2371 SEMINOLE RD ERES22-0194 Electrical Permit Application **ALL INFORMATION
HIGHLIGHTED IN
_ City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 322332l5
{� L22 �7
Phone: (904) 247-5826 Email: Buiiding-Dept@.coab.us PERMIT#: 'LRESZ2-dl`--)z
JOB ADDRESS: P -'7-1- I 5e-I`^t uo`�- 1Rci PROJECT VALUE$ `x'000 .r �y
IEA INFORMATION REQUIRED ON ALL PERMITS: ZOO AMPS 12v VOLTS 1 PHASE
Ti NEW SERVICE: 0 Overhead ['Underground ❑Underground up Pole L' 54-i05
EIResidential(Main) Service:
00-100 amps 13101-150amps 0151-200amps 0 amps #of Meters
❑Commercial (Main)Service:
00-100 amps 0101-150amps E1151-200amps ❑ amps OCT Service amps
Conductor Type Size
DMulti-Family(Main) Service:
❑D-100 amps 0101-150amps 0151-200amps 0 amps #of Unit Meters
n TEMPORARY POLE: amps
❑SERVICE UPGRADE: ❑ amps OCT Service amps
in NEW FEEDER (ADDITIONS,ACCESSORY STRUCTURES, ETC.):
0100 amps 0150amps 0200amps 0 amps ❑cT Service amps
Ti ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
Outlets/Switches: I 0-30amps 31-100amps 101-200amps
Appliances: '2 0-30amps 31-100amps 101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ kw ,i 4 cVeNI ex,- :.) e_ 1
Number of Lighting Outlets, Including Fixtures: V
C OTHER ELECTRICAL PROJECTS:
❑Swimming Pool['Sign OSmoke Detectors (Qty) ❑Transformers KVA OMotors HP
n FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
n REPAIRS/MISCELLANEOUS: )- ; ->c_Lc.N ` .` �
Replace Burnt/Damaged Meter Can OSafety 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: S O i_ 13 LkR I ` Phone Number:
s v
Electrical Company: 5 e ;c r' r
O C t�\;of $ L-L-L Office Phone: q"1 C)\--k '33q-53 15
1 Fax:
Co.Address: 1 15-- ''IAN ' k-sk City: -SAN, d C k state:CL Zip: 32 Z co
License Holder: 1�s.--)\APN i--I. N4 N-N-. `. Sttate�Certification/Registration It: L' i 1301 S aci
Notarized Signature of License Holder '_\ <-7-/- 1.,-t 1
41
The foregoing instrument was acknowledged be ore me this- day of /4--Kci ,201-Z- in the State ofaFlorida,County of�ctuf4 L
.u� Notary PuDlicSts�ofFlo lde Signature of Notary Public 1-(2 .1 l '-t
Beverly K Elias vv
My Comtni,uioo GG 315109 personally Known OR [ ] Produced Identification
�ei F.xpins siaks„s„
Type of Identification: