2061 Beach Ave SFR ELEC 2013 CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
JF3 )r�
Application Number . . . . . 13-00002633 Date 5/08/13
Property Address . . . . . . 2061 BEACH AVE
Application type description ELECTRIC ONLY
Property Zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 0
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Application desc
NEW SERVICE
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Owner Contractor
------------------------ ------------------------
SHAW RICHARD AND MIMI TRUST ADKINS ELECTRIC INC.
2061 BEACH AVE 10477 NEW KINGS RD
ATLANTIC BEACH FL 322335934 JACKSONVILLE FL 32219
(904) 765-1622
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Permit . . . . . . ELECTRICAL PERMIT
Additional desc . . NEW 300 AMP SERVICE
Permit Fee . . . . 145 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 11/04/13
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Other Fees . . . . . . . . . STATE ELEC DCA SURCHARGE 2 . 18
STATE ELEC DBPR SURCHARGE 2 . 18
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 145 . 00 145 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 36 4 . 36 . 00 . 00
Grand Total 149 . 36 149 . 36 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC: BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
From: FAXmaker To: 2475845 Page:3/3 Date: 5/8/2013 9:59:25 AM
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach,FL 32233
�Ph(904)247-5826 Fax(904) 247-5845
.TOB ADDRESS: o�D l2 t �C—�- � PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS �t30 AMPS Sfp VOLTS Sri PHASE
VALUE OF WORK S
NEW SERVICE ❑ Overhead El Underground WT Underground up Pole
❑Residential(Main)Service
110-100 amps ❑101-150amps ❑151-200amps ❑ T66R amps #of Meters
❑Commercial(Main)Service
00-100 amps D 101-150amps ❑151-200amps ❑ amps OCT 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 0 CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
0100amps 0150amps 0200amps ❑ amps OCT 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
AIC Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
❑Swimming pool ❑ Sign ❑Smoke Detectors Qty ❑Transformers KVA ❑Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change ❑OH 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 M-1./IX `J l [J✓ Phone Number
Electrical Company Qmrj'S C LAGCT23X_ -INC1 Office Phone XP5. 1fi a-2., Fax
Co.Address: *=IN'S City State CYL Zip SMIT
License Holder(Print): UZZ1,0XI, i State Certtificaattio gistration# FIG 1
Notarized Signature of License Holder
R
o ate of Florida ornand ubscribed before e this day of 20 3
? ms
< DD908784 gnature of Notary Public
cr 013
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From: FAXmaker To: 2475845 Page:3/3 Date: 5/8/201310:46:33 AM
BUILDING CONTRACTOR AND OWNER
TOP PORTION;MUST BE COMPLETED FIRST
We will not allow the building to be occupied until the electrical has been final inspected and final Building Inspection,C.O.,T.C.O.,
or A.C.O.is approved.Violation of this agreement will result in an immediate disconnection of electrical power.
we are aware of being subject to prosecution under Chapter 1 of the Florida Building Code and the associated local municipal codes.
Building Qualifying Agent(Print) (JL4S�d4)
Property Owner Name(Print)Enerson
Signature
Signature
Address Phone 9
State of
State of
The County of The County at
Sworn to and subscribed before me Sworn to and subscribed before me
this day of
this day of
'0
20
Personally known^ID
Personally known—ID Notary Public
Notary Public State of Florida
State of Florida My Commission Expires
My Coaurusgion Expires
NOTARY PUBLIC
NOTARY PUBLIC
ELECTRICAL CONTRACTOR
BUILDING OCCUPIED yes no
DATE: Electrical Co.
14
Name of Job "NQ •�j� �Q`'y
Mr,Jimmy Douglas,Supervisor
Electrical Inspections Address:
City Hall {
220 E.Bay Sheet,Room 100 Permit#
Jacksonville,Florida 32202
Dear Sir.
for the address listed above be cut on for testing purpose only.
[respectfully request that temporary power 'ble for
I will be rtsponst
and completion of the Jobg that moy occur due to the energizing of the service prior
I acknowledge by my signature below drat
to the final electrical inspection,and the approval
It is the customer responsibility to make application for power with the Utility Company. /"�' �
1
Signature
Electrical Qualifying Ageenn(tt Name(Printed or Typed)
State of
The County of_ �
Sworn to and subscribed before me
this eT5ay of
.�
20-15 .
Personally known I-/— ID
Notary Public
State orFloridaovpr v Notary Public State of Florida
tyly Commission Expires _ : Angela M Williams
,�� My Commission DD908754
art„ >Btegr;etrormaramp.doe 7OFno Expires 08/27/2013
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