501 CLIPPER SHIP LN ERES22-0264 }; Electrical Permit Application **ALL INFORMATION
�S-Li.,:,,„..,, HIGHLIGHTED IN
�. 'j' City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 E(ZES7 Z z - CD2G4
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: p`1 FS a2—02-5)
JOB ADDRESS: Sb ! C ,t P e1r 54-1.:(9(9 Iyl PROJECT VALUE$ 2 0 c
JEA INFORMATION REQUIRED ON ALL PERMITS: /50 AMPS 2140 VOLTS / PHASE
❑ NEW SERVICE: ❑ Overhead ❑Underground ❑Underground up Pole
❑Residential (Main)Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps #of Meters
ECommercial(Main)Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps ECT Service amps
Conductor Type Size
'Multi-Family(Main)Service:
❑0-100 amps D101-150amps o151-200amps ❑ amps #of Unit Meters
n 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 3�
Number of Lighting Outlets, Including Fixtures: 9
❑ OTHER ELECTRICAL PROJECTS:
❑Swimming Pool ❑Sign ❑Smoke Detectors (Qty) oTransformers KVA ❑Motors HP
n FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
EPAIRS/MISCELLANEOUS:
oReplace Burnt/Damaged Meter Can oSafety Inspection anel Change ❑OH to UG
oOther: �k' Icy cct + e ifc e P-r-c,( L ( e c i/�c>,4'1C;� Lt'C 1'1 14) 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: /- Phone Number:
Electrical Company: S e 6 0-/-EC—I Vb CC( CCvt(-vA C Office Phone: goL( —1/3 Li -Cla Fax:
Co.Address: 3 5-6 5 sf i'cigib-i k`C bv- Al City: j et..i, State: Zip:3z2Lb
License Holder: 84-t ft a Leo- State Certification/Registration#: Cs' e-C 13011'-it
Notarized Signature of License Holder /'k. • I f/
The foregoing instrument was acknowledge before me this day o' er • /4.8 4rthe Sta a of Florida,County of
:o i; •.. TON;c `:DLE:>>pEMERGER Signature of Notary Public ' , C
o•% . MYCPI;tES aG620232021'rb PersonallyKnown ORProduced Identification
:`°;.+u�. o= -EXPIRES. ..?;,.,r6;;26g32023 [ ] l I
'jFOF:i„ 4onded'in'ru Nctz$'rl !ic Undekki aair rs Type of Identification: h ,