2233 SEMINOLE RD #20 ELEC PERMIT CITY OF ATLANTIC BEACH
r s 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
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-1825
Job Type: ELECTRIC ONLY
Description: installed & replacing 20 outlets, 2 appliances
Estimated Value:
Issue Date: 8/11/2016
Expiration Date: 217/2017
PROPERTY ADDRESS:
Address: 2233 SEMINOLE RD UNIT 020
RE Number: 169519-0138
PROPERTY OWNER:
Name: SHORSTEIN, JACK F
Address: 8265 BAYBERRY RD
GENERAL CONTRACTOR INFORMATION:
Name: PHASE ONE ELECTRIC LLC
Address: 2076 CORONA CT OLIVER VAN DE KAMP
Phone: -
FEES:
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Electrical Appliances $4.00
Lighting Outlets, Including Fixtures $12.00
Trade Permit Base Fee $55.00
Total Payments: $75.00
PERMIT IS APPROVED ONLY W ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach,FL 32233
Ph(904)247-5826 Fax (nn904)247-5845
JOB ADDRESS: rern�l 02"2 '7;e-onnO1G PERMIT# 110-6L6L-
1412S
JEA INFORMATION REQUIRED ON ALL PERMITS JSo AMPSIeY1 VO VOLTS �_PHASE
VALUE OF WORK$
NEW SERVICE ❑ Overhead ❑ Underground ❑1 Underground up Pole
❑Residential(Main)Service
00-100 amps C 101-150amps ❑151-200amps ❑ amps # of Meters
❑Commercial(Main)Service
00-100 amps 11101-150amps 0151-200amps ❑ amps -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 ❑ amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps 0200amps amps ❑CT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 10 0-30amps 31-100amps 101-200amps
Appliances: 0-30amps 31-100amps 101-200amps
A/C Circuits: 0-60amps 61-I00amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS _
[]Swimming Pool 11 Sign ❑Smoke Detectors_Qty ❑Transformers KVA 7Motorshp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
❑Replace Bumt/Damaged Meter Can El Safety Inspection EJ 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 end know the same to be one 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
consovction. "� f1
Property Owners Name I. 1 [�'1 aP� p. !1 Phone Number QOq-3 Iy 0 aU
Electrical Company Nr. se Dnc.. E�e,Cytc /�C Office Phone4diAG51-S/b37 Fax
Co.Address: Q01 C, L 3(C1(�Gl G+• city state E�-t zip 322%4
License Holder(Print): ,n,,- (p State Certifrcation/Registration# 1100.1,3$0
Notarized=nalureldIderYNaEPF9N951 Before me d11S day of 20
6 2V19
0n°°'Nibi Signature of Notary Public