1907N Sherry Dr 2-14 Elec X
`1 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
'J ATLANTIC BEACH, FL 32233
ELECTRICAL PERMIT INSPECTION PHONE LINE 247-5814
J=� ALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job - -
Job Type: ELECTRIC ONLY
Description: 20 OUTLETS 200AMPS 240VOLTS 1 PHASE
Estimated Value:
Issue Date: 10/23/2014
Expiration Date: 4/21/2015
PROPERTY ADDRESS:
Address: 1907 N SHERRY DR
RE Number: 172020-0818
PROPERTY OWNER:
Name: GABRYNOWICZ, CDR
Address: 1907 NORTH SHERRY DR
GENERAL CONTRACTOR INFORMATION:
Name: LIMBAUGH ELECTRICAL CONTRAC
Address:
Phone: - -
FEES:
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Lighting Outlets, Including Fixtures $12.00
Trade Permit Base Fee $55.00
Total Payments: $71.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904)247-5845
JOB ADDRESS: IQO_1 9-1Pyrw T�-i VC, PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE
VALUE OF WORK 11 f0
NEW SERVICE ❑ Overhead ❑ Underground ❑T Underground up Pole
❑Residential(Main)Service
110-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Meters
❑Commercial(Main)Service
00-100 amps 1110 1-1 50amps ❑151-200amps ❑ amps 0 C Service amps
Conductor Type Size
[]Multi-Family(Main)Service
00-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Unit Meters
❑Temporary Pole ❑ amps
SERVICE UPGRADE ❑ amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps ❑200amps ❑ amps OCT Service amps
ADDITIONS,REMODEL,,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: I 0-3 Damps 31-100amps 101-200amps
Appliances: ,,— 0-30amps __ZG31-100amps 101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
❑Swimming Pool ❑ Sign ❑Smoke Detectors_Qty ❑Transformers KVA ❑Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection []Panel Change Ll 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. n
Property Owners Name[ � n n i c (%brvna_) (C one Number
Electrical Company M ��V i ccA COIItYGGti nl ce hone24 l-GO5l Fax
Co.Address: Z h �� • CityAt IC IC- tate L zip S2233
License Holder(Print): AAt State Certification/Registrown
Notarized Signature of License Holder 11
r t ' ay of ' `e, 20_
�+►"Y No. Notary Publictate of Florida
Barbara Kay4lWa4hy-e of otary Public CL_ "M_L�
�P My Commission EE 884631
N 'or wv` Expires 03/17/2017