1757 OCEAN GROVE DR ERES22-0225 -:,, Electrical Permit Application **ALL INFORMATION
HIGHLIGHTED IN
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City of Atlantic Beach Building Department GRAY IS REQUIRED.
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,. ) 800 Seminole Rd, Atlantic Beach, FL 32233
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Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: l-7 57 CC.esti 1(70 V . PROJECT VALUE$ f,.. 2-0
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JEA INFORMATION REQUIRED ON ALL PERMITS: AMPS VOLTS PHASE
❑ NEW SERVICE: iverhead ❑Underground CI Underground up Pole
❑Residential (Main)Service:
❑0-100 amps o101-150amps X151-200amps ❑ -Z-C1`) #of Meters
❑Commercial (Main)Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps ❑CT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
❑O-100 amps o101-150amps 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 [ACT Service amps
❑ 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 ESign ❑Smoke Detectors (Qty) ❑Transformers KVA ❑Motors HP
n FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
ffritEPAIRS/MISCELLANEOUS: V�
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection Panel Change DOH to UG
❑Other: /,1,r5 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. 1
Owner Name: */U4'I 'e G wit,-Fe _57 Phone Number: �`t` 37,5 2- Q
Electrical Company: `V',}- al
( ;,✓r ( I, /C PC' Office Phone: '7(s6 - 3‘ 2 6 Fax:
Co.Address: 33A I q�v c�r'(€' r � T
/ City: f State: 6 Zip: 3 Z ' 4
License Holder: O/ /vrkt. O vvi Z Gt ik_ /� tate Certification/Registration#:
Notarized Signature of License Holder J7,yv '(--- A .
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The foregoing instrument was acknowledged before me thiL3 day oar' 0 'n a State ofjFlorida,_ County of �V Q__-
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;ot Y?u . TONT GINDLESPERGER Signature of Notary Public Q _ 1
-' ' `•s ,: MY COMMISSION#GG 353178
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EXPIRES:October 6,2023 -4-Personally Known OR[ ] Produced Identification
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� °`° f3andelfiru Notary Public underwriters Type of Identification:
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