705 ATLANTIC BLVD UNIT 2 ELPP22-0019 BE-IN BRIDAL 4 � L
tir; Electrical Permit Application **ALL INFORMATION
HIGHLIGHTED IN
111r ' City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 moi_ P(�Z Z -00\
n
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
J, B ADDRESS: �° S e A-9 . PROJECT VALUE$ k u , ,D C o c' ''
i' -c $JEA INFORMATION REQUIRED ON ALL PERMITS: AMPS 2- VOLTS PHASE
S
NEW SERVICE: 6verhead ❑Underground ❑Underground up Pole
❑Residential (Main)Service:
❑0-100 amps R1t1-150amps o151-200amps ❑ amps #of Meters
❑Commercial (Main)Service:
❑O-100 amps D101-150amps o151-200amps ❑ amps [ACT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
❑O-100 amps D101-150amps o151-200amps ❑ amps #of Unit Meters
n TEMPORARY POLE: amps
❑ SERVICE UPGRADE: ❑ amps DCT Service amps
❑ NEW FEEDER(ADDITIONS, ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps ❑200amps ❑ amps DCT Service amps
❑ ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
Outlets/Switches: 3 " 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 ❑Sign ❑Smoke Detectors (Qty) ❑Transformers KVA ❑Motors HP
n FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
n 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: Ftiak-r‘1e 6 t�G1c\t -j s Phone Number: 4-131 — Z- - 5 Z 3'
Electrical Company: 'fr^`L k rc 4.. A-.. '' " ( Office Phone: `A o'-\- Z"S-I - 4 I.t Fax:
Co.Address: \S.2 l 1 ry v c-,z...e s $ f2 P City: f`tr.i,.,t-.J n: w/- State: r-L Zip: -i 2 0 3 4-
License Holder: R -r'``c. v K- Trt State Certification/Registration#: V CZ-o o o to e t co
Notarized Signature of License Holder ��
r
o led ed before me this 2/ day o 'ik a , 0. A. the a of Florida,County of O✓Uc..-(
. Y•'�''•• TONI GINDOESPERGER �_
' ',,, : Signature of Notary •-. c
t MY COMMISSION#GG 353178
'`;ice' EXPIRES:October 6,2023 ersonally Known OR[ ] Produced Identification
,�of F.... Bonded Thru Notary Public Underwriters
«..�.:...�„„ Type of Identification: