507 Selva Lakes Cir elec permit S- J ,
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
]OB INFORMATION:
Job ID: 16-ELEC-2383
Job Type: ELECTRIC ONLY
Description: change out breakers on heat and a/c to fuse properly
Estimated Value: $125.00
Issue Date: 10/24/2016
Expiration Date: 4/22/2017
PROPERTY ADDRESS:
Address: 507 SELVA LAKES CIR
RE Number: 172027-5042
PROPERTY OWNER:
Name: CLAYTON, BOB E
Address: 507 SELVA LAKES CIR
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
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.
V.LE(TRI('AL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
S00 Semimde Rd,Atlantic Beach,FL 32233
�'f lPh(91M 1247-5526 F'ux(904)247-s5`845 Ib-E L&C- a3$3
JOB ADBRExS: �Q L!l KC C I L 1 P PERMIT M�
JE:A INFY)RM � ��7� AMPS VOLTS PHASE
ATION REQUIRED ON ALL PERMITS 1ydi.
11 ���� n0
VALUE OF WORK Jam+
NF.W SF.RVI('F, EDOverhead ElUnderground [3Underground up Pok
I 'ResidentialMd )e Service
i �0-1011 amps n 101.1 50amps Li 151.200amps U___emps Is of mations
(Commercial(Mahn)Serviceamps
UO-IOOamps L1101-ISOamps '
1151.200ampe Il�amPb OCT Service
Conduclor Type Sim
1 (Multi-Family(Main)Service
110-100 amps U101.150amps ❑151-200amps Ll amps #of Unit Meten�
Multi-Family
Pok I Lamps
SERVICE UPGRADE Ll—amps LI CT Service_amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
11100 amps f 1150amps L1200amps El—amps OCT Service_amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outicts/Swimhes: 0-30amps 31-I00amps _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
I1Swimmingpool ❑ Sign ❑Smoke DdectM_Qty OTransformers KVA ❑Motors_hp
FIRE ALARM SYSTEM (Require,3 sees of plans)
Qty_volts/amps VALUE OF WORK S
REPAERS/MISCELLANEOUS
f 1Replece Bumt/Demeged Memr C`lan OSafety Inspection OPanel Change OOH to UG
((Other. Ohingz /lA d)rfCAVe.fS �n h�r(�- .b Aid VO FIA<L RD�_
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six m=s. 1 hereby tarty Net 1 ha
read this application sad know the same to be tate and comxa All provisions of laws and ordinances governing this work will be complied with whethe
Spwifcd or not The permit does act give authority m violate the provisions of my other state or local law regulation concoction or the peliormence o1
construction.
Property Owners Name L 1()O (...I'A.A?ri Phone Number
T
Electrical Comp,a��ny E m-7Q%ire E�e�:kr'tC 1'in0` Office Phone�J� Fax
11 /��
Co.Address: 4' " Z 1'lfi IrY) S City V`State h_zip .32
License Holder(Print): Rl(�VAV_j ti£tcation/Registration# F_Cl l
Notarized Signature ofLicewe Horde
JAMES M SULLIVAN Sworn and subscribed before me thi /9�day of Cc-,( -4c ,
MY COMMIb "a FF074214 /))
E%FIRES Marty 22,2020 Signature of Notary Public/!)(/
CITY OF ATLANTIC BEACH
BOO SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
PHONE (904) 247-M
Cashier Id: atibcld\atlbbja
Receipt Date: 10/24/2016 12:23:05 PM
Receipt Number: OS-71559
Job ID: 16-ELEC-2383 - change out breakers
on heat and a/c to fuse properly EDBPR - St
ate Elec DERR Surcharge SZ.00
Job ID: l6-ELEC-2363 - change out breakers
an heat and a/c to fore properly EDEA - Sta
to Elec DCA Surcharge $2.00
Job ID: 16-ELEC-2303 - change out breakers
on heat and a/c to fuse properly EL 18 - Ele
ctrical Repairs $35.00
Job ID: 16-ELEC-2393 - change nut breakers
on heat and a/c to fuse properly TP - Trade
Permit Base Fee $55.00
Amount Due: $94.00
Tender Information: Cash $94.00
Tender Type: CC
Tender Amount: $94.00
Change Due: $0.00