363 Atlantic Blvd Unit 3 ELPP25-0053�S ELECTRICAL PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
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rJ City of Atlantic Beach Building Division PERMIT # I DQ r W
800 Seminole Road, Atlantic Beach, FL 32233 "ALL information required to process
Phone: (904)247-5826 Email: Building-Dept@coab.us
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JOB ADDRESS S � � � �/�.vl f -,'G �7j wA PROJECT VALUE $ ���� C� 0�
JEA INFORMATION REQUIRED ON ALL PERMITS: AMPS 2� VOLTS 9lPHASE j
❑ NEW SERVICE: ❑ Overhead ❑ Underground ❑ Underground up Pole
❑ Residential (Main) Service:
0-100 amps E]101-150 amp 151-200 amps ❑ amps # of Meters
Commercial (Main) Service:
❑ 0-100 amps ❑ 101-150 amps151-200 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 E]200 amps ❑ amps ❑ CT Service amps
ADDITIONS, E] REMODELS, REPAIRS, BUILD -OUTS, ACCESSORY STRUCTURES, ETC:
Outlets/Switches: Z- 0-30 amps 31-100 amps Z 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 al - c -2 Phone
ELECTRIC COMPANY Name `t,2f Cc`�. G-lec t-A"C[., ( ('O jt;ht ipjr Phone !7,9!� -6 3 f: —.3 z---, -z-
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Address /2-'-1 b u moi( z:- L4. 1- City TpcLE=Sa e -W 'Ile— State F` Zip 3; Z 72 -
License
License Holder- J c; P1/1 t) State Certification # �G %30D6o31 Email r✓� eG(d rCwi
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"In lieu of signed, sworn and notarized signatures of the property owner, agent and/or Xnttactor, an n er`pe�i es of
per' ry, eclare that I have r d and examined the f ing application and that the facts stated in it are true and correct."
ATU 1124 I-VtO
OF CONTRACTO INT OR E NAME OF CONTRACTOR DATE
Electric Permit Application 07.03.2025
ELECTRICAL COMMERCIAL OR PERMIT NUMBER
MULTIFAMILY DETAILS PER BLDG ELPP25-0053
V" ISSUED: 9/26/202025
�,;i 9r PLANS PERMIT 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- PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
ELECTRICAL COMMERCIAL OR
363 ATLANTIC BLVD 2-14 MULTIFAMILY DETAILS PER BLDG SAFETY INSPECTION - UNIT 3 $250.00
PLANS
169730 0000
RIVER CITY ELEC 12496 NE GATELY OAKS L
CONTRACTORS
NSHORE LLC PO BOX 357742
ATLANTIC BEACH
JACKSONVILLE FL 32225
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 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 APPLIANCES FIXED OR STATIONERY
455-0000-322-1000
0
$12.00
ELEC SWITCH AND RECEPTACLE OUTLETS
455-0000-322-1000
0
$8.00
ELECTRICAL BASE FEE
455-0000-322-1000
0
$55.00
SAFETY INSPECTION
455-0000-322-1000
0
$50.00
Issued Date: 9/26/2025 1 of 2
s
ELECTRICAL COMMERCIAL OR PERMIT NUMBER
MULTIFAMILY DETAILS PER BLDG ELPP25-0053
ISSUED: 9/26/2020
25
F;,• PLANS PERMIT EXPIRES: 3/25/2026
I STATE DBPR SURCHARGE I 455-0000-208-0700 1 0 1 $2.001
I STATE DCA SURCHARGE 1 455-0000-208-0600 1 0 1 $2.001
TOTAL: $129
Issued Date: 9/26/2025 2 of 2