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363 Atlantic Blvd Unit 4 ELPP25-0052srS=Lir,,, FOR OFFICE ELECTRICAL PERMIT APPLICATION YA,L s, City of Atlantic Beach Building Division PERMIT #�C.� !" 800 Seminole Road, Atlantic Beach, FL 32233 "ALL information required to process Esc 9Phone: (904)247-5826 Email: Building-Dept@coab.us JOB ADDRESS a j 6 I &��- �� G 311ad �� PROJECT VALUE $ D .� JEA INFORMATION REQUIRED LL PERMITS: AMPS cg� VOLTS 9410 PHASE ❑ NEW SERVICE: ❑ Overhead Under ❑ Underground up Pole ❑ Residential (Main) Service: ❑ 0-100 amps ❑ 101-150 amps ❑ 151-200 amps ❑ amps # of Meters [Ej' ommercial (Main) Service: ❑ 0-100 amps ❑ 101-150 amps V151-200 amps ❑ amps ❑ CT Service amps Conductor Type Conductor Size ❑ Multi-Famil (Main) Service: ❑ 0-100 amps ❑ 101-150 amps ❑ 151-200 amps ❑ amps # of Unit Meters ❑ TEMPORARY POLE: amps ❑ SERVICE UPGRADE: ❑ amps ❑CT Service amps ❑ NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.): ❑ 100 amps ❑ 150 amps ❑ 200 amps ❑ amps ❑ CT Service amps ❑ ADDITIONS, REMODELS, REPAIRS, BUILD -OUTS, ACCESSORY STRUCTURES, ETC: Outlets/Switches: 0-30 amps 31-100 amps 101-200 amps Appliances: 0-30 amps 31-100 amps 101-200 amps A/C Circuits: 0-60 amps 61-100 amps Heat Circuits: # circuits @ kw # of Lighting Outlets, Including Fixtures: ❑ OTHER ELECTRICAL PROJECTS Generator ❑ Whole house (ATS) or ❑ Stand alone ❑ Swimming Pool ❑ Sign ❑ FIRE ALARM SYSTEM (Requires 1 set of digital plans): Quantity volts/amps ❑ REPAIRS/MISCELLANEOUS: ❑ Replace Burnt/Damaged Meter Can Safety Inspection ❑ Panel Change ❑ OH to UG ❑ Other: NOTICE: Permit becomes expired if work does not commence within a six month period or work is suspended or abandoned for six months. 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 OWNER Name f l -e -Z lj� "A6 L J �` Phone ELECTRIC COMPANY Name <<�Q /- �1 �le ij"h 4c �j,gRbone 2 Address Cit J3 _ y r%uG f�yU✓IJ�`1� State Zip License Holder < < i �,,t,p State Certification # j�5C /300,6031 Email lOe1'Glt r t`GcZ L� rylCc "In lieu of signed, sworn and notarized signatures of the property owner, agent and/or contractor, and under penalties of perjur eclare that I have read a �d examined the foregoing application Aand ,44that the facts stated in it are true and correct." ,� S UREgr CONTRAC OR PRINT ORPFPE NAM OF CONTRACTOR DATE Electric Permit Application 07.03.2025 ELECTRICAL COMMERCIAL OR MULTIFAMILY DETAILS PER BLDG -�D'i 9;PLANS PERMIT PERMIT NUMBER ELPP25-0052 ISSUED: 9/26/2025 EXPIRES: 3/25/2026 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: PERMITTYPE: DESCRIPTION: VALUE OF WORK: ELECTRICAL COMMERCIAL OR 363 ATLANTIC BLVD 2-14 MULTIFAMILY DETAILS PER SAFETY INSPECTION - UNIT 4 $250.00 BLDG PLANS 169730 0000 ATLANTIC BEACH COMPANY:ADDRESS: RIVER CITY ELEC 12496 NE GATELY OAKS L JACKSONVILLE FL 32225 CONTRACTORS • ADDRESS: NSHORE LLC PO BOX 357742 GAINESVILLE FL 32606 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 • . Roll off container company must be on City approved list . Container cannot be placed on City right-of-way. DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT ELECTRICAL BASE FEE 455-0000-322-1000 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 Issued Date: 9/26/2025 1of2 ELECTRICAL COMMERCIAL OR MULTIFAMILY DETAILS PER BLDG PLANS PERMIT Issued Date: 9/26/2025 2 of 2 PERMIT NUMBER ELPP25-0052 ISSUED: 9/26/2025 EXPIRES: 3/25/2026 TOTAL: $109.00