645 MAYPORT #2 - SAFETY ELEC r \S f CITY OF ATLANTIC BEACH
1 , .,t_ �� 800 SEMINOLE ROAD
' ' ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-ELEC-3014
Job Type: ELECTRIC ONLY
Description: ELECTRIC - SAFETY INSPECTION
Estimated Value: $125.00
Issue Date: 1/17/2017
Expiration Date: 7/16/2017
PROPERTY ADDRESS:
Address: 645 MAYPORT RD UNIT 2
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: VALDAN ELECTRIC CO.
, EC13002670
Address: 338 19TH ST QA DANIEL J GWIZDAK
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: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph(904)247-5826ax (904) 247-5845 l'--/ —ELEC.-30 (4
JOB ADDRESS: & ' 4YL7L- fo 65-'(-(/)(E.; c2--
PERMIT#
.IEA INFORMATION REQUIRED ON ALL PERMITS 5() AMPS ' VOLTS / PHASE
VALUE OF WORK S /75
NEW SERVICE ❑ Overhead ❑ Underground [3 Underground up Pole
0 Residential(Main)Service
U0-100 amps 0101-150amps x-1151-200amps U amps # of Meters
C]Commercial(Main)Service
❑0-100 amps U 101-150amps U151-200amps ❑_ amps UCT Service amps
Conductor Type Size
CJMulti-Family(Main)Service
00-100 amps 0101-150amps U 151-200amps 0 amps #of Unit Meters
❑Temporary Pole 0 amps
SERVICE UPGRADE U amps U CT Service___ amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
0 100 amps 0150amps U200amps U amps OCT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-30amps 31-100amps 101-200amps
Appliances: 0-30amps 31-100amps 101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
0 Swimming Pool f Sign 0 Smoke Detectors_Qty Transformers KVA nMotors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
DReplace Burnt/Damaged Meter Can Safety Inspection !Panel Change DOH to UG
:Other: 4/4U- //at rj4 09-9 < 0 6 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. / / `� 1
Property Owners Name kL 672_ B retv4 I'AC.r/10,--41-0 Hone Number `�Y? — 6-33 1" \=/D.
Electrical Company Vel LG{I L L C r2 cc., c A- Office Phone 7 b " 3 i Zb Fax •-------
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Address: 3S 9 1-1k City `4 ( 8.� State Zip 3 ZZ 33
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License Holder(Print): p14A)h L , b.,...?,)4Ake_ State Certification/Registration#F'C/3 CI, 7 a
Notarized Signature of L4f:re :
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."' ' EXd Two No;ary PubtwUnderoters Signature of Notary Public �Q ��
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