1813 Seminole Rd ELPP21-0068 App Electrical Permit Application **ALL INFORMATION
�� HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
, 800 Seminole Rd, Atlantic Beach, FL 32233 :,
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: '
JOB ADDRESS: /X3/3 .c-t'1M ;v7 r_; j e A/A(1 PROJECT VALUE $
JEA INFORMATION REQUIRED ON ALL PERMITS: AMPS VOLTS PHASE
i NEW SERVICE: u Overhead ❑Underground ❑Underground up Pole
Residential (Main)Service:
L0-100 amps n101-150amps o151-200amps ❑ amps #of Meters
Commercial (Main) Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps ❑CT Service amps
Conductor Type Size
❑Multi-Family(Main) Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps #of Unit Meters
I I TEMPORARY POLE: amps
❑ SERVICE UPGRADE: ❑ amps iiCTService 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: 0-30am ps 31-100am ps 101-200amps
Appliances: 0-30amps 31-100amps 101-200am ps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
1 1 OTHER ELECTRICAL PROJECTS:
❑Swimming Pool -Sign ❑Smoke Detectors (Qty) ❑Transformers KVA ❑Motors HP
ri FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty _ volts/amps
✓ REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection ilPanel Change EON to UG
Eher: Updated 10/17/18
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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: ,.,.'f}t K 4 // / 2e !no -,r , Phone Number:
Electrical Company: Dr -& .. /`7.e . ; e. /yr C._ Office Phone: gS —(J'/ 5 Fax: --------
Co.
--_-Co.Address: // ii. 3:`'1 Ave /14,1u-1-'41.-- City: Jam..)( ,c A State:/--/ Zip: 3 27yZi
License Holder: moi,,,, / ; Ar ....." / S to Certification/Registration#: 4i/5 ?/Zf—??
Notarized Signature of License Holder ,fir
The foregoing instrument was acknowledged before me this 20 day of 0 GT 20 7(,in the State of Florida,County of by V ct
4
s`! CHRISTIAN GlLES Signature of Notary Public �%
,. ,; MY COMMISSION#HH 117153
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•:'�`;c` EXPIR&S:Apri113,2025 [ ] Personally Known OR[ roduced Identification
�OF �p`. BOrld9d Thtu Ny , e Type of Identification: F L- 0• L.