1941 SEMINOLE RD ERES23-0065 �S vL`!r/r;
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Electrical Permit Application **ALL INFORMATION
�g HIGHLIGHTED IN
City of Atlantic Beach Building DepartmentC GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 RE-S23-00
``'~ Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: Z3 a 97
JOB ADDRESS: / ' `/ f -C-e.-it- -L,L:/. PROJECT VALUE$ 2 D do
JEA INFORMATION REQUIRED ON ALL PERMITS:2cob AMPS 2/6 VOLTS ( PHASE
❑ NEW SERVICE: E Overhead ❑Underground ❑Underground up Pole
❑Residential (Main)Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps #of Meters
❑Commercial (Main)Service:
❑0-100 amps D101-150amps o151-200amps ❑ amps ❑CT Service amps
Conductor Type Size
❑Multi-Family(Main) Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps #of Unit Meters
❑ TEMPORARY POLE: amps
❑ SERVICE UPGRADE: ❑ amps ECT 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 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
Number of Lighting Outlets, Including Fixtures: /c'
❑ 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 ❑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: L u c c S Phone Number:
Electrical Company: .. v 4rx-r- 1.--) 1,-1...cif.-'t... Office Phone: !o 9 - 796- O/1/ Fax:
Co.Address: 2-2- 3 / - 3 6,,,-f S7 3/.J 3 2 2/C City: -Tc c CS 0-4 v, I(4 State: / f Zip: 3 2-2- I
License Holder: Si u M 2T- `- a .r.s State Certification/Registration#: FC 1 .Ob 3 2-7(
Notarized Signature of License Holder i%i r"' (/
The foregoing instrument was acknowledged before me thi-" day of 11971i0 : State of Florida,County of V- �t 1/� (
Signature of Notary Public I�,
;&!* TONI GINDLESPERGER
=,; ,A, : : MY COMMISSION#GG 353178 [ ] Personally Known OR[ ] Prod d Identification
EXPIRES:October 6,2023 Type of Identification: ��
FO°,.°� Bonded Thru Notary Public Underwriters