1165 Ocean Blvd ERES22-0261 PermitELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
n CITY OF ATLANTIC BEACH ERES22-0261
800 SEMINOLE ROAD ISSUED: 11/18/2022
3..... ATLANTIC BEACH. FL 32233 EXPIRES: 5/17/2023
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other
Rovernmental entities such as water management districts, state agencies, or federal agencies.
• • ADDRESS: PERMIT TYPE: DESCRIPTION:
1165 OCEAN BLVD ELECTRICAL RESIDENTIAL REMODEL UPSTAIRS ADDED $900.00
WIN. & DOORS
170276 0010
ATLANTIC BEACH
I• ADDRESS:
COOPER ELECTRICAL 89 CODY ST SAINT AUGUSTINE FL 32084
SERVICES LLC
•ADDRESS:
JASKIEWICZ ADAM 1165 OCEAN BLVD ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT Il�
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF . r
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
ELEC APPLIANCES FIXED OR STATIONERY 4550000-3224000 0 $000
ELEC LIGHTING OUTLETS, INCLUDING FIXTURES 455-0000.322-1000 20 $12.00
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-W 10�20IF0600 0 $2.00
Issued Date: 11/18/2022 1 of 2
INFORMATIONElectrical Permit Application HIGHLIGHTEDIN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 p
Phone: (904) 247-1I582`6` Email: Buildine-Dept@coa}b.us PERMIT #:
�RESZZ- bZ�
JOB ADDRESS: II �5 Diu -.0113 I+VW,L ht-LL,413 PROJECT VALUE$ `'1'm
JEA INFORMATION REQUIRED ON ALL PERMITS: ):jN AMPS b`Yo
VOLTS I_ PHASE
El NEW SERVICE: ❑Overhead ounderground ❑Underground up Pole
❑Residential (Main) Service:
❑O-100amps 0101-150amps n151-200amps ❑_amps
#of Meters
❑Commercial (Main) Service:
00-100amps o101-150amps c151-200amps ❑ amps
oCTSewice_amps
Conductor Type Size
oMuln-Family (Main) Service:
00-100amps 0101-150amps 0151-200amps damps
#of Unit Meters_
❑ TEMPORARY POLE: amps
❑ SERVICE UPGRADE: vamps oCT Service _amps
❑ NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps o2DOamps damps oCTService_amps
ADDITIONS, REMODEIS/REPAIRS, BUILD -OUTS, ACCESSORY STRUCTURES, ETC:
Outlets/Switches:— VT 0-30amps 31-100amps _101-200amps
Appliances: -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:
o5wimming Pool ❑Sign uSmoke Detectors (Qty) oTransformers KVA oMOton HP
❑ FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
❑ REPAIRS/MISCELLANEOUS:
oReplace Burnt/Damaged Meter Can oSafety Inspection oPanel Change oOH to UG
oOther: Updated 10/17118
1111�
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 lout law regulation construction or the performance of
construction. 1 � 9LII I SS
Owner Name: \ Q S hcLCt,JLC Phone Number: gkZ -6
Electrical Company: C�pr-� iz lUinLv) SWL�U.3 yLLC Office Phone: "1°t')'7 )��1 '� Fax:
Co. Address: �5 GoUy SZ City: IL, 414,9^ State:PL zip:lA.'Z
License Xoltler. � « Czeov� _State Certification/Registration #: %C I'So)Dl 6 /
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this 1�5ay of 2 k State of Florida, of a__X)If4
Signature of Notary Public
r
TONI GINDLESPERGER [ ]Personally Known OR [ ] lno u<ep Identification
Z. MY COMMISSION N GG 353178 Type of ldenORwtion: 44.J� (/
?`
:° EXPIRES: Cumber 6, 2023
,� `� BonOelIDrvNoaerPuOlic Untlerxrl;are