2268 MAYPORT RD SAFETY INSPECTION CITY OF ATLANTIC BEACH
Il 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-1837
Job Type: ELECTRIC ONLY
Description: SAFETY INSPECTION
Estimated Value:
Issue Date: 7/30/2015
Expiration Date: 1/26/2016
PROPERTY ADDRESS:
Address: 2268 MAYPORT RD
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: CLG ELECTRICAL CONTRACTORS LLC
Address: 453 GRAMPIAN HIGHLANDS DR
_ 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: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: .22 68 Mp POeT Com, Idi 90 PERMIT#
A-fla44"c eeac ln , F-L 3 2 2 3 3
JEA INFORMATION REQUIRED ON ALL PERMITS /00 AMPS 2-1)0 VOLTS PHASE
VALUE OF WORK$ �
NEW SERVICE ❑ Overhead ❑ Underground ❑T Underground up Pole
`Residential(Main) Service
❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Meters
El Commercial(Main) Service
F10-100 amps ❑101-150amps ❑151-200amps ❑ amps ECT 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 I J CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps ❑200amps ❑ amps OCT 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 VALUE OF WORK$
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can Vafety Inspection ❑Panel Change ❑OH to UG
❑Other:
Pen-nit 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
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
,onstruction.
?roperty Owners Name �OO°/ 'et �J Phone Number 1710V 4 L/L /O 3 >f
?lectrical Company CG �' ��-l�nca� �►Ir'aL�' L� C Office Phone q� 6ZZ?x'79 Fax
.o. Address: ¢53 grdn�cart 'ffi h�ah�S City 0117f j0bn-s State FL Zip 322 9
License Holder (Print): CarIoS IOe State Certification/Registration# F2130)463oO
Notarized Si nature of i e : e lder
E0410:Py%, =eforeate of Florida efore me this da 20 )6 —t/ 14am FF 086990
18 ignature of Notary Pub