160 MAGNOLIA ST ELEC St, 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-1817
Job Type: ELECTRIC ONLY
Description: OVERHEAD TO UNDERGROUND
Estimated Value:
Issue Date: 7/29/2015
EVImbon Date: 1/25/2016 _ _
PROPERTY ADDRESS:
Address: 160 MAGNOLIA ST
RE Number: 170616-5000
PROPERTY OWNER:
Name: PASKO TRUST, PAULA & FRANK,
Address: 13692 VICTORIA LAKES DR
GENERAL CONTRACTOR INFORMATION:
Name: DEPENDENT ELECTRIC INC
Address: 6360 LOUIS CLARK CT BRYAN SCOTT CAMERON
Phone: - - -
FEES:
State Elec DBPR Surcharge $2.00
Electrical Repairs $35.00
Trade Permit Base Fee $55.00
State Elec DCA Surcharge $2.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: 6o nrn4� PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS 2�(U VOLTS PHASE
VAL F WORK$
NEW SE E ❑ Overhead Underground ❑J Underground up Pole
�ntial(Main) Service
❑0-100 amps ❑101-150amps 51-200amps =1 amps #of Meters
❑Commercial(Main) Service
x:70-100 amps ❑101-150amps 01151-200amps ❑ amps ❑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.)
❑100 amps ❑150amps ❑200amps ❑ amps [I CT 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 VAL UE OF WORK$
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can FI Safety Inspection ]Panel Change C_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
•ead 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
>pecified 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
;onstruction.
?roperty Owners Name Phone Number
3lectrical Company o en "&"-- 1p_` rL�{ L Office Phone
�o. Address: City State Zip
Acense Holder (Print): Q"' f r'c- State Certification/Registration# 0?/--3d 1"ee,
Votarized Si nature o License Holder
o09°u� Notary Public State of Florida efore me is'--, f 20
? Shirley L Graham
yc ` My Commission FF 086990
'�,,,� Expires 02/14/2018 ignature of Notary P