290 Beach Ave - Electric (2) CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J "r 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-1237
Job Type: ELECTRIC ONLY
Description: ELECTRIC - NEW SERVICE 200 AMPS, 240 VOLTS, SINGLE
PHASE
Estimated Value:
Issue Date: 6/1/2016
Expiration Date: 11/28/2016
PROPERTY ADDRESS:
Address: 290 BEACH AVE
RE Number: 170196-0010
PROPERTY OWNER:
Name: PITLER, ANDY
Address: 273 OCEAN BLVD
GENERAL CONTRACTOR INFORMATION:
Name: TITAN ELECTRIC GROUP, INC.
Address: 2730 -7 CL CLYDO RD QA CHARLES WILLIAM BELINGHOFF
Phone: - -
FEES:
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
New Single Family Electrical $70.00
Trade Permit Base Fee $55.00
Total Payments: $129.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845 (0_EL EC- ( z 37
JOB ADDRESS: ).CIO &� A w-- PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS -V VOLTS ' PHASE
VALUE OF WORK$
NEW SERVICE ❑ Overhead ❑ Underground [Underground up Pole
❑Residential(Main) Service
❑0-100 amps ❑101-150amps V(51-200amps ❑ amps #of Meters
❑Commercial(Main)Service
❑0-100 amps ❑101-150amps ❑151-200amps I I amps 71 CT 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 El-amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps ❑200amps ❑ amps ❑CT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-30amps 31-l 00amps 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
El Swimming Pool ❑ Sign 71 Smoke Detectors_Qty [I Transformers KVA []Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
❑Replace Bumt/Damaged Meter Can I Safety Inspection []Panel Change ❑OH to UG
-i 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. n /l
Property Owners Namel'' �I Ct` ►�cr��� Phone Numbe (O �
Electrical Company \�CiA �i G`���L E(�pU{� Office PhonerD lQ Fax;vl "GS
Co. Address: C do y Zip31-2-01
�v� Qd• Cit c14�n v I�� State�-- Zi
License Holder (Print):vnoa-rkS W• ���' � / Sta C f 'on/Registration# EC-1300-52b2
Notarized Signature of License Holder /il/.
4 Denise A.Emla
)NOTARY PUBIC Sworn and subscribed before this 31_ day of 20
STATE OF FLORIDA
Ummf FF9W426 Signature of Notary Public
. EXOM 3/1/2020
EARLY POWER AGREEMENT & RELEASE
J CITY OF ATLANTIC BEACH
Electric power is requested now under the conditions and terms of this fully executed Agreement&Release
Job Address:
Permit No. 1 - �k' t— M2_ Service Type(Circle One): Overhead Underground
We,the undersigned General Contractor and Electrician,understand and agree:
1. "Early Power" is purely for our construction convenience, it is not required by Codes and does not
substitute for Final Inspections or the C/O (Certificate of OccupancyTtlat must be issued before occupancy,
and as such is at the discretion of the Building Official.
2. The City of Atlantic Beach will make a special inspection prior to the early power energizing. All rough
inspections must have prior Approval,including meter base connections.
3. Occupancy or use of the new construction before a formal C/O constitutes fraudulent use of the early
electric service. Such action is expressly prohibited and penalized by The City of Atlantic Beach
Ordinances. A violation of this Agreement shall result in a request for prompt removal of electric service
after a twenty-four hour notice.
4. "Early Power"release authority is the Electrician and/or the Contractor and must not occur before:
a. Equipment,devices and fixtures are installed(or blanked off)safely.
b. Panel is complete with breakers and cover, and(labeling required at final inspection).
c. Service connection and grounding is complete.
d. The electric system has safely passed through electrical check.
e. Meter can is permanently marked with address.
f. Temporary address numbers displayed(Permanent numbers are required for C/O).
5. This fully completed form is to be submitted to the Building Department by hand,mail or fax.
6. Future such Agreements will not be accepted from those who violate any one of the above items.
i
CONTRACT DATE
PRINT NAME
ELECTRICIAN �J_ flu,
DATE
PRINT NAME
800 Seminole Road,Atlantic Beach FL 32233
Phone: (904)247-5826 Fax:(904)247-5845 http://www.coab.us revised 01 30 09