78 FORRESTAL ELEC CITY OF ATLANTIC BEACH
f 800 SEMINOLE ROAD
j ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB NFORMATION:
Job ID: 15-ELEC-1672
Job Type: ELECTRIC ONLY
Description: ELECTRICAL REPAIR - A/C FUSE
Estimated Value:
Issue Date: 7/15/2015
Expiration Date: 1/11/2016
PROPERTY ADDRESS:
Address: 78 FORRESTAL CIR
RE Number: 171754-0000
PROPERTY OWNER:
Name: RIVERA, ROMAN ANA CELIA
Address: 78 S FORRESTAL CIR
GENERAL CONTRACTOR INFORMATION:
Name: AMERICAN ELECTRICAL CONTRACTOR
Address: 5065 ST AUGUSTINE RD APT 13 QA EARL W. FRICK
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: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
From:9047371099 07/14/2015 09:57 0044 P.002/002
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (9104) 247-5845 i 5 --ELEc-1' &7z
.TOB ADDRESS: ` 0 c..�. ro,(y e5 f a l (? mf L PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS c W AMPS c94O VOLTS PHASE
VALUE OF WORK$ 1%6 . 0'*
NEW SERVICE ❑ Overhead ❑ Underground ❑l Underground up Pole
-.Residential (Main) Service
0-100 amps 101-150amps 151-200amps amps #of Meters
Commercial(Main)Service
0-100 amps 101-I SOamps ]151-200amps amps 1 CT 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.)
]OU amps --ISOamps !200amps amps :CTService 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 ITransformers KVAMotors 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 OH to UG
`' other: Pf o se `✓
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. �yQ
Property Owners Name q\'%V CX1--Q.. Phone Number `1y`��,r'
Electrical Company y l fan CJeW'A ea 1 O: n*roy i i% Office Phone 9W-%9-??1D�F!ax
Co. Address: �05% 3 C�(1, r City ! State 1Z— Zip c 0/�-
License Holder (Print): �5 �.- 4cation/Registration # �WjS314P
Notarized .f .
Signature o License Holder - 4L. . / '�
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6r� Notary public State of Fl°^de worn and subscribed fore a this_ y f� 20&
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'� g My Com�iallionEEt350790 .,FKT„r�.