84 Nicole Ln. ERES22-0032 Electrical Permit Application HIGHLIGHTED
ON
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 ERCS2 Z 'C�o3 z
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMITfb
JOB ADDRESS: 84 Nicole Lane PROJECT VALUE $$ 1,500.00
JEA INFORMATION REQUIRED ON ALL PERMITS: 200 AMPS 240 VOLTS 1 PHASE
❑NEW SERVICE: [3 Overhead OUnderground OUnderground up Pole
Mitesidentlal(Main)Service:
130-100 amps 0101-150amps E3151-2DOamps CL--amps #of Meters
OCommercial(Main)Service:
00-100amps 0301-150amps 0151-2DOamps E amps OCT Service amps
Conductor Type Size
OMuRI-Famlly(Main)Service:
EID-100 amps 0301-150amps 0351-200amps CL-amps R of Unit Meters
❑TEMPORARY POLE: amps
❑SERVICE UPGRADE:❑ amps ❑CTService_amps
❑ NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.):
O100amps 0150amps )3200amps 0 amps MService_amps
❑� ADDITIONS,REMODELS, REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
Outlets/Switches: 10 0-30amps 31-100amps 101-200amps
Appliances: 1 0-30amps 1 31-300amps 101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: R circuits @ kw
Number of Lighting Outlets, Including Fixtures: 8
OTHER ELECTRICAL PROJECTS:
[)Swimming Pool❑Sign ❑Smoke Detectors (Qty) E]rransformers KVA ❑Motors HP
❑FIRE ALARM SYSTEM(Requires 3 sets of plans):
Qty volts/amps
REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can OSafety Inspection ❑Panel Change ❑OH to UG
❑Jther: updoredm/v/ta
Permit becomes void N 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: Scott& Jennifer Fortune Phone Number: (004)525-5522
Electrical Company: Island Electric Office Phone:1swl�s Fax:
Co.Address: 628 5th Ave N City: lax Bch State: FL Zip: 32250
License Holder: Johnson Reeo State Certification/Registration n: EC13007394
Notarized Signature olticense Holder Ay ij ma) B-
dged before me thisL-Co—da of Q b the State of Florida,County of
, ;.'j.3; TONI GINDLESPERGER
MY COMLIISSIONq GG 353178 Signature of Notary Public
�. .ii EI(PIRES:Odobar 6,2023
•:$a;rv^'' 6aneaEnw NowyPuNkuaE°nx6°rs [ ]Personally Known OR Produced Identification
Type of Identification: n-t _