345 4TH ST - ELECTRICAL „ r :\JJ
r !” ` ;\, CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
'�J;31 Wr
ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ELEC-704
Job Type: ELECTRIC ONLY
Description: 15 OUTLETS
Estimated Value:
Issue Date: 3/23/2016
Expiration Date: 9/19/2016
PROPERTY ADDRESS:
Address: 345 4TH ST
RE Number: 169837-0000
PROPERTY OWNER:
Name: MCCAWLEY, PETER V & INGRID D, *
Address: 320 5TH ST
GENERAL CONTRACTOR INFORMATION:
Name: GREEN BUILT CONSTRUCTION & DEVELOPMENT
Address: P 0 BOX 54007 JKVL FL 32245
Phone: - -
FEES:
Trade Permit Base Fee $55.00
State Elec DCA Surcharge $2.00
State Elec DBPR Surcharge $2.00
Lighting Outlets, Including Fixtures $9.00
Total Payments: $68.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACII ORDINANCES AND THE FLORIDA
BUILDING CODES.
I
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach,FL 32233
Ph(904)247-5826 Fax (904) 247-5845
JOB ADDRESS: 3' t y ('rVg! PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS 2°0 AMPS l2°f 2Y°VOLTS / PHASE
VALUE OF WORK$ d°a' ao
NEW SERVICE ❑ Overhead n Underground I v Underground up Pole
°Residential(Main)Service
00-100 amps 0 101-150amps ❑151-200amps U amps #of Meters
0Commercial(Main)Service
00-100 amps ❑101-150amps ❑151-200amps 0 amps OCT Service amps
Conductor Type Size
°Multi-Family(Main)Service
00-100 amps 0101-150amps °151-200amps ❑ amps #of Unit Meters
['Temporary Pole 0 amps
SERVICE UPGRADE 0 amps 0 CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps 0150amps 0200amps 0 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
O Swimming Pool 0 Sign °Smoke Detectors_Qty ❑Transformers KVA °Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps • VALUE OF WORK$ Z J.
REPAIRS/MISCELLANEOUS
°Replace Burnt/Damaged Meter Can Li Safety Inspection Panel Change OOH to UG
❑Other:
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
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
>pecified 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 af,„, p - ' °C/A"I' Phone Number 96Y - 200-9'74 3
3lectrical Company ® E ' RJ4. Office Phone Fax
L'o.Address: 36S3 �rG�� �� to 30(3' City 511 - State zip 3 Z Z 2 Y
_icense Holder(Print): g°f3&t2 DA1/44 S State Certification/Registration# /3o0 6 t4
Notarized Signature of License Holder rr^^
Before me this Z? da 4 A._! ,L_I,// 20 1 Y0
otr Poe%o Notary Public State of Florida r
Snlrley L Graham
7:c� , My Commission FF 086990 Signature of Notary Publi= — /
poi�`oQ. Expires 02/14/2018 ` //l O - 54 Z. ^6—