765 BONITA RD ERES22-0018 Y,...w.j`% ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
of
CITY OF ATLANTIC BEACH ERES22-0018
'' ISSUED: 1/28/2022
800 SEMINOLE ROAD
01;19-%"7 ATLANTIC BEACH. FL 32233 EXPIRES: 7/27/2022
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: VALUE OF WORK:
REWIRE HOUSE - CHANGE
765 BONITA RD ELECTRICAL RESIDENTIAL OVERHEAD TO $8000.00
UNDERGROUND
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171134 0000 ROYAL PALMS UNIT 01
COMPANY: ADDRESS: CITY: STATE: ZIP:
MCCLURE ELECTRICAL
CONTRACTORS 1521 Inverness Rd Fernandina Beach FL 32034
OWNER: ADDRESS: CITY: STATE: ZIP:
SIENKIEWICZ ROBERTJ JR 765 BONITA RD ATLANTIC BEACH FL 32233-4206
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT II\
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.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
ELEC REPAIRS AND MISC 455-0000-322-1000 0 $35.00
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
Issued Date:1/28/2022 1 of 2
ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
f
CITY OF ATLANTIC BEACH ERES22-0018
800 SEMINOLE ROAD ISSUED: 1/28/2022
ATLANTIC BEACH. FL 32233 EXPIRES: 7/27/2022
TOTAL:$94.00
Issued Date:1/28/2022 2 of 2
(._119'.
„Lv Electrical Permit Application **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: (RESZZ.-C I
JOB ADDRESS: -76 s 3 v. 1 r, C- PROJECT VALUE$ ill cow , 0 c
JEA INFORMATION REQUIRED ON ALL PERMITS: Z e 0 AMPS Z av VOLTS , PHASE
,�� ewer he�.4
L,CJ NEW SERVICE: ❑ Overhead underground oUnderground up Pole
U rva e�0-‘ ro o n
❑Residential (Main)Service: J
❑0-100 amps o101-150amps i 1 1-200amps ❑ amps U of Meters
❑Commercial (Main)Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps ECT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps #of Unit Meters
n TEMPORARY POLE: amps
❑ SERVICE UPGRADE: ❑ amps ECT 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: 0-30am ps 31-100amps 101-200am ps
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 ❑Sign ❑Smoke Detectors (Qty) ❑Transformers KVA ❑Motors HP
❑ FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
✓REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Cin ❑Safety Inspection ePranel Change EaOH to UG
❑Other: R-c. - ,c v-, c, c 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: (Z�6 c.,-,c.-c S t e rV i c '-' $ c Z Phone Number:
Electrical Company: 'Y`^ `� l_.-.•__e 1 t . -(-n, c r. } Office Phone: oto'{- Z-31
- 4-7°l Fax:
Co.Address: I.S Z t -1..‘.-”, S S to 0 City: Fc-,SNP I7 wa State: FL Zip: 3 2 c>3 4-
License
License Holder: 67.._.Y'^ic_L-a State Certification/Registration#: 1= A o 0- f e, i g
/
Notarized Signature of License Holder / _ ,... .lion
v -
The foregoing instrument was acknowledg-• before me this Z�ay o ,, 112 Ora e State of Florida,County of �JVV�.
TGNI GINDLESPERGER Signature of Notary Public �, i .
• SApY PUe('° _
`=MY COMMISSION#GG 353178 ] Personally Known OR[ ] Produced Identification
-'"77:-...f-
as, 0' E:PIRES:October 6,2023 Type of Identification:
":Fod c°P` Bcnded Thru Notary Public Underxrlte� YP