270 5th St ERES21-0261 Elec Int Remodel f"'% ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
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CITY OF ATLANTIC BEACH ERES21-0261
ISSUED: 10/28/2021
V' 800 SEMINOLE ROAD
�`rti9,' ATLANTIC BEACH. FL 32233 EXPIRES:4/26/2022
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
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: I VALUE OF WORK:
270 5TH ST ELECTRICAL RESIDENTIAL Electrical Fixtures: INTERIOR $9500.00
REMODEL & WOOD DECK
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172557 0000 ATLANTIC BEACH
TERRACE
COMPANY: ADDRESS: CITY: STATE: ZIP:
A & L ELECTRICAL 5757 HECKSCHER DR JACKSONVILLE FL 32226
CONTRACTORS
OWNER: ADDRESS: ,, CITY: STATE: ZIP:
KUROSKO STEVEN & 270 5th St ATLANTIC BEACH FL 32233
MEREDITH
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT If\
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.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
ELEC APPLIANCES FIXED OR STATIONERY 455-0000-322-1000 0 $2.00
ELEC LIGHTING OUTLETS,INCLUDING FIXTURES 455-0000-322-1000 3() $18.00
ELEC SWITCH AND RECEPTACLE OUTLETS 455-0000-322-1000 0 $15.00
Issued Date: 10/28/2021 1 of 2
-SLAV-r ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
r A )i CITY OF ATLANTIC BEACH ERES21-0261
, `" ISSUED: 10/28/2021
800 SEMINOLE ROAD
las> ATLANTIC BEACH, FL 32233 EXPIRES:4/26/2022
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$94.00
Issued Date:10/28/2021 2 of 2
Electrical)`"ermit Application
09cf **ALL INFORMATION
�s �lifHIGHLIGHTED IN
' City of Atla tic Beach Building Department GRAY IS REQUIRED.
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73
" 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERM�IT#:.W5C,�1 —Cis:: i
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JOB ADDRESS: 7 04n PROJECT VALUE $ , 5
JEA INFORMATION REQUIRED ON ALL PERMITS: AMPS
1z-
),CC `� VOLTS .- PHASE
IT NEW SERVICE: El Overhead ❑Underground ❑Underground up Pole
❑Residential (Main) Service:
00-100 amps D101-150amps D151-200amps El amps #of Meters
DCommercial (Main) Service:
00-100 amps 0101-150amps 0151-200amps 0 amps OCT Service amps
Conductor Type Size
❑Multi-Family(Main) Service:
❑3-100 amps 0101-150amps 0151-200amps ❑ amps #of Unit Meters
ri TEMPORARY POLE: amps
0 SERVICE UPGRADE: ❑ amps OCT Service amps
fl NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
0100 amps 0150amps ❑200amps 0 amps al-Service amps
❑ ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS, ACCESSORY STRUCTURES, ETC:
Outlets/Switches: ',i 0-30amps 31-100amps 101-200amps
Appliances: / 0-30amps 31-100amps 101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ J kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS:
❑Swimming Pool Sign ElSmoke Detectors (Qty) ❑Transformers KVA ❑Motors HP
n FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
n REPAIRS/MISCELLANEOUS:
OReplace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change DOH to UG
❑jther: updated l0/17/18
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. /� K
Owner Name: lj, 1E'r 1 f Ai 11-1 KL-ci.-,6trot:_ Phone Number: ('7/7 "/3y' 4 s'
Electrical Company: l") 4 4_, ESL (-LA i.._ Cc c.AL Y-`_, Office Phone: Oit-Ii\.) 3111.91Z ) Fax:
Co.Address: I 1`%C4' 15r_.-Xi—7t_) f'•,(1,-( he City: 1/4(..7?.: -44L1._1.1.— State: FL Zip: j2"V
License Holder: --._c03-71 IJ 1/01/L'N State Certification/Registration#: g<--/-300,570
Notarized Signature of License Holder //Z `
.. . oregoiniii+++%� C . -- •r owled:,�•-fore me this 2(6 day of C T- ,2021 , in the Sta f Florida, County of fl L( VA L.
... MY COMMISSION#HH 117163 (.1/14 ��il�
'•: Signature of Notary Public
EXPIR68:Apr1119 2026
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,;',:176:#`77� �
Bonded ThruNotary Pubic u ey [ ] Personally Known OR [ti lgduced Identification
Type of Identification: >L L_- n L _