260 6th ST ERES22-0104 / **ALL INFORMATION
rt' 11/'j;, Electrical Permit Application HIGHLIGHTED IN
r y' « City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 7
J'111
;'`9,- Phone: (904) 247-5826/ Email: Building-Dept@coab.us PERMIT#: •E,R' ES G Z-oi 0
JOB ADDRESS: �bL SCG N- Si 4-t e I PROJECT VALUE$ `�C'
JEA INFORMATION REQUIRED ON ALL PERMITS: 2 VI AMPS 1 V VOLTS I PHASE
❑ NEW SERVICE: ❑ Overhead ❑Underground KOnderground up Pole
❑Residential(Main)Service:
❑0-100 amps D101-150amps o151-200amps ❑ amps #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
❑ TEMPORARY POLE: amps
❑ SERVICE UPGRADE: ❑ amps DCT Service amps
❑ NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps ❑200amps ❑ amps ❑CT Service amps
n ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
Outlets/Switches: 0-30a m 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 Can ❑Safety Inspection ❑Panel Change ,i1H-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 aut ority to violate the provisions of any other state or local law regulation construction or the performance of
construction. ,y !p Ktc 1 I-i),�� I
Owner Name: + '` 1 Phone Number:
Electrical Company: I SWt(ilc LZ-I-t L LL[L L L--4" Office Phone: /q 1 - i .9 Fax:
Co.Address: ()US ll J"-Ge S-c`" City: A l' ` State: 1 I Zip.:3 2 2 CC'
License Holder: -�iV`' 9 fi f - State Certification/Registration#: Lie/ 3: L c2j
4______
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this 4', day of LiA , 2' - fif the State of Florida,County of r)0 v'«,
r
Signature of Notary Public _ _Q le
1 :::,,„,,y,,,,,,, TONI GINDLESPERGER
[ rsonally Known OR[ ] Produced Identification
F.: lMY COMMISSION#GG 353178 Type of Identification:
' ;....A.-:'5; EXPIRES:October 6,2023
I
'SO ,,,, Bonded Thru Notary Public Underwriters