1911 CREEKSIDE CIR 2014 SAFET INSPECTION ELEC ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: 1 R\1 L e-Lks!S�AC t-cue PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS 1,5-D AMPS Z`� VOLTS PHASE
VALUE OF WORK S r
NEW SERVICE LVJ Overhead ❑ Underground ❑T Underground up Pole
Lv4esidential (Main) Service
LJO-100 amps i 1101-150amps E 151-200amps 1-1_amps # of Meters
7Commereial (Main) Service
110-100 amps a 101-150amips 151-200amps L! amps ='CT Service amps
Conductor Type Size
Multi-Family(Main) Service
L.IO-100 amps -101-150amps L 151-200amps '7 amps # of Unit Meters
Temporary Pole ❑ amps
SERVICE UPGRADE1.� amps El CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
I 1100 amps ! 1150amps !200amps 7— amps 1'ICT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES, ETC.
Outlets/Switches: 0-30amps 31-100amps 101-200amps
Appliances: 0-30amps J 3 1-1 OOamps �l 01-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ _kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
C1 Swimming Pool C Sign FI Smoke DetectorsQty i-iTransformors KVA Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans) VALUE OF WORK S
Qty volts/amps
REPAIRS/MISCELLANEOUS
Replace Burnt/Damaged Meter Can NSafety Inspection F-IPanel Change ❑OH to UG
LJ 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 Owtn, Phone Number
Electrical Company ( 4r clroq
Office Phone Irk"Z)o'O+ i rax gots- -3(),()t430
Co. Address; l l� (U ��^n � -e lv^ City S�• dw�,+,ti,e —State a—Zip 3Za`r
'l State Certification/Registration#EL130u,6S-�I
License Holder (Print):
Notarized Signature of License Holder
WY810*8 worn and ubscribed before me this day of 20 t
MY COMMISSION w 2018
! '• EXPipEB:May 265,,2416
6wedTnruNotary KwicunderwrUm ignature of Notary
T00 XVJ Cb:TZ CTOZ/OC/TO
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
;. '. ELECTRICAL PERMIT INSPECTION PHONE LINE 247-5814
•^'i ALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMA
Job - -
Job Type: ELECTRIC ONLY
Description: SAFETY INSPECTION
Estimated Value:
Issue Date: 10/23/2014
Expiration Date: 4/21/2015
PROPERTY ADDRESS:
Address: 1911 CREEKSIDE CIR
RE Number: 172020-1214
PROPERTY OWNER:
Name: OWENS ET AL, LAURI A
Address: 1911 CREEKSIDE CIR 1911 CREEKSIDE CIR
GENERAL CONTRACTOR INFORMATION:
Name: PREMIER COMMUNICATIONS GROUP INC
Address: 110 Cumberland Park Dr Ste 109 ST STE 109
Phone: - -
FEES:
State Elec DCA Surcharge $2.00
Electrical Repairs $35.00
Trade Permit Base Fee $55.00
State Elec DBPR Surcharge $2.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.