2359 SEMINOLE RD - ELECTRIC r -_;_ , JJs
�" \ CITY OF ATLANTIC BEACH
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J 800 SEMINOLE ROAD
JJATLANTIC BEACH, FL 32233
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INSPECTION PHONE LINE 247-5814
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ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ELEC-1629
Job Type: ELECTRIC ONLY
Description: ELECTRIC - CIRCUT FOR SEWAGE PUMP
Estimated Value:
Issue Date: 7/19/2016
Expiration Date: 1/15/2017
PROPERTY ADDRESS:
Address: 2359 SEMINOLE RD
RE Number: 168349-0000
PROPERTY OWNER:
Name: JACOBSON, SAMUEL S
Address: 2359 SEMINOLE RD
GENERAL CONTRACTOR INFORMATION:
Name: LIBERTY ELECTRICAL CONTRACTORS
Address: PO BOX 8743 QA LOUIS JOSEPH DEPETRIS
Phone: 904-745-1850
FEES:
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Motors $4.00
Trade Permit Base Fee $55.00
Total Payments: $63.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach,FL 32233
Ph(904)247-5826 Fax 904)247-5845 I Co-LLC- I Co Z-9
JOB ADDRESS: ,'� S-3 5 c e 0 iiy. /e..— 1?, PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS d O D AMPS 2 VO VOLTS / PHASE
VALUE OF WORK$
NEW SERVICE ❑ Overhead D Underground ❑T Underground up Pole
❑Residential(Main)Service
❑0-100 amps ❑101-150amps 0151-200amps 0 amps #of Meters
0 Commercial(Main)Service
❑0-100 amps 0101-150amps 0 151-200amps ❑ amps OCT Service amps
Conductor Type Size
0 Multi-Family(Main)Service
0 0-1 00 amps ❑101-150amps 0151-200amps ❑ amps #of Unit Meters
0Temporary Pole ❑ amps
SERVICE UPGRADE 0 amps 0 CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps 0200amps 0 amps DCT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-3 Damps 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 j / hp
❑Swimming Pool LI Sign [I Smoke Detectors_Qty DTransformers KVA otors
FIRE ALARM SYSTEM (Requires 3 sets of plans) G o
Qty volts/amps VALUE OF WORK$ , c7
REPAIRS/MISCELLANEOUS
0 Replace Burnt/Damaged Meter Can 0 Safety Inspection ❑Panel Change DOH to UG
Other: l/'o+!i‘&p..1 I/-o ft" D-4 C,vvvy ,2'_ (',or',/v, co 7 h -�/" .,,,,/,... f)
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. Q / /-
Property Owners Name ,J o of ` -a CSO k,S is..) Phone Number o2-�A, CL 167
Electrical Company (" t c--Fr,�.1 « f�_ ric.Office Phone 7�1 S=/t b Fax "21(r' 'F
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Co. Address: I VD. -/ 4nDCI-t, o r AK A v fl.-
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- City LTo� S v ! State 0 Zip3V.z) ) 1
License Holder(Print): LO U LS `1 . LJ J -(- State Certification/Registration# 60017gg
' Nota zvak nts,tl6
atttp H der 7 y4?
4. ';.__ MY COMMISSION i FF 924951 t= i
p••tom,;:as EXPIRES:October 6,2019 efore me thi 1 9 day o § .:., 20�
4„.8 n... Bonded Thru Notary Public Undmwriten v WI
Signature of Notary Public 42— '