623 Selva Lakes Cir elec permit ` i?S 1'-Lyljrl
CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
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-2156
Job Type: ELECTRIC ONLY
Description: 200 AMPS 115/230 VOLTS 1 PHASE
Estimated Value:
Issue Date: 9/26/2016
Expiration Date: 3/25/2017
PROPERTY ADDRESS:
Address: 623 SELVA LAKES CIR
RE Number: 172027-5554
PROPERTY OWNER:
Name: CORBITT, TERESA BOYKO
Address: 623 SELVA LAKES CIR
GENERAL CONTRACTOR INFORMATION:
Name: CRAWFORD ELECTRIC
, EC13002649
Address: P O BOX 51045 QA JOHN ROBERT CRAWFORD III
Phone: 904-241-5591
FEES:
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Electrical Repairs $35.00
Lighting Outlets, Including $1.80
Fixtures
Trade Permit Base Fee $55.00
Total Payments: $95.80
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 1'� `s/ �,. a 6
Ph(90/4) 247-5826 Fax(904) 247-5845 Y
JOB ADDRESS: U rL 3 Se�✓A- L.L4-,ems J 62/'C /L PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS / VOLTS PHASE
VALUEOFWOR%E72-6 0r9
NEW SERVICE ❑ Overhead ❑ Underground 0 Underground up Pole
❑Residential(Main)Service
00-100 amps C101-150amps 11151-200amps ❑ amps #of Meters
❑Commercial(Main)Service
00-100 amps 11101-150amps 11151-200amps ❑ amps OCT Service amps
Conductor Type Size
❑Multi-Family(Main)Service
110-100 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 ❑200amps ❑ 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: -1
OTHER ELECTRICAL PROJECTS
❑Swimming Pool Sign ❑Smoke Detectors_Qty -Transformers KVA ❑Minors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORKS
REPAIRS/MISCELLANEOUS
Replace Bumt/Damaged/Meter Can El Safety Inspection :]Panel Change ❑OH to UG
. ..Other: /7 G/+o��N'� :.a c'✓Cn3L +"J Zo/3-
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. T �j q
Property Owners Name / r�� / Phone Number !b
Electrical Company /[ Office Phone 76 Y 25�/5'-T(Fax2 /—�' 7
%
Co.Address: 2-2q /Yl v4 !>o a1- Rrr City State Zip.37-4
License Holder(Print): Jo4.akfication/Registration# >`C x3602Cyj
Notarizes(Signature of License Holder n
omMal.Ikwnr Before me this u*` day of V GM 20 1f'o
.f MYtxMI5510ar FF117
E%FIRES.May14,2011
,syr,,,' somas muri,nnr.es awmrn Signature of Notary Public ftmig