65 19TH ST ELEC t
�J It CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
+� 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-1108
Job Type: ELECTRIC ONLY
Description: ELEC REPAIRS
Estimated Value:
Issue Date: 5/12/2015
Expiration Date: 11/8/2015
PROPERTY ADDRESS:
Address: 65 19TH ST
RE Number: 169723-1040
PROPERTY OWNER:
Name: SWEENEY,DAVID & PATRICIA,
Address: 65 19TH ST
FEES:
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Lighting Outlets, Including Fixtures $1.20
Trade Permit Base Fee $55.00
Total Payments: $60.20
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: �Q�� � 5 r 0.h��� f5-fQrt, F( �3 -Z33PERMIT #
JEA INFORMATION REQUIRED ON ALL PERMITS -'-(9 C AMPS Z 9 0 VOLTS ti PHASE
VALUE OF WORKS Z-00
NEW SERVICE ❑ Overhead ❑ Underground ❑1 Underground up Pole
Residential (Main) Service
0-100 amps 101-150amps 151-200amps amps # of Meters
.Commercial (Main) Service
0-100 amps - 101-150amps 1151-200amps amps - CT Service amps
Conductor Type Size
Multi-Family (Main) Service
0-100 amps ^101-150atnps 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 amps CT Service amps
A 1)DITIONS,REMODELS, REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES, ETC.
Outlets/Switches: 0-30amps 31-1 OOamps 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 & Fire Alarm Checklist)
Qty volts/amps VALUE OF WORK S
REPAIRS/MISCELLANEOUS
Replace Burnt/Damaged Meter Can Safety Inspection Panel Change 'i OH to UG
Other: �D�S "w l I ���ry10 Z 0 a) -,
�, �� r^c c-.F
Punct 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 t�I2 2. n �.1 Phone Number
/+ r
Electrical Company l_r' e Cfr7 Office Phone qo,)-7143-77,31 F�ax10q-7qJj d 3
Co. Address: Ei, 1t>v?c f�ZoLq �o,C)e.50,V ll�e Z, 2Z 39 City � CsckSEnyilfe State!'L, Zip:3 Z Z39
License Holder (Print): 'Al1141af( h 0JIIA State Certification/Registration 9 j5(�6On(ZZ31
:Notarized Signature of License Holden —��
.''.PRIL LYNN CREGG Sworn and subscribed before me this l 2 day of L; 2016
'CG�/MISSION#EE097149
_'<PIRES May 25,2015 Signature of Notary Public.___.
(407)';; F loiidallotaryService.com