19 N SARATOGA CIR SAFETY INSPECTION 2015 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
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ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ELEC-911
Job Type: ELECTRIC ONLY
Description: SAFETY INSPCETION
Estimated Value:
Issue Date: 4/20/2015
Expiration Date: 10/17/2015
PROPERTY ADDRESS:
Address: 19 N SARATOGA CIR
RE Number: 171792-0000
PROPERTY OWNER:
Name: BRANDT NOBUKO B ESTATE,
Address: POST OFFICE BOX 7239
GENERAL CONTRACTOR INFORMATION:
Name: GREEN BUILT CONSTRUCTION & DEVELOPMENT
Address: P O BOX 54007 JKVL FL 32245
Phone: - -
FEES:
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Electrical Repairs $35.00
Trade Permit Base Fee $55.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach, FL 32233
/�, Ph (904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: `�1 PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS 5) AMPS Z,40 VOLTS PHASE
VALUE OF WORK$�M
NEW SERVICE ❑ Overhead ❑ Underground ❑J Underground up Pole
❑Residential(Main)Service
00-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Meters
❑Commercial(Main) Service
00-100 amps ❑101-150amps ❑151-200amps ❑ amps OCT 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 0200amps ❑ amps OCT 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
❑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 OOH 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 Nama:�U)C JICIY) )2&Q;j:d.:btQ> a.��e n Phone Number -�
Electrical Company 0S L-k Office Phone Fax Q041 12�Q9$'
Co. Address:��DS 3� ► City Stat` Zip�3ZZ-Z-q
License Holder(Print : "''% State Certification/Registration#r::0.I?LW(.o4
Notarized Signature of License HoW
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