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1021 Atlantic Blvd #975 - Tenant Build-Out ‘ CITY OF ATLANTIC BEACH j 800 SEMINOLE ROAD 9 V ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 ELECTRICAL PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814 JOB INFORMATION: Job ID: 16 -ELEC -231 Job Type: ELECTRIC ONLY Description: ELECTRICAL - UNIT 975 ,TENANT BUILD -OUT Estimated Value: Issue Date: 2/16/2016 Expiration Date: 8/14/2016 PROPERTY ADDRESS: Address: 1021 ATLANTIC BLVD RE Number: 177602 -0040 PROPERTY OWNER: Name: EQUITY ONE ATLANTIC VILLAGE, Address: 16 NE MIAMI GARDENS DR ATTN: TREASURY DEPT GENERAL CONTRACTOR INFORMATION: Name: C & R ELECTRICAL SERVICES, INC Address: 5368 MUSCOVY RD QA RANDY PARKER COLLINS Phone: 904 - 291 -9436 FEES: State Elec DBPR Surcharge $2.00 State Elec DCA Surcharge $2.00 Electrical Repairs $35.00 Trade Permit Base Fee $55.00 Total Payments: $94.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. ELECTRICAL PERMIT APPLICATION - L CITY OF ATLANTIC BEACH ' L - Z t �,) 0) 7cz 800 Seminole Rd, Atlantic Beach, FL 32233 3 V Ph (904) 247 -5826 Fax (904) 247 -5845 -, JOB ADDRESS: tpal Q � �,� �n PE 6 # 15'C1T�31 �� .J �4M -'C JEA INFO ATION REQUIRED ON ALL ' ERMITS NO AMPS C>ID5 VOLTS PHASE —A-, • . ..r L- , e ■ 11%.04 0 r„ e, . RCULleh 4f; ' . « —I • 64 t UE OF WORK $ NEW SERVICE ❑ Overhead ❑ Underground ❑J Underground up Pole ❑ Residential (Main) Service ❑ 0 -100 amps ❑ 101- 150amps ❑ 151- 200amps 0 amps # of Me ers 1Commercial (Main) Service ❑ 0 -100 amps LI 101- 150amps [1 151- 200amps L 7 amps i) CT S vice amps Conductor Type Size ❑Multi- Family (Main) Service ❑ 0 -100 amps [1101 - 150amps ❑ 151- 200amps L] amps # of Un1 Meters ❑Temporary Pole L1 amps SERVICE UPGRADE Li amps ❑ CT Service amps NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.) ❑ 100 amps ❑ 150amps 0 200amps [1 amps ❑CT Service amps ADDITIONS, REMODEL REPAIRS, BUILD -OUTS, ACCESSORY STRUCTURES, ETC. Outlets /Switches: Ic 0- 30amps 31- 100amps 101- 200amps Appliances: 0- 30amps 31- 100amps 101- 200amps A/C Circuits: 0- 60amps 61- 100amps Heat Circuits: # circuits @ kw Number of Lighting Outlets, Including Fixtures: 1 0 OTHER ELECTRICAL PROJECTS ❑ Swimming Pool ri Sign " I Smoke Detectors _ Qty iL Transformers KVA ❑ Moto s hp FIRE ALARM SYSTEM (Requires 3 sets of plans) Qty volts /amps VALUE OF WORK $ REPAIRS /MISCELLANEOUS ❑Replace Burnt/Damaged Meter Can } 0 Safety Inspection ❑Panel Change L_l to UG ]Other`--k, - 1 0(14 Y 11Q9 -& Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. 1 h; eby 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 mplied with whether specified or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction 1 r the performance of construction. Property Owners Name V lam! " I k) y I r Phone Numbe (SU Electrical Company C.c.': ► .,. „ ' ‘' Office Phon °l t310 FaxCI19 1 Co. Address: 5,)11 lrnt� COL) - City 1 Y1 Stat Zip 3 o(i License Holder (Print): - '' C>4,,ft•-r State Certification /Registratio Notsn; . , , y , , • . r —_– _ . ` ' "` `•: JEANNE L. HAVENS I I. .1 Notary Public • State of FloridS orn and subscribed before me this 2- t day of --�> 20 l Co 1 r: .� of My Comm. Expires Sep 18, 2018 i I � "q;g ,,;° •• Commission # EE 838074 S •. ature of Notary Public :_, _._. _ - r - ---- CITY OF ATLANTIC BEACH CITY OF ATLANTIC BEACH 800 SEMINOLE RD 800 N I C BLE ROAD FL 32233 ATLANTIC BEAC, FL 32233 ATLANTIC BEACH, PHONE (904) 247 -5855 02/16/2016 13:30:15 Cashier Id: aspcust \atlbbja CREDIT CARD Receipt Date: 2%16/2016 1 :29 :55 PM VISA SALE Receipt Number: 0S -69205 Card # XXXXXX)00000(1903 Job ID: 16- ELEC -23i - ELECTRICAL - UNIT 975 SEQ #; 6 ,TENANT BUILD -OUT EDBPR - State Elec DBPR Batch #; 66 Surcharge $2.00 INVOICE 6 Job ID: 16 -ELEC -231 - ELECTRICAL - UNIT 975 Approval Code: 00431G ,TENANT BUILD -OUT EDCA - State Elec DCA S urcharge $2.00 Entry Method; Manual Job ID: 16- ELEC - 231 - ELECTRICAL - UNIT 975 Mode; Online T Amount: ,TENANT BUILD -OUT EL18 - Electrical Repai $0,00 rs $35.00 Card Code; M Job ID: 16- ELEC -231 - ELECTRICAL - UNIT 975 ,TENANT BUILD -OUT TP - Trade Permit Base Fee $55.00 SALE AMOUNT, Amount Due: $94.00 Tender Information: Cash $94.00 Tender Type: CC CUSTOMER COPY Tender Amount: $94.00 Change Due: $0.00