1935 BRISTA DE MAR CIR ERES21-0234 Electrical Permit Application **ALL INFORMATION
Application HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 RE--SZ I - COQ 3/
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 'IS Z I
JOB ADDRESS: 5�� ,'>; . /lc' /LJAv (, . PROJECT VALUE $ 5-0 00
JEA INFORMATION REQUIRED ON ALL PERMITS: 7 AMPS PEI: VOLTS L PHASE
❑ NEW SERVICE: 0 Overhead ❑Underground ['Underground up Pole
Dtesidential (Main)Service:
00-100 amps 171101-150amps 0151-200amps ❑ amps #of Meters
❑Commercial (Main)Service:
1:10-100 amps 0101-150amps 0151-200amps ❑ amps OCT Service amps
Conductor Type Size
DMulti-Family(Main)Service:
❑0-100 amps 1:1101-150amps 1:1151-200amps ❑ amps #of Unit Meters
❑TEMPORARY POLE: amps
❑SERVICE UPGRADE: ❑ amps OCT Service amps
I1 NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
0100 amps 0150amps 0200amps 0 amps OCT Service amps
❑ ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS, ACCESSORY STRUCTURES, ETC:
Outlets/Switches: 20 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: /
OTHER ELECTRICAL PROJECTS:
"'Swimming Pool DSign amoke Detectors (Qty) ['Transformers KVA ['Motors HP
FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change DOH 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:
'de Pf'• 1.4."4 Z 5 Phone Number:
Electrical Company: [4,/`tS Office Phone: 743 S/y 7 Fax:
Co.Address: car r�/�✓� / City: Cjl. %Jc44 State:p r(Zip: 3ZZ Sb
License Holder: / ( ,, N, State Certification/Registration#: CSF /3 d / S-3 Z
C
Notarized Signa re of License Holder
4 G-71--The foregoi _ rument was acknowled d-before rdthis day of 'I in the tate of Florida,County of �rc.."(
TONI GINDLESP RGE ER Signature of Notary Public
'•' MY COMMISSION#GG 353178
EXPIRES:October6,2023Personally Known OR[ ] Produced Identification
'q�F FlV OBonded Thru Notary • Type of Identification: