388 4TH ST ELEC CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814
30B INFORMATION:
Job ID: 16 -ELEC -1081
Job Type: ELECTRIC ONLY
Description: 30 FIXTURES REMODEL
Estimated Value:
Issue Date: 5/10/2016
Expiration Date: 11/6/2016
PROPERTY ADDRESS:
Address: 388 4TH ST
RE Number: 169826 -0000
PROPERTY OWNER:
Name: MODICA, TAMELA A
Address: 388 4TH ST
GENERAL CONTRACTOR INFORMATION:
Name: KNIGHT ELECTRIC LLC
Address: 908 S 11TH AVE QA MARK STEVEN KNIGHT
Phone: - -
FEES:
Trade Permit Base Fee $55.00
State Elec DCA Surcharge $2.00
State Elec DBPR Surcharge $2.00
Lighting Outlets, Including Fixtures $18.00
Total Payments: $77.00
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: 5visl '- f 5/ PERMIT #
VALUE OF WORK $
NEW SERVICE ❑ Overhead ❑ Underground rlJ Underground up Pole
❑Residential (Main) Service
❑0 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps # of Meters
[Commercial (Main) Service
00 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps [CT Service amps
Conductor Type Size
❑Multi- Family (Main) Service
00 -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 0 C Service amps
ADDITIONS, REMODELS,.REPAIRS, BUILD -OUTS, ACCESSORY STRUCTURES, ETC.
Outlets /Switches: (0 0- 30amps 31- 100amps 101- 200amps
Appliances: l4 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 El 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:
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 /Coc -e Phone Number
Electrical Company Nl c if Office Phone Fax
Co. Address: (p g• l / ' f S "' City VA • 1k)\ State 9 / Zip
License Holder (Print): L State Certification/Registration # Q 4'i 7 / AS;
Notarized Signature of License Holder
0 , ,taf Notary Public State of Florida � • • fore me this / D d• •' • i / ' ) R iI 20 / (Y
`ey 1_ Graham • try
cmmis i on FP 086990 1 g nature of Notary Pub c =�
fi -FF Exp, 02/14/2018
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