61 Ardella Rd ERES21-0253 Safety rtf ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
rl kir? ERES21-0253
CITY OF ATLANTIC BEACH
Vr 800 SEMINOLE ROAD ISSUED: 10/18/2021
'`0i1I9r ATLANTIC BEACH. FL 32233 EXPIRES: 4/16/2022
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:
61 ARDELLA RD ELECTRICAL RESIDENTIAL Safety $200.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172032 0000 SECTION LAND
COMPANY: ADDRESS: CITY: STATE: ZIP:
Service of Knights LLC 415 N 4th Avenue Jacksonville Beach FL 32250
OWNER: ADDRESS: CITY: STATE: ZIP:
BOEREM DAVID L 61 ARDELLA RD ATLANTIC BEACH FL 32233-4305
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT If\'
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.
FEES ": L,.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
ELECTRICAL BASE FEE 455-0000-3221000 0 $55.00
SAFETY INSPECTION 455-0000-322-1000 0 $50.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$109.00
Issued Date:10/18/2021 1 of 2
,.:\..' ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
e
}jrERES21-0253
. . '-. . CITY OF ATLANTIC BEACH�'� ISSUED: 10/18/2021
�� 800 SEMINOLE ROAD();: ATLANTIC BEACH. FL 32233 EXPIRES:4/16/2022
Issued Date:10/18/2021 2 of 2
f-'''
Electrical Permit Application **ALL INFORMATION
HIGHLIGHTED IN
pp
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#:
CF
JOB ADDRESS: ' ( /
,-, 4: I (Gi PROJECT VALUE $ 7C'C
JEA INFORMATION REQUIRED ON ALL PERMITS: 7U0 AMPS Z6(o VOLTS PHASE
Li NEW SERVICE: Overhead ❑Underground ❑Underground up Pole
[ Residential (Main) Service:
❑0-100 amps 101-150amps o151-200amps ❑ amps #of Meters
ICommercial (Main) Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps ❑CT Service amps
Conductor Type Size
iMulti-Family(Main) Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps #of Unit Meters
TEMPORARY POLE: amps
I I SERVICE UPGRADE: amps ECT Service amps
❑ NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
❑100 amps 150amps 200amps H amps ECT Service amps
[ I ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
Outlets/Switches: 0-30am ps 31-100amps 101-200amps
Appliances: 0-30am ps 31-100am ps 101-200am ps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
I I OTHER ELECTRICAL PROJECTS:
I 1Swimming Pool Sign ❑Smoke Detectors (Qty) ❑Transformers KVA ❑Motors HP
Li FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
ill REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can KSafety Inspection oPanel Change ❑OH 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.
Owner Name: jatit o el wl Phone Number: Z 3 7-6 q Z.
Electrical Company: tiic.- c4 te'fivi-; Office Phone: 1' 17G -s 1 I97 Fax:
Co.Address: 4/(c `I t- .,.. City: ,AX, lei,41 State: rt._ Zip: '5? Z 5-0
License Holder: /C (11h A ,} $- State Certification/Registration#: £ •i • 13 0 I '5-se `r
Notarized Signature ofLicense Holder
The foregoing instrument was acknowle ged be r e this I g day�of
�0/Ct , 202.! in the$ate of Florida,County of I7 U VA L
�� Signature of NotaryPublic �lv 14./'S F'"P l ` /ViW4 _I
:►ir;. CHRISTIAN GILES g
MY COMMISSION#HH 117153
,���� : EXPIRES: 113,2025 [ ] Personally Known OR[ Produced Identification
•fPFTh... Bonded TNuNotary Public Underwriters Type of Identification: J'L. n• L -