps #of Unit Meters
n TEMPORARY POLE: amps
I I SERVICE UPGRADE: ❑ amps DCT Service amps
NEW FEEDER (ADDITIONS,ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps ❑200amps ❑ amps ECT Service amps
ADDITIONS, EMODELS REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
Outlets/Swit es: ✓0-30amps 31-100amps 101-200amps
Appliances: ✓ Omps 31-100amps 101-200amps
A/C Circuits: 0- Oamps 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures: 7
OTHER ELECTRICAL PROJECTS:
❑Swimming Pool ❑Sign ❑Smoke Detectors (Qty) ❑Transformers KVA ❑Motors HP
FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
REPAIRS/MISCELLANEOUS:
oReplace Burnt/Damaged Meter Can oSafety Inspection oPanel Change DOH to UG
❑Other:
Updated 10/17/18
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. c
Owner Name: ,,t/sf//J /A/(J Phone Number: 7 a' -2;*
Electrical Company: 0 "2e/- Office Phone: Fax:
Co.Address: City: State: Zip:
License Holder: State Certification/Registration#:
Notarized Signature of License Holde6�.f'►--%.__.
The foregoing instrument was acknowledged before me this 1 Sday o •_ 1 ~ din the S ate of Florida,County of L--)L2t/C,_\
Signature of Notary Public
.4«li. 4' TOM GINDLESPERGER
1•1 - MY COMMISSION#GG 353178 [ ] Personally Known OR[ I I'Pedt�ce Identification
`"A'• Ti. c*` EXPIRES:October 6,2023
+,41.Q Type of Identification:
',f.F,F`;?' Bonded Thru Notary Public Underwriters
'ter/n
Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
` n City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
°' Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
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.
II. 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-DEPT@COAB.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.
Job Address: 2 3/ 7 .444/c
Owner Name: IPprr/A.,/J ) k / PhonefNumber: `tel
Mailing Address: $ . € City: 6Qt I7 c 44(..h State: F2 Zip: 222-21
Notarized Signature of Owner
Thee ping instr ment was acknowledged before me this day of.)Q l v , 202 in the State of Florida, County
Signature of Notary Public
[ ] Personally Known OR [ ] Produced Identification
Type of Identification:
ERGER dated 10/24/18
GG 353178
� � EY .t October 6,2023
Bonded T r�c,ar;Public Underwriters