455 Selva Lakes Cir - Electrical - Repair, 3 Fans, 10 Fixtures I's. f
\S 1 CITY OF ATLANTIC BEACH
-. , 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 INFORMATION:
Job ID: 16- ELEC -11
Job Type: ELECTRIC ONLY
Description: ELECTRICAL - REPAIR , 3 FANS, 10 FIXTURES
Estimated Value: $375.00
Issue Date: 1/5/2016
Expiration Date: 7/3/2016
PROPERTY ADDRESS:
Address: 455 SELVA LAKES CIR
RE Number: 172027 -5016
PROPERTY OWNER:
Name: DICKERSON, ROGER & SHELLEY K, *
Address: 425 E WOODHAVEN DRIVEE
GENERAL CONTRACTOR INFORMATION:
Name: WADE'S ELECTRIC SERVICE
Address: P O BOX 17237 QA WADE EUGENE KETCHUM
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 4/
• Ph (904) 247 -5826 Fax (904) 247 -5845 UO `ELEC. / 1
JOB ADDRESS: ( 55 SCE vet L.ak C-I/�cJ -Q PERMIT # l
i .-C21 "2.. Liu S i 4.)6te
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE
VALUE OF WORK $ 3 7 5
NEW SERVICE 1 1 Overhead rx Underground 1 U Underground up Pole
❑Residential (Main) Service
❑0 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps # of Meters
❑Commercial (Main) Service
❑0 - 100 amps D101 150amps 0151- 200amps ❑ amps OCT 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 0200amps ❑ amps ❑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:
)THER ELECTRICAL PROJECTS
❑Swimming Pool ❑ Sign ❑ Smoke Detectors Qty ❑Transformers KVA ❑Motors hp
IRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts /amps VALUE OF WORK $
EPAIRS/MISCELLANEOUS
❑Replace Burnt /Damaged Meter Can ❑ Safety Inspection ❑Panel Change DOH to UG
Nkcieti
.
PfOther: 3 ce1 l 1, .vf ; Z - l Cep f (5 ` /0 CIW Lerti) �S
unit 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
d 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
:cified or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the perfonnance of
istruction.
)perty Owners Name Phone Number
r
;ctrical Company id Qaes Elei4r7c. Servi ce t c _ Office Phone(q 513 0 9} ZZI - ?060
. Address: 7 6 O P [e4Suire y D/ Q- Cit T 2 cT'
State ( Zip 32 z2.5
ense Holder (Print): I JCJe — t • k /J 'lv/ 1 "1 State - rtification/Registration # CO 3 V 53
tarized Sign % , ;rij , ; �Iol �, 'r IJII i ��, �,,,/1 —, tNi` TONI GINDLESPERGER
".1Y COMMISSION i FF 924951 ,.■ _ MY COMMISSION # FF 924951
'WIRES: October 6, 2019 p s ore me this S da y of I ' 4 t ' ; " EXPIRES: October 6, 2019
,:.:i MN Notary Pubic UM _ � 1 r: TTuu Nosy Pubic Undenriters
4 Signature of Notary Public �rk& 011■„`r
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC REACH, FL 32233
PHONE (904) 247 -5855
Cashier Id: aspcust \atibbja
Receipt Date: 1/5/2016 2:40:11 PM
Receipt Number: 05 -68916
Job ID: 16- ELEC -i1 - ELECTRICAL - REPAIR ,
3 FANS, 10 FIXTURES EDRPR - State Elec DEP
R Surcharge $2.00
Job ID: 16- ELEC -11 - ELECTRICAL - REPAIR ,
3 FANS, 10 FIXTURES EDCA - State Elec DCA
Surcharge $2.00
Job ID: 16- ELEC -11 - ELECTRICAL - REPAIR ,
3 FANS, 10 FIXTURES EL18 - Electrical Repa
irs $35.00
Job ID: 16- ELEC -i1 - ELECTRICAL - REPAIR ,
3 FANS, 10 FIXTURES TP - Trade Permit Rase
Fee $55.00
Amount Due: $94.00
Tender Information: Check # 1150 $94:00 ,
Tender Type: CK
Tender Amount: $94.00
Change Due: $0.00