587-1 BEACH AVE SAFETY 2013 ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
n Ph(904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: - [ — I /4 Il`� PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS ��d AMPS C;), VOLTS PHASE
VALUE OF WORK$
NEW SERVICE ❑ -O rhead ❑ Underground ❑J Underground up Pole
❑Residential(Main) Service
00-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Meters
0Commercial(Main) Service
00-100 amps ❑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 3 amps
SERVICE UPGRADE ❑ amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑15 amps 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 I Sign ❑Smoke Detectors_Qty ❑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 Safety Inspection Panel Change DOH to UG
Other:
Permit becomes void if work dons 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. n '
Property Owners Name l� O rO W 0 Phone Number
Electrical Company—\r" v� E, -C, /N Office Phone D407lo�a 11 Fax es!F6
Co. Address: A rl� City State �ip 35�
License Holder (Print): 1/ ' State e ' cat n/Registration#&koal,S/Iy
ood'�, e, 1g A Ider
?�• �`� Notary Public-St to of Florida
r• My Comm. Expire dui f tot s Sworn and subscribed befor me is _ day of 20
Commission # E 202003
e°:;`��• Signature of Notary Publi
Bonded Through National Notary Assn.
u
CITY OF ATLANTIC BEACH
i f 800 SEMINOLE ROAD
J
V� ATLANTIC BEACH,FL 32233
F INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00003082 Date 7/17/13
Property Address . . . . . . 587 BEACH AVE
Tenant nbr, name . . . . . . 587-1 GUEST HOUSE
Application type description ELECTRIC ONLY
Property Zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 0
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Application desc
SAFETY INSPECTION
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Owner Contractor
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KIRK & ANNE MARIE MOQUIN TRI COUNTY ELECTRICAL
2375 PONTE VEDRA BLVD S 11637 E. COLUMBIA PRK. DR
PONTE VEDRA BEACH FL 32082 JACKSONVILLE FL 32258
(904) 260-9669
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Permit . . . . . . ELECTRICAL PERMIT
Additional desc . Plan Check Fee . 00
Permit Fee . . . . 90 . 00 0
Issue Date Valuation
Expiration Date . . 1/13/14
----------- - ----- --
- -- - -----------
2 . 00
Other Fees-- . - . - . - . - . - . -
ees STATE ELEC DCA SURCHARGE
STATE ELEC DBPR SURCHARGE 2 . 00
_ ________ ----
Fee summary Charged
Paid Credited ----Due--
. 00
_ _ ----------
----- ----------
- . 00
Permit Fee Total 90 . 00 90 . 00 00 . 00
Plan Check Total . 00 . 00
Other Fee Total 4 . 00 4 . 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.