1543 MAIN ST - ELECTRIC S J\J\I
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' '" ' \ CITY OF ATLANTIC BEACH
l _", v _ ) 800 SEMINOLE ROAD
w;" ATLANTIC 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-1777
Job Type: ELECTRIC ONLY
Description: ELECTRIC - 5 FIXTURES
Estimated Value: $1;500.00
Issue Date: 8/5/2016
Expiration Date: 2/1/2017
PROPERTY ADDRESS:
Address: 1543 MAIN ST
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: HWV MECHANICAL/ELECTRICAL CONTRACTORS
Address: 12797 Wilderness LN
Phone: - - _
FEES:
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Switch Outlets $3.00
Trade Permit Base Fee $55.00
Total Payments: $62.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach, FL 32233 t Co- EL-EC l 7
I Ph(904)247-5826 Fax (904)247-5845
JOB ADDRESS: L r�a,w S4— PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS 12C AMPS u. VOLTS � PHASE
VALUE OF WORK 43 S CO
NEW SERVICE ❑ Overhead ❑ Underground n1 Underground up Pole
❑Residential (Main)Service
Ll 0-100 amps ❑101-150amps 0151-200amps amps #of Meters
❑Commercial(Main)Service
10-100 amps ❑101-150amps 0151-200amps 0 amps OCT Service amps
Conductor Type Size
❑Multi-Family(Main)Service
00-100 amps ❑101-150amps I51-200amps Li amps # of Unit Meters
OTemporary Pole El amps
SERVICE UPGRADE ❑ amps Li CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
0100 amps ❑150amps 0200amps 0 amps OCT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: d. 0-30amps 31-100amps 101-200amps
Appliances: f 0-30amps 31-100amps 101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures: S-
OTHER ELECTRICAL PROJECTS
0 Swimming Pool 0 Sign 0 Smoke Detectors Qty ❑Transformers KVA 0 Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can 0 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 —; ,1 P%•-Pr' ! D Phone Number t*4 t,e 3
Electrical Company t4'W J E(t .-cl - .:v* Office PhoneC' 73 Fax /10'0j'43
Co.Address: 1 ayP''c5s Gvm. Dr, City 52r4s•n-II4 State J(• Zip 3?ls 6
License Holder(Print): r k 1L1 / / State Certification/Registration# A (30 I c-21 3
Notarized Signature of License Holder L....
NI GINDrEPERGER ;=efore me thisc3 day211k 20
•Pin+�^F'%: • � �
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MY COMMISSION!FF 924951 ,
EXPIRES:October 6,tots Signature of Notary Public Q 'I
'•:e'„„`d' Bonded'rim Notary Fabric Underwnters _ —