396 11th St 2015 New service rir�`Irlr' .
CITY OF ATLANTIC BEACH
11
�+ 800 SEMINOLE ROAD
r� ATLANTIC BEACH,FL 32233
v
INSPECTION PHONE LINE 247-5814
ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ELEC-309
Job Type: ELECTRIC ONLY
Description: NEW SERVICE
Estimated Value:
Issue Date: 2/10/2015
Expiration Date: 8/9/2015
PROPERTY ADDRESS:
Address: 396 11TH ST
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: ERICKSON ELECTRICAL CONTRACTOR
Address: 2807 ST JOHNS QA FRANK W ERICKSON
Phone: - -
FEES:
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
New Single Family Electrical $70.00
Trade Permit Base Fee $55.00
Total Payments: $129.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach,FL 32233
Ph(904) 247-5826 Fax(904) 12,47-5845
JOB ADDRESS: ' 1 ` �� ` Z 'r► 1 T Z PERMIT#
.01
JEA INFORMATION REQUIRED ON ALL PERMITS 1,0 _AMPS VOLTS PHASE
VALUE OF WORK$
NEW SERVICE ❑ Overhead [Underground ❑T Underground up Pole
❑Residential(Main)Service
[10-100 amps [1101-1 50amps /151-200amps []_______,amps #of Meters
❑Commercial(Main) Service
00-100 amps [I101-150amps El151-200amps ❑ amps [ICT Service amps
Conductor Type Size
[I Multi-Family(Main)Service s #of Unit Meters
[10-100-100 amps Ll 101-1 50amps 11151-200amps ❑ amp
[]Temporary Pole ❑ amps
SERVICE UPGRADE ❑ amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
100 amps ❑150amps ❑200amps El 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 KVA []Motors hp
❑Swimming Pool ❑ Sign ElSmoke Detectors_Qty Transformers
FIRE ALARM SYSTEM (Requires 3 sets of plans) VALUE OF WORK$
Qty volts/amps
REPAIRS/MISCELLANEOUS
[]Replace Burnt/Damaged Meter Can ❑Safety Inspection []Panel Panel Change OH to UG
❑Other:
eriod or work is suspended or abandoned for six months.
Permit becomes void if work does not commence within a six month pI 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. ��\-0 '1
y�� Phone Number
Property Owners Name
�/ ( PO
Electrical Company r�
lX,\( , h� �f , Office Phone \ 'A F
ax
AkUj",J[� State Zip
Co.Address: t��C"1 1`I �+ City�^ �( f '�70
License Holder(Print): � �4����-- �1'� State Certification/Registration#R
Notarized Signature of License Holder
Before me this day of 20
Signature of Notary Public