178 BEACH AVE - ELECTRIC UNDERGROUND -)' ,* CITY OF ATLANTIC BEACH
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: 17-ELEC-3029
Job Type: ELECTRIC ONLY
Description: underground up pole 200 amps/240 volts/ single phase
Estimated Value: $350.00
Issue Date: 1/18/2017
Expiration Date: 7/17/2017
PROPERTY ADDRESS:
Address: 178 BEACH AVE
RE Number: 170210-0000
PROPERTY OWNER:
Name: 178 BEACH AVE LLC
Address: 6 E BAY ST SUITE 500
GENERAL CONTRACTOR INFORMATION:
Name: NGUYEN ELECTRIC CONTRACTOR, LLC
Viet Nguyen, EC13007395
Address: 1602 Lockend RD
Phone: 904-612-9135
FEES: -- - - -----
Electrical Service Change $50.00
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $109.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach, FL 32233
Ph(904)247-5826 Fax (904)247-5845 I-1 —L LE L-3 O(.V�
JOB ADDRESS: /7 42a6E_ A (/L. t A7% / ( c / PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS ,,�O�O AMPS sO VOLTS ( PHASE
VALUE OF WORK S - C.
NEW SERVICE ❑ Overhead ❑ Underground L1 Underground up Pole
Residential(Main)Service
0-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Meters
Commercial(Main)Service
0-100 amps ❑101-150amps ❑151-200amps ❑ amps ❑CT Service amps
Conductor Type Size
❑Multi-Family(Main)Service
❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Unit Meters
❑Temporary Pole LI amps
SERVICE UPGRADE ❑ amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps 0200amps ❑ amps OCT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-3 Damps 31-100amps 101-200amps
Appliances: 0-30amps 31-100amps 101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
❑Swimming Pool ❑ Sign ❑Smoke Detectors Qty ❑Transformers KVA [Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
❑Replace Burnt/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 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.
/] L /I
Property Owners Name /Vl4t f 1c t-avt1/1-/ Phone Number W(fy S q c— Cio2g
/
Electrical Company 4 PIA c/Ci t C , ,1,,G�i✓ Office Phone Fax
Co.Address: /6 0a &c- lid IZ City J4-X State FC Zip 3,7-7'21
License Holder(Print): Vi ej /v? e-1/ State Certification/Registration#&( 13o 7 3 9 S.,
Notary _ — - --- .-- elder i. .
;�.-:,-- JENNIFERJOHNSTON 20 '�
MY COMMISSION#cc 042964 efore me this l day of )(.4(w.
�'L
- ,M' 1 EXPIRES:October 27.20 Underwriters's+; ill"
N Nohry c
t _ — ignature of Notary Public ._, .e,_ _ \,._, A ,ti_