383 3rd st 2015 elec j ,y J
CITY OF ATLANTIC BEACH
J
800 SEMINOLE ROAD
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: 15-ELEC-846
Job Type: ELECTRIC ONLY
Description: 3 fixtures
Estimated Value:
Issue Date: 4/14/2015
Expiration Date: 10/11/2015
PROPERTY ADDRESS:
Address: 383 3RD ST
RE Number: 169825-0100
PROPERTY OWNER:
Name: GAJEWSKI,THADDEUS J & MARIANNE,
Address: 383 3RD ST
GENERAL CONTRACTOR INFORMATION:
Name: BEACHES ELECTRIC SERVICES INC.
Address: 214 COKESBURY CT QA TODD ASTOR LOCKWOOD
Phone• - -
FEES:
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Lighting Outlets, Including Fixtures $1.80
Trade Permit Base Fee $55.00
Total Payments: $60.80
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
�-
113-3
Ph(90�) 247-5826 Fax (904)247-5845 /� � 2
JOB ADDRESS: 1 '3 � ��1 � �t PERMIT# :Z
JEA INFORMATION REQUIRED ON ALL PERMITS Z"o AMPS .Z_!(y VOLTS PHASE
VALUE OF WORK$
NEW SERVICE ❑ Overhead ❑ Underground ❑T Underground up Pole
❑Residential(Main)Service
❑0-100 amps 11101-1 50amps ❑151-200amps []-amps #of Meters
❑Commercial(Main) Service
00-100 amps 1110 1-15 Oamps ❑151-200amps ❑ amps OCT 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 El amps
OCT 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
❑Swimming Pool ❑ Sign ❑Smoke Detectors_Qty El Transformers KVA ❑Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans) VALUE OF WORK$
Qty volts/amps
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change El 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 l� SIC Phone Number
Electrical Company j Office Phone �o Z�1 (F Z Fax
oZ O
Co.Address: � �vf City C�C S State Zip
License Holder(Print): kc>ckok Sta
e istration#
Notarized Signature of License Holder
A, JENNIFER WALKER Before me this ay of r l 0
MY COMMISSION#FF 0'1480
_.:
y. EXPIRES:April 24,201 Signature of Notary Public
,t
d Bonded Thru Notary Public underwriters