1542 W Park Terr elec permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
r1 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-3102
Job Type: ELECTRIC ONLY
Description: replace burnt meter jaw
Estimated Value: $200.00
Issue Date: 1/25/2017
Expiration Date: 7/24/2017
PROPERTY ADDRESS:
Address: 1542 W PARK TER
RE Number: 171940-0000
PROPERTY OWNER:
Name: Coleman, Cynthia
Address: 1542 Park TER
GENERAL CONTRACTOR INFORMATION:
Name: RIVER CITY ELECTRIC
John Rex Cook,EC0000568
Address: 2825 HOLLYBAY RD QA JOHN REX COOK
Phone: -
FEES:
Electrical Repairs $35.00
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach,FL 32233
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Ph(904) 247-51826 Fax (904)247-5845 --�L�- 3 10a,
JOB ADDRESS: f 5'yZ P4,� T2:r"c- t✓ . PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS 9710 AMPS Zc1b VOLTS 3 PHASE
VALUE OF WORK$ Z6Dr rp
NEW SERVICE ❑ Overhead ❑ Underground ❑i Underground up Pole
❑Residential(Main) Service
r .0-100 amps 101-150amps ❑151-200amps ❑ amps #of Meters
❑Commercial(Main)Service
110-100 amps 0101-150amps ❑151-200amps ❑ amps 11 CT Service amps
Conductor Type Size
❑Multi-Family(Main)Service
00-100 amps ❑101-150amps ❑151-200rmps ❑ amps #of Unit Meters
❑Temporary Pole El amps
SERVICE UPGRADE ❑ amps n CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps 0200amps ❑ amps DCT 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 ❑Transformers KVA Motorshp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAH2.S/MISCELLANEOUS
❑ReplaceBumt/Damaged Meter Can /❑� Safety Inspection ❑Panel Change ❑OH to UG
d1er: aplzice �0 � Me"TCr ^ qy-I ,
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 noL The perom does not give authority to violate the provisions of any other nate or local law regulation construction or the performance of
conshvMion. `
Property Owners Name C',
l�•-t. Ay, w �. u\t Phone Number —71 Cg67
, i
Electrical Company '-, '9 C'.r m Z�-e-A\ ��`L . Office Phone�9 O'=b7s Fax
Co.Address: AZT L{I'k-t4 .�... f a-, A�7 City f7+ p• State• Zip37y-73
License Holder(Print): Q- , CL w State Certification/Registration#
Notarized Signature of License Holder Q
eroN Sworn d subscribed before me thi day of = -----�—. 20 70
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i's Commlubn FF 940.718 Signattue of Notary Public 1
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