540 royal palm dr eres22-0157 ALL
* INFORMATIONElectrical Permit Application HIGHLIGHTEDIN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 ZZ,kE5 _Q 157
Phone: (9004) 247-`5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: S 0 1�-uti� 1 ��1�"`5 C�r• PROJECT VALUE $ Z U✓o t�
JEA INFORMATION REQUIRED ON ALL PERMITS:1,00 AMPS NO VOLTS I PHASE
P"NEW SERVICE: 0"Verheod ❑Underground []Underground up Pole
_;gfe-sidential(Main)Service:
D0-100 amps 0101-150amps 51-200amps ❑ amps #of Meters
❑Commercial(Main)Service:
❑0-100 amps [3101-150amps [1151-200amps ❑ amps [JCT Service amps
Conductor Type Size
E3Multi-Family(Main)Service:
❑0-100 amps [1101-150amps []151-200amps []_amps #of Unit Meters
17 TEMPORARY POLE: amps
SERVICE UPGRADE-
Z?i60 amps ❑CT Service amps
❑ NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps []200amps ❑ amps []CTService 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):
Qty volts/amps
❑ REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection �anel Change ❑OH to UG
Updated 10/17/18
❑Dther:
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: -kAVf'i Phone Number:
Electrical Company: 1I,.�yl /����G ✓�L • Office Phone: ;f / � 26775 Fax:
Co.Address: U7- !l
1-b�14 b`1 W OX. A" City: 0�. StateA.—Zip: 7073
License Holder: '� ✓� State Certification/Registration#: G(® S(z
Notarized Signature of License Holder
The foregoing instrument was acknowle a before me this Jday of 0 in the State of Florida County of
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a
KITTY COOK
- Signature of Notary Pu
•• *' MY COMMISSION#GG 953197 Personally Known ]Produ entification
EXPIRES Jatnuery 29.2024
,.�. ,�3 �� ���� . Type of Identification:
Notary
MMh�y• f