872 AMBERJACK LN - ELECTRICAL e.)� CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
7.5111 _ _.• - 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-2683
Job Type: ELECTRIC ONLY
Description: 70 FIXTURES
Estimated Value:
Issue Date: 11/13/2015
Expiration Date: 5/11/2016
PROPERTY ADDRESS:
Address: 872 AMBERJACK LN
RE Number: 171146-0000
PROPERTY OWNER:
Name: MCKENZIE, JEROME & CHARLENE, *
Address: 509 CAMELIA ST
GENERAL CONTRACTOR INFORMATION:
Name: JAX ELECTRICAL CONTRACTING INC
Address: 1839 LANE AVE SUITE 110 PAUL KEANE
Phone: - -
FEES:
Lighting Outlets, Including Fixtures $42.00
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $101.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
gi n Ph (904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: 2- A t32_\AcK L,J PERMIT #
,4 I Lc; C6 c c i 3 zz 33
JEA INFORMATION REQUIRED ON ALL PERMITS 2o° AMPS 2 LW VOLTS / PHASE
VALUE OF WORK$ 1507
NEW SERVICE ❑ Overhead ❑ Underground nl Underground up Pole
Residential(Main) Service
0-100 amps 101-150amps 151-200amps amps # of Meters
Commercial(Main) Service
0-100 amps 101-150amps 151-200amps 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 CT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: (pt) 0-30amps 31-100amps 101-200amps
Appliances: 2._ 0-30amps 31-100amps 101-200amps
A/C Circuits: [ 0-60amps 61-100amps
Heat Circuits: I # circuits @ S' 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 Panel Change OH to UG
- ,
Other: Q ri, a I 're,...)..-t /�e t.: .c-e +L., re,,+,,_,_,, 44.4 e S
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 SALTM WO iftl time . Phone Number q0i(- 33-660
Electrical Company .100( -Cie c. 1 c- 4( eon 'rcJ ),-,s, .1"c_Office Phone 203 Sf'6 0 Fax 3 7`/06 70
Co. Address: ZO17 LA-1 e Ave- S, Cityf t cksoA viI4 State F7. Zip 12.2 it-D
License Holder(Print): I—av 1 free^ e tate rtification/Registration#6.03oo 6`l 3 6
Notarized Signature of License Holder
O�F ?J i , Malaea Robidart Sworn and subscribed before me this � day of r�IP r vkQX 20 (T
' = COMMISSION 01:F230743 EXPIRES: May 14, 2019 Signature of Notary Public
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