185 Pine St 2013 safety inspection t �Ly
�S r tju�
CITY OF ATLANTIC BEACH,
1 j 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
�. � INSPECTION PHONE LINE 247-5814
rR
Application Number . . . . . 13-00003498 Date 10/04/13
Property Address . . . . . . 185 PINE ST
Application type description ELECTRIC ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
----------------------------------------------------------------------------
Application desc
SAFETY INSPECTION
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
MITCHELSON THEO K III ELITE ELECTRICAL SERVICES LLC
185 PINE ST 11611 CAPE HORN AVE
ATLANTIC BEACH FL 322334011 JACKSONVILLE FL 32246
(904) 353-0190
----------------------------------------------------------------------------
Permit . . . . . . ELECTRICAL PERMIT
Additional desc . .
Permit Fee . . . . 90 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 4/02/14
----------------------------------------------------------------------------
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
JOB ADDRESS: �� PERMIT#
JEA INFORMATION QUIRED ON ALL PERMITS � AMPS L�VOLTS PHASE
VALUE OF WORK$
NEW SERVICE Overhead ❑ Underground ❑T 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 [I CT 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 El-amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps 11200amps ❑ amps [ICT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-3 Damps 31-l 00amps 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 ❑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 cal law regulation construction or the performance of
construction.
Property Owners Name 16e Ae Phone Number
Electrical Company s / �t �� L ffice Phone Tsx y�a Fax
Co.Address: IN7 ��� City_7A'1_r State f G Zip
License Holder (Print): d Atate rtific 'on/Registration#
Notarized Signature of License Holder
Before me this day of 20
Signature of Notary Public