1758 W park ter panel chg le \ CITY OF ATLANTIC BEACH
f 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
]OB INFORMATION:
Job ID: 15-ELEC-2196
Job Type: ELECTRIC ONLY
Description: PANEL CHANGE
Estimated Value:
Issue Date: 9/16/2015
Expiration Date: 3/14/2016 —
PROPERTY ADDRESS:
Address: 1758 W PARK TER
RE Number: 172020-0360
PROPERTY OWNER:
Name: BELL SR TRUST, RICHARD W
Address: 1758 W PARK TER
GENERAL CONTRACTOR INFORMATION:
Name: DEPENDABLE ELECTRICAL
Address: 2009 S JIMMY LN MUKESH T VARDE
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: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904) 247-5845
.TOB ADDRESS: 1"I-GB Qo,,r���.� tae `' ' 'a'�O'^ �-�0"e-�^ PERMIT#
L
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS 2-'Lu VOLTS PHASE
VALUE OF WORK$ 6 000 . 00
NEW SERVICE ❑ Overhead ❑ Underground ❑T Underground up Pole
❑Residential(Main)Service
00-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Meters
❑Commercial(Main)Service
00-100 amps ❑101-150amps ❑151-200amps ❑ amps OCT Service amps
Conductor Type Size
❑Multi-Family(Main)Service
00-100 amps ❑101-15Oamps ❑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 OCT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-3 Oamps 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 KVA ❑Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection iXanel Change OOH to UG
❑Other: UlQ Acte lx.t �ru�wn v��e:�`� 'tv cm P'Q"'r
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 C_V---�S c Ai,"°o 0\ Phone Number S0- 9e0 - 3^0\
Electrical Company 'O-cie av-A-064- L'—VWa`V/`-S Office Phone 100K"53"k-S6k4 Fax
Co.Address: Zooal '"S"^^�^ti1 k-0wv` Q- City State- Zip
License Holder(Print): State Certification/Registration# GQ k3bkk S 38
Notarize 11i�
aeY P46� Notary Public State of Florida
Shirley L Graham Befor me this--s(�da of 20
�� My Commission FF 086990
'�+9F�nP Expires 02/14/2018
re of Notary Public-