395 SKATE RD ERES23-0191 Electrical Permit Application **ALL INFORMATION
_��' HIGHLIGHTED IN
J "'' City of Atlantic Beach Building Department GRAY IS REQUIRED.
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\' 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: `?yS ck ' 42 PROJECT VALUE$ 20°
JEA INFORMATION REQUIRED ON ALL PERMITS: /So AMP0,17u VOLTS / PHASE
NEW SERVICE: ❑ Overhead ❑Underground ❑Underground up Pole
❑Residential (Main)Service:
❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Meters
❑Commercial (Main)Service:
❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps ❑CT Service amps
Conductor Type Size
❑Multi-Family(Main) Service:
❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Unit Meters
TEMPORARY POLE: amps
I SERVICE UPGRADE: ❑ amps ECT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES, ETC.):
,( ❑100 amps ❑150amps ❑200amps ❑ amps ECT Service amps
LJ ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
Outlets/Switches: 41 '41 1 0-30amps 31-100amps 101-200amps
Appliances: I 0-30amps 31-100amps 101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures: g----
OTHER
'"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 ❑OH 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
constru
Owner Na Tor- 1/
Owner Name: �� Z,r;4, Phone Number: '90`l S0 _2 S`J39
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Electrical Company: 7.1 e F(«71\,-;< Office Phone: q'1, X7/•-3,.$A;/1 Fax:
Co.Address: 2.3// ,/:-.;,,-... v-....-,"�.if 2/ City:' 14)6 State:,( Zip: ?- •2-2 y
License Holder: —Strv^s ii /.5 �/; State Certification/Registration#: /.fD/O/e'S
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this ( day of -- 20 nth-State of Florida,County of i( )vc-�
m=om a Signature of Notary Public -- Y .k
iii+,.?;* TONI GINDLESPERGER
•,` MY COMMISSION#GG 353178 I ) Personally
r.. Known OR Produced Identification
%;:,•"..-a•.,.. : EXPIRES:October 6,2023 , Type of Identification:
'O°,?4°'' Bonded Thru Notary Public Underwriters