1777 Beach Ave elec 2014 � } CITY OF ATLANTIC BEACH
s�
S 800 SEMINOLE ROAD
;r ATLANTIC BEACH, FL 32233
ELECTRICAL PERMIT INSPECTION PHONE LINE 247-5814
ALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMA 121
Job - -
Job Type: ELECTRIC ONLY
Description: switches outlets
Estimated Value:
Issue Date: 10/2/2014
Expiration Date: 3/31/2015
PROPERTY ADDRESS:
Address: 1777 BEACH AVE
RE Number: 169676-0000
PROPERTY OWNER:
Name: ANDREWS, LEE
Address: 853 QUEENS HARBOR BLVD
GENERAL CONTRACTOR INFORMATION:
Name: LORE ELECTRICAL CONTRACTORS
Address:
Phone: - -
FEES:
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Switch Outlets $18.00
Trade Permit Base Fee $55.00
Total Payments: $77.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
7 Ph(904) 2/4477-582,66 Fax (904)247-5845
JOB ADDRESS: / C� I'T (L� ` PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS G'U AMPS `�U VOLTS PHASE
VALUE OF WORK$ 0-0 cD
NEW SERVICE ❑ Overhead ❑ Underground ❑J Underground up Pole
❑Residential(Main)Service
00-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Meters
❑Commercial(Main)Service
E10-100 amps ❑101-150amps [I151-200amps ❑ amps F1 CT Service amps
Conductor Type Size
❑Multi-Family(Main)Service
❑0-100 amps ❑101-150amps ❑151-200amps LI-amps # of Unit Meters
[I Temporary Pole ❑ amps
SERVICE UPGRADE ❑ amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps ❑200amps ❑ amps ❑CT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: Id 0-30amps 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: Zo
OTHER ELECTRICAL PROJECTS
[I Swimming Pool ❑ Sign [I Smoke Detectors_Qty ❑Transformers KVA Ll Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans) VALUE OF WORK$
Qty volts/amps
REPAIRS/MISCELLANEOUS
[]Replace Burnt/Damaged Meter Can El Safety Inspection ❑Panel Change L1 OH to UG
❑Other: S.�
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 iPIa'Zo S Phone Number
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Office Phone / L 3-/l�F Fax V3 ?0/,f
Electrical Company E- o
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(J �, City 6 State K Zip
Co.Address: �Z
License Holder(PrinS 'fication/Registration#(,!!C /3(�/3d Z
t): ar �
Notarized Signature of License Holder
Before e this day of u is State of Florida
Shirley L Graham
Signature of Notary Public
as Expires 02/14/2018