2179 Fairway Villas Ln elec permit PS'-11f/n-
��nl CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J =" ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
ELECTRICAL PERMIT
MUSE CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
30B INFORMATION:
7obID: 16-ELEC-2303
)ob Type: ELECTRIC ONLY
Description: install condensate receptacle, change out A/C breaker
Estimated Value:
Issue Date: 10/13/2016
Expiration Date: 4/11/2017
PROPERTY ADDRESS:
Address: 2179 S FAIRWAY VILLAS LN
RE Number: 169398-1060
PROPERTY OWNER:
Name: REVELS, ALMA BELO
Address: 2179 FAIRWAY VILLAS LN
GENERAL CONTRACTOR INFORMATION:
Name: EMPIRE ELECTRIC INC
Richard W.Speaker,EC13004667
Address: 6999-2 Merrill RD #351
Phone: 904-365-7777
FEES:
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
AC Circuits $5.00
Trade Permit Base Fee $55.00
Electrical Repairs $35.00
Total Payments: $99.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC REACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach,FL 32233
r7// �' Ph(904)247-58226 /Fax(904)247-5845�• /
JOB ADDRESS:r?I / 7 {:a/rlofi I Y l'�)-1/G�{, 1G17 &5 J& A PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS X50 AMPS �VOLTS Z PHASE
VALUEOFWORKJ
NEW SERVICE ❑ Overhead Underground D Underground up Pole
LResidential(Main)Service
00-100 amps 8101-150amps U 151-200amps 0_amps #of Meters_
❑Commercial(Maio)Service
00-100 amps 0101-150amps 0151-200amps Uamps OCT Services_amps
Conductor Type Sin
OMuld-Family(Maio)Service
00-100 amps U 101.150amps 0151-200amps D amps #of Unit Meters
UTemporary Pole [] amps
SERVICE UPGRADE ❑_amps OCT Service_amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
0100amps U150amps O200amps 0_____-amps OCTSmiw_amps ^
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: _0-30amps 31-100amps 101-200amps
Appliances: 0.30amps 31-100amps _101-200amps
AIC Circuits: 0;6.
A/C 61-100amps
Heat Circuits: #circuits @ kw
Number of Lighting utlets,Including Fixtures:
OTHER ELECTRICAL PROJECTS I
❑Swimming Pool ❑ Sign OSmoke Deteaors_Qty OTmns(omboes KVA ❑Motorshp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty_volts/amps VALUE OF WORK 8
REPAIRS/NHSCELLANEOUS
❑Replace Burnt/Darnaged Meter Can OSafety Inspection OPmel Change UGH to UG
OOthee'l)1STa(I docta n-c fed/()Athol !a .6Q Q.�2nair--10A foo. I
Permit becomes void if work does oot commena within a ax month period or work is suspaded or abandoned for six months I hereby comfy Mat 1 h
ave
read this application sM knew the same to be true and ooneot. All provisions of laws and ordinances governing this work will be complied with whether
specified or net The permit does not give authority to violate the provisions army other state or local lew mgulaion construction orate
perfammce of
wnmuaion. _
Property Owners Nam. &IQ, a/" &W—& Phone Number
Electrical Company F',M /G ��CC!7Trl �Tner- ice Phone 3,62277 FIVE &Q. r
Co.Address: P-d At 14 City,kaon rl l lr State ELC ZiP' M77/J
License Holder(Print):' ) P State Certifrration/Registration#, 7
�.s canon SJ'e!1sca�
Notarized Signature of License Holder
'+>y ,IAMEf M BULLNAN om and subscribed before this daY of C O'" 20
aY ClH.M118610H N FFailata j
e:wlnes uam m-mia gnature of Notary Public
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