645 OCEAN BLVD - ELECTRICAL PERMIT 05/13/2016 04:08 9042609688 TRICOUNTY PAGE 01/01
- . ELECTRICAL PERMS APPLICATION f
CI'T'Y OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach,FL 32233 ( c _ACC
Ph(904)247-5826 Fax (904)247-5845 #
JOB ADDRESS: A L-( ' . 0 C ea s : /1/.../
PERMIT
D ON ALL PERMITS .AMPS ? L2-•'VOLTS -
PtAS>
1 INFORMATION REQUIRED�0 „ %. VALUE OF WORK$ - -
Nov SE CS ❑ 'Overhead
Underground ❑T Underground up Pole
°Residential(Main) Service Q 151-200atnp9 0 _cps of Meters
❑0-100 amps Q 101-1 SOapctps
0Commercial(Main) Service p 151-200am s 0atnps OCT Service amps
DO-1,00 amps 0101-1SOantps
Conductor Type Size,_ p
❑Malti-Family(Main)Service # of Unit Meters
0-100 amps 0101-150amps 0151-200amps Q_ ^.�amps
tempOraryPole OO amps
•
SERVICE UPGRADE ❑_
cps 0 CT Service amps
NEW FEEDER(ADDr'I'IONS,ACCESSORY STRUCTURESETC.)
OCT Service amps
0100 amps O 150amps O200amps E.
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
' Outlets/Switches: I LP 0-30amps _ 31-100amps -----101-200a.mps
Appliances: —__ O-30amps -_ 31-100amps
A/C Circuits: � �0>60atrzps _G1-100amps ,
Heat Circuits: _ # circuits @ kw , l� r . "� •
Number of Lighting Outlets, Itleluding Fixtures: __12,. 1..,,.y
OTHER ELECTRICAL PROJECTS
❑Swimming Pool 0 Sign 0 Smoke Detectors ..Qty ❑Transformers. ,I(VA OMotors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans &fire Alarm Checklist) VALUE OF WORK Qty volts/amps .
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can 0 Safety Inspection °Panel Change 00H to UC3
00ther: - .. _
Permit becomes void if work does not commence within asix mAll ltrovilsiolns off'laws��and ordinances govern g this six
wo k wit!he oompiied�w�that
whetharhave
read this application and know the same to be true and corn p
specii'ied 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. r
Property Owners Name,_7o .r-/
G _ s/,,.-�'a �U Phone Number
Electrical Company
CV✓n Fie.C, • , _Office Phone .01,..-97,o 65 Fax,a-40,---2
Co. Address: 1.k 63,7 0. Co 1 v 4, + ,�,Jc p'7 . .T C ry e; ' State, Zip
License folder(Pent): Vi L . Wk( " 1 fate)Certification/)Z.egisn'ation# .5 4
Notarized Signature a License Holder
I-er✓.>::✓ Z.. y.-C
.^�;0Y�,�e4,, . TAMMY PALL Worn and subscribed before me this ..5 day off 'f� 20
ar I �, Notary Public•State of Florida
10 i11. -I My Comm, Expires Jul 6.7.016., . of Notary Public , �( w� /-� U�/
%, j�-� o: Commisslon# EE 202003
J V��y rOrf.^0 dnndad Thrminh NatInnal Nnlary AVM
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4
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-815
Job Type: ELECTRIC ONLY
Description: 28 CIRCUITS AND SWITCHES
Estimated Value:
Issue Date: 4/6/2016
Expiration Date: 10/3/2016
PROPERTY ADDRESS:
Address: 645 OCEAN BLVD
RE Number: 170126-0000
PROPERTY OWNER:
Name: LACKIE, RAYMOND & AUDREY, *
Address: 1300 FLORIDA BLVD
GENERAL CONTRACTOR INFORMATION:
Name: TRI COUNTY ELECTRICAL
Address: 11637 E COLUMBIA PRK DR QA KEVIN LEE WEIR
Phone: - -
FEES:
Trade Permit Base Fee $55.00
State Elec DCA Surcharge $2.00
State Elec DBPR Surcharge $2.00
Lighting Outlets, Including Fixtures $16.80
Total Payments: $75.80
PERiIIT IS APPROVED ONLY IN ACCORDANCE W I'III ALL CITY OF ATLANTIC BEACH ORDINANCES AND 'HIE FLORIDA
BUILDING CODES.