469 Atlantic Blvd #11 elec safety permit rs I Irl
CITY OF ATLANTIC BEACH
Y " 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-2232
Job Type: ELECTRIC ONLY
Description: safety inspection
Estimated Value:
Issue Date: 10/3/2016
Expiration Date: 4/12017
PROPERTY ADDRESS:
Address: 469 ATLANTIC BLVD UNIT 11
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: PHASE ONE ELECTRIC LLC
,EC33005388
Address: 2076 CORONA CT OLIVER VAN DE KAMP
Phone: -
FEES:
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Electrical Repairs $35.00
Trade Permit Base Fee $55.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
i
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach, FL 32233
Ph
4b� (904)247-582\6 Fax (904)247-5845
JOBADDRESS:_ AAC NJ VnvT1IPERMIT
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JEA INFORMATION REQUIRED ON ALL PERMITSQS_AMPS,LLIa VOLTS PHASE
VALUE OF WORKS Cr
NEW SERVICE ❑ Overhead ❑ Underground D Underground up Pole
❑Residential(Main)Service
❑0-100 amps 11101-150amps 0151-200amps ❑ amps #of Meters
❑Commercial(Main)Service
❑0-100 amps 0101-150amps ❑151-200amps ❑ amps 0 C Service amps
Conductor Type Size
❑Multi-Family(Main)Service
❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Unit Meters
❑Temporary Pole ❑ amps
SERVICE UPGRADE ❑ amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps 0200amps ❑ amps OCT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-30amps 31-100amps 101-200amps
Appliances: 0-30amps 31-100amps 101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
❑Swimming Pool ❑ Sign ❑Smoke Detectors_Qty ❑Transfomters KVA ❑Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
❑Replace Burn/Damaged Meter Can /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 cartity that I have
mad 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 nmvisigps of any other state or local law regulation construction or the performance of
construction. 'Q,ni QM10� Q'IRI &SjCk C pfo"ES M, !.t•-
pertyOwnersNamee 1V\\(` ^ \ 1nifOy5� �^ Phone Number
Electrical Company(: ,G,,,e \ �nP �`m<!Y .�k Office Phone aVW Fax
Co.Address: ��C' \crrv- m City State Zip
License Holder(Print): �W/P r Ur State Certification/Registration# -\ S RC1
Notarized Si nat der
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�t="`-'"�`° ar caxnlssloNtFF�aest efore me this ayo 20
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n,�>, ' e",N.er°"NasrP"°ru"""'"" ignatme of Notary Public