1158 VIOLET ST ELEC SAFETYCITY OF ATLANTIC BEACH
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-1060
Job Type:
ELECTRIC ONLY
Description:
ELECTRIC SAFETY 200AMP, 240VOLTS, SGL PH
Estimated Value:
Issue Date:
5/5/2015
Expiration Date:
11/1/2015
PROPERTY ADDRESS:
Address:
1158 VIOLET ST
RE Number:
171010-0007
PROPERTY OWNER:
Name:
PETERSON ET AL, CONNIE
Address:
1158 VIOLET ST
GENERAL CONTRACTOR INFORMATION:
Name:
JAX ELECTRICAL CONTRACTING INC
Address:
1839 LANE AVE SUITE 110 PAUL KEANE
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
.TOB ADDRESS: 1 (s � V o It_f PERMIT #
JEA INFORMATION REQUIRED ON ALL PERMITS 900 AMPS -7-10 VOLTS
NEW SERVICE ❑ Overhead
❑Residential (Main) Service
110- 100 amps ❑ 101-150amps
❑Commercial (Main) Service
00-100 amps ❑ 101-150amps
Conductor Type
❑Multi -Family (Main) Service
110- 100 amps ❑ 101-150amps
❑Temporary Pole ❑ amps
SERVICE UPGRADE
VAL UE OF WORK $ Z o
❑ Underground ❑T Underground up Pole
Size
❑ 151-200amps ❑ amps # of Meters _
❑ 151-200amps ❑ amps OCT Service
❑ 151-200amps ❑ amps
❑ amps ❑ CT Service amps
NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.)
❑ 100 amps ❑ 150amps ❑200amps ❑ amps OCT Service
PHASE
# of Unit Meters
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 ❑ Transformers
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps
REPAIRS/MISCELLANEOUS
El Replace Burnt/Damaged Meter Can
❑■
KVA Motors
VALUE OF WORK $
afety Inspection []Panel Change ❑OH to UG
hp
amps
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 O 1.',ee �,- q �t Phone Number 333 G 6 O 7
Electrical Company J 4X tin Office Phone '4'0'3 9' 3 fs y Fax
Co. Address: 2_o17 �-��� A U Ve S City _1_�c K51-1 StateF1 Zip 3 2 2 / 0
License Holder (Print): ?.�` Keck—'- State Certification/Registration # CfZ 13 o) 4Z3 1
Notarized Signature of License Holder
JENNIFER WALKER
`CL
s.: .: MY COMMISSION 9 FF 011480
EXPIRES: April 24, 2017
VIX Bonded Thru Notary Public Underwriters
Befo.
Sign
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845
JOB ADDRESS:
PERMIT #
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS
NEW SERVICE ❑ Overhead
[]Residential (Main) Service
❑0-100 amps ❑ 101-150amps
[]Commercial (Main) Service
❑0-100 amps ❑ 101-150amps
Conductor Type
[]Multi -Family (Main) Service
❑0-100 amps ❑ 101-150amps
❑Temporary Pole ❑ amps
SERVICE UPGRADE
VALUE OF WORK $
❑ Underground ❑T Underground up Pole
Li 151-200amps ❑ amps # of Meters
❑ 151-200amps ❑ amps [I CT Service amps
Size
L 151-200amps ❑ amps # of Unit Meters
❑ 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: 0-3 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 ❑ Transformers
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps
KVA ❑Motors
VALUE OF WORK S
REPAIRSIMISCELLANEOUS
❑ Replace Burnt/Damaged Meter Can ❑ Safety Inspection ❑ Panel Change ❑ OH to UG
❑ Other:
hp
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
Electrical Company
Co. Address:
License Holder (Print):
Notarized Signature of License Holder
Before me this day of
Signature of Notary Public
Phone Number
Office Phone Fax
City
State Zip
State Certification/Registration #
Iff