300 5TH ST 2015 ELEC C,sl\ CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
oji 19
ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ELEC-632
Job Type: ELECTRIC ONLY
Description: SWITCHES
Estimated Value:
Issue Date: 3/18/2015
Expiration Date: 9/14/2015
PROPERTY ADDRESS:
Address: 300 5TH ST
RE Number: 169827-0500
PROPERTY OWNER:
Name: JERNAGAN 111, LOUIS R & HOPE V,
Address: 300 5TH ST
GENERAL CONTRACTOR INFORMATION: L CONTRACTORS
Name: SEASIDE ELECTRICA K GEISSMAN
Address: 12381 APPLE LEAF DR QA CLAIR
Phone:
FEES:
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Lighting Outlets, Including Fixtures $3.00
Trade Permit Base Fee $55.00
Total Payments: $62.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: 6)0 '�'M& PERMIT# S_-
JEA INFORMATION REQUIRED ON ALL PERMITS YOO AMPS ?-Y� VOLTS PHASE
VALUE OF WORK$ /
NEW SERVICE F-1 Overhead Underground Underground up Pole
[-]Residential(Main) Service
00-100 amps 0 101-1 50amps 0 151-200amps L! amps of Meters
Ll Commercial(Main)Service
LIO-100 amps F1 101-1 50amps L1 151-200amps O—amps EICT Service amps
Conductor Type Size
LIMulti-Family(Main)Service
00-100 amps 0 10 1-1 50amps 0 151-200amps _J_ainps #of Unit Meters
OTemporary Pole Fl_____amps
SERVICE UPGRADE Li—amps 0 CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
F1100amps F1150amps [1200amps 0 amps OCT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 5— 0-30amps 3 1-1 00amps _101-200amps
Appliances: 0-30amps 3 1-1 00amps 10 1-200amps
A/C Circuits: 0-60amps 6 1-1 00amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
OSwirmning Pool 0 Sign L1 Smoke Detectors_Qty 0 Transfortners KVA OMotors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty_volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
OReplace Bumt/Damaged Meter Can 0 Safety Inspection F!Panel Change 11 OH to UG
00ther: Y
�� 'J�—1 , I-FL& 't'o-
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 n C) Phone Number
Electrical Company 5�;�_c 14 C(,O- C" 41 4. TAj-. Office Phone.V��673T Fax.. �YZ-Atlq
Co.Address: le2f.20 -3 T-?'S- _ City 7D�Yi SDA, lh -e State Zip _?'Z z V
License Holder(Print): -- State Certification/Registration#
Notarized Signature of License Holder
ry Public state of Florida Before me this 210 1.!'>
1,0 Py,, Nota
0'4�11 lic
Shirley L Graham
my c mmission FF 086990 Signature of Notary Public
Exproes 02/14/2018