Permit Elec Safety 380 Seminole 2011 Ails -
4 4, , , 1 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
=� " INSPECTION PHONE LINE 247 -5814
-0f3
Application Number 11- 00003001 Date 12/14/11
Property Address 380 SEMINOLE RD
Application type description ELECTRIC ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
safety inspection
Owner Contractor
DUVAL HOME BUYERS LLC SAM'S ELECTRIC, INC.
941 WATERMAN RD S 467 W 67TH STREET
JACKSONVILLE FL 32207 JACKSONVILLE FL 32208
(904) 469 -4433
Permit ELECTRICAL PERMIT
Additional desc . SAFETY INSPECTION
Permit Fee 90.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 6/11/12
Other Fees STATE ELEC DCA SURCHARGE 2.00
STATE ELEC DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 90.00 90.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 94.00 94.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph (904) 247 -5826 Fax (904) 247 -5845 2
JOB ADDRESS: 3s- 0 $ 1, , r vt r✓ i t A cl` J PERMIT # (/ — ;J 00 1
JEA INFORMATION REQUIRED ON ALL PERMITS ZC--C AMPS , \ VOLTS 1 PHASE
VALUE OF WORK $ 3563 GG
NEW SERVICE L iJ- 'Overhead I ( Underground Ti Underground up Pole
L esidential (Main) Service
00 -100 amps ❑ 101- 150amps 51- 200amps ❑ amps # of Meters
❑ Commercial (Main) Service
00 -100 amps ❑ 101- 150amps ❑ 151 200amps ❑ amps 0 C Service amps
Conductor Type Size
❑Multi- Family (Main) Service
00 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps # of Unit Meters
❑Temporary Pole ❑ amps
SERVICE UPGRADE ❑ amps LI CT Service amps
NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.)
❑ 100 amps ❑ 150amps 0200amps ❑ amps OCT Service amps
ADDITIONS, REMODELS, REPAIRS, BUILD -OUTS, ACCESSORY STRUCTURES, ETC.
Outlets /Switches: 0 -3 Damps 31- 100amps 101- 200amps
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 ❑ Sign ❑Smoke Detectors _Qty El Transformers KVA ❑Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans & Fire Alarm Checklist)
Qty volts /amps VALUE OF WORK $
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can S a f ety Inspection ❑Panel Change ❑ to UG
❑ Other:
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.
Property Owners Name \) l '\ a, 6 e'r�" ``\ d'' Phone Number Y / `1 - ''j Co U
Electrical Company "je=,v' -\ 1 5 L 1 - e - —f `L' t ✓n l— - Office Phone lo''/ ` - ` - t`t 3 Fax
Co. Address: 1- { .i,-,' lt/ C ) fk 5 'F" 3 ).....), C S City .) " State P-- Zip 3 . CC"
License Holder (Print): . ' iM 1, kc � "I �' - State eertificationlRegistration # c l - 3 o/�f 1 7 4
Notarized Signature of License Holde i /-
.. so .nd subscribed befor e its / day o
2Q_ l/
o-j , " '„ DEBORAH AMANDA ITE
t t ,m, 4 mY COMMISSIONM E gaat e of Notary Public
r'.,,: EXPIRES: May 21, 2015
Bonded Thru Notary Public Underwriters / , / 2 . 3 7 r ' 7 , 5 V