455 Selva lakes Cir - Electric only Panel Replacement .jyi�f\
�� '`� � v CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
j � m ;' 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 -398
Job Type: ELECTRIC ONLY
Description: panel replacement
Estimated Value:
Issue Date: 2/17/2016
Expiration Date: 8/15/2016
PROPERTY ADDRESS:
Address: 455 SELVA LAKES CIR
RE Number: 172027 -5016
PROPERTY OWNER:
Name: DICKERSON, ROGER & SHELLEY K, *
Address: 425 E WOODHAVEN DRIVEE
FEES:
Trade Permit Base Fee $55.00
State Elec DCA Surcharge $2.00
State Elec DBPR Surcharge $2.00
Electrical Repairs $35.00
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: `J �5 c..)-6 Vier /. (- l PERMIT
JEA INFORMATION REQUIRED ON ALL PERMITS / J
�s�/ AMPS C VOLTS f PHASE
VALUE OF WORK $ /
NEW SERVICE 1 1 Overhead 1 1 Underground nT Underground up Pole
C esidential (Mai 1 : • vi
00 -100 amps 0101-150a•• .s 0151- 200amps ❑ amps #of Meters
❑ Commercial (Main) ervice
00 -100 amps 0101- 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 @ k
Number of Lighting Outlets, Including Fixtures:
OTHER 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 0 Safety Inspection ❑Pane hange ❑OH to UG
r.....epCres
❑ Other: (...4_; U ` I i.U&: f " C d � 1 r .
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
ad 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
ecified 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
nstruction. � ( t C •operty Owners Name ' 1 , ` & ` t
� '' Phone Nu '7 '7 tuber 2 � ��
ectrical Company / 4W ". c _ O P V Office Pone 23 6 79 ax
). Address: a , �/ k �� City v State � Zip Y 2 - U
s re___,, A ense Holder (Print): � ,�c_ U t Z State Certification/Registration # /3 6o PG '0
?tarized Signature of License Holder �%���
� _ 411P_ w t
Before me this / day I 11 :T /V
Signature of Notary Pub ' va . '0
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