1021 ATLANTIC BLVD #977 - ELECTRIC DISCONNECT ON ROOF ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845 1 ' - C C - ( 38 7
JOB ADDRESS: 'f ' / 4 7- IvcQ U N l q -77 PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS 3 VOLTS PHASE
VALUE OF WORK$ al LI O 4.0
NEW SERVICE D Overhead El Underground ❑J Underground up Pole
Residential(Main) Service
0-100 amps 101-150amps 151-200amps amps #of Meters
Commercial(Main) Service
0-100 amps 101-150amps 151-200amps amps CT Service amps
Conductor Type Size
Multi-Family(Main)Service
0-100 amps 101-150amps 151-200amps amps #of Unit Meters
Temporary Pole amps
SERVICE UPGRADE amps CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES, ETC.)
100 amps 150amps 200amps amps CT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-30amps ,A%1-100amps 200amps
Appliances: .®' 0-30amps -� . 31-100amps 101-200amps
A/C Circuits: Z 0-60amps 7_ 61-100amps
Heat Circuits: Tr # circuits @ gqbbrrZ� kw.
Number of Lighting Outlets, Including FRtures: X
OTHER ELECTRICAL PROJECTS
Swimming Pool Sign Smoke Detectors_Qty I Transformers KVA Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty,olts/amps VALUE OF WORK$ a�
REPAIRS/MISCELLANEOUS
Replace Burnt/Damaged Meter Can Safety Inspection Panel Change OH to UG
Other: CDCA ("0,2 d.cs con no ,'o
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 havenn nn
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 /'"tl.
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 Owners Name E %vci V O h e Art),v fyc, t11)) e_ _ Phone Number
Electrical Company 4)l O r r/1') A e m tvr 4A/�_ 4Office Phone 8 3` x8/3 -4574
Co. Address: City State Zip
License Holder (Print): re-e.4 State Certification/Registration #
Notarized Signature of License Holder (..-G7,4100
Sworn and subscribed before me this )--S- day e of c],,.,v _ 20 A6
Signature of Notary Publi •
IW.��
Ptikis Notary Public State of Florida
Agnieszka Murray
�1' My Commission FF 202531
oe"ow Expires 03/20/2019
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