363 12TH ST - NEW ELECTRIC �� CITY OF ATLANTIC BEACH
A ' SJ 800 SEMINOLE ROAD
Si -
;�, r� ATLANTIC BEACH, FL 32233
J INSPECTION PHONE LINE 247-5814
ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ELEC-2117
Job Type: ELECTRIC ONLY
Description: ELECTRIC - NEW SERVICE 300 AMPS, 240 VOLTS,
SINGLE PHASE
Estimated Value:
Issue Date: 9/21/2016
Expiration Date: 3/20/2017
PROPERTY ADDRESS:
Address: 363 12TH ST
RE Number: 171917-0000
PROPERTY OWNER:
Name: Hand, Michael B
Address:
GENERAL CONTRACTOR INFORMATION:
Name: LORE ELECTRICAL CONTRACTORS
, ER13013026
Address: 210 N ROSCOE BLVD QA MICHAEL LEE LORE
Phone: - -
FEES:
Electrical Primary Service $50.00
State Elec DCA Surcharge $2.00
New Single Family Electrical $80.00
Trade Permit Base Fee $55.00
Total Payments: $187.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph( 04)247-5826F (904)247-5845 1 (o- L�-Z i l l
JOB ADDRESS: 363 / 4. . e&7 eS PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS 70 Z-' AMPS Z-{6 VOLTS PHASE
VALUE OF WORK$
NEW SERVICE ❑ Overhead ❑ Underground Underground up Pole
❑Residential(Main)Service / '
00-100 amps 0101-150amps D 151-200amps ✓ 'O amps #of Meters
0Commercial(Main)Service
00-100 amps D 101-150amps O 151-200amps L. amps OCT Service amps
Conductor Type Size
Multi-Family(Main)Service
00-100 amps 0101-150amps 0151-200amps 0 amps #of Unit Meters
OTemporary Pole 0 amps
SERVICE UPGRADE 0 amps 0 CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
0100 amps O 150amps 0200amps O amps OCT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-30amps 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
❑Swimming Pool 0 Sign 0 Smoke Detectors_Qty OTransformers KVA ❑Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK S 26 0-06
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can 0 Safety Inspection ❑Panel Change OOH to UG
OOther:
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 ///f/Y�'7 Phone Number
Electrical Company /..0/i ---- c/ /crs/O . u C Office Phone 2 73-/iv3 Fax 323-yd/r
Co.Address: 2/0 N 4.CL,D C-- Nod' City Ai . State 2 Zip 3 w!a
License Holder(Print): A d ii}g1 G., 4,0"ZC Sta Certification/Registration#EG/3o p 6 6 9 Z
Notarized Si- ; , tiler --71 -l
„ :4:;WLESPERGSR I
....._
a '' ..,,; ,aiisil0y*FF924951 i;efore me this 2 ' day o '0
rXPIR£3:October o,2019 .
y?�"`; `ordn'Th.., aa. undo r .ignature of Notary Public