ERES22-0166 Applic Waters Electrical Permit Application **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
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800 Seminole Rd, Atlantic Beach, FL 32233 a000
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 0-0 16 6
JOB ADDRESS: �F_� � C`?82, 'V 19A0 V C /./ PROJECT VALUE$ kfo d
JEA INFORMATION REQUIRED ON ALL PERMITS:0-110 AMPS CV VOLTS � PHASE
NEW SERVICE: ❑ Overhead ❑Underground ❑Underground up Pole
)tResidential (Main)Service:
❑O-100 amps ❑101-150amps X151-200amps ❑ amps #of Meters
❑Commercial (Main)Service:
110-100 amps ❑101-150amps ❑151-200amps ❑ amps ❑CT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
❑O-100 amps ❑101-150amps D151-200amps ❑ amps #of Unit Meters
❑ TEMPORARY POLE: amps
❑ SERVICE UPGRADE: ❑ amps ❑CT 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: 0-30amps 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
❑ FIRE ALARM SYSTEM (Requires 3 sets of plans):
ty volts/amps
REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection anel Change ❑OH to UG
Updated 10/17/18
❑Other:
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 givegiu.thority to violate the provisions of any other state or local law regulation construction or the performance of
construction.
Owner Name:, hYt���`"L��� Phone Number: ` '��
Electrical Company: NL Office Phone: —E� ar
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Co.Address: 7J S City: Zip:
License Holder: '��2 / QState Certification/Registration#,e-_
Notarized Signature of License Holder
dged before me this day of 20'� n the State of Florida,County of 0.
JOHNSTON
My \\\
CO uJENN�W /N HH 057579 Signature of Notary Public
s.3 EXPIRES:October 27,20Y4
z+.i a,�• 8���"pd* ANer~ [ ] Personally Known OR
;�rVodu `dent[#ication
Type of Identification: r���