327 5TH ST ELEC sss
CITY OF ATLANTIC BEACH
' 800 SEMINOLE ROAD
j ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 14-ELEC-671
Job Type: ELECTRIC ONLY
Description: SWIMMING POOL
Estimated Value:
Issue Date: 12/17/2014
Expiration Date: 6/15/2015
PROPERTY ADDRESS:
Address: 327 5TH ST
RE Number: 169860-0100
PROPERTY OWNER:
Name: BUCKLAND, JAMIE
Address: 327 5TH ST
GENERAL CONTRACTOR INFORMATION:
Name: HAZOURI ELECTRIC, INC.
Address: P O BOX 56559 QA ROBERT HAZOURI
Phone: - -
FEES:
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Swimming Pools $40.00
Trade Permit Base Fee $55.00
Total Payments: $99.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
2 Ph(904)247-5826 Fax (904) 247-5845
I
JOB ADDRESS: J 5� "A S �— PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE
VALUE OF WORK$
NEW SERVICE ❑ Overhead ❑ Underground ❑T Underground up Pole
❑Residential(Main) Service
❑0-100 amps ❑101-150amps ❑151-200amps []—amps #of Meters
El Commercial(Main)Service
00-100 amps ❑101-150amps ❑151-200amps Fl—amps ❑CT Service amps
Conductor Type-
Size
❑Multi-Family(Main)Service
❑0-100 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 ❑CT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 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:
OTHER ELECTRICAL PROJECTS
Li Swimming Pool ❑ Sign El Smoke Detectors_Qty ❑Transformers KVA 11 Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRSIMISCELLANEOUS
❑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 local law regulation construction or the performance of
construction.
Property Owners Name Phone Number Z 1 G — g 7 �( I
Electrical Company ,�`" a �'� F Office Phone Fax
Co.Address: -),of— h' �'` City S� ' State f Zip z
License Holder(Print): b f—, 1� v r State Certification/Registration# eq
Notarized Signature of License Holder
Before me this day of 20
Signature of Notary Public