2021 Selva Madera Ct elec permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXr DAY INSPECTION: 247-5814
30B INFORMATION:
Job ID: 17-ELEC-3321
Job Type: ELECTRIC ONLY
Description: ELECTRIC - NEW SUB PANEL FOR KITCHEN REMODEL
Estimated Value: $2,000.00
Issue Date: 2/23/2017
Expiration Date: 8/22/2017
PROPERTY ADDRESS:
Address: 2021 SELVA MADERA CT
RE Number: 169506-1650
PROPERTYOWNER:
Name: BURBRIDGE, H CLINTON
Address: 2021 SELVA MADERA CT
GENERAL CONTRACTOR INFORMATION:
Name: MUNSON & BRYAN ELECTRICAL CO.
,ECO001795
Address: 3434 ST AUGUSTINE RD QAJOHNMICHAEL
SCIOLINO
Phone:
FEES:
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Electrical Repairs $35.00
Trade Permit Base Fee $55.00
Totai Payments: $94.00
PERMIT IS APPROWD ONLY IN ACCOBI)ANCE WITH ALL CITY OF ATLANTIC BEACH OBIONANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach,FL 32233 17-ELFC--5-�5-Z k
JOB ADDRESS: Ph(904)247-5826 Fax (904)247-5845
'i5�deei .4i,,der4 'Cf PERMT it 17-1,cld'30A
JEA INFORMATION REQUIRED ON ALL PERMITS ZA��l"2 AMPS `?�Y'9 VOLTS PHASE
VALUE OF WORKS—W&00
NEW SERVICE 0 Overhead E] Underground ED Underground up Pole
LiRmidential(Main)Service
[ lo-100 amps U101-150amps 0 151-200amps I]—amps ft of Meters
t'Commercial(Main)Service
[10-loomps 71101-150antpus U 151-200amps Fl_amps I CTService_amps
Conductor Type_ Sin
LiMuld-Family(Main)Service
E10-100amps E1101-150amps 0 151-200amps I amps 4 of Unit Meters
UTemporary Pole []_amps
SERVICE UPGRADE 0—amps Fl CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
1-1100amps 71150amps U200amps 11 amps FICT Service amps
ADDITIONS,REMODEL§,REPAIRS,BUMD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switcha: 2� 0-30amps 31-100amps —101-200amps
Appliances: -�0-30amps _31-100amps —101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: #circuits�@ -Aw
Number of Lighting Outlets, Including Fixtures: /0
OTHER ELECTRICAL PROJECTS
oSwimmingPool ElSign U Smoke Detectors_Qty LITransformers KVA []Motors_hp
FIRE ALARM SYSTEM (Requires 3 at&of plans)
Qty_voltstamps_ VALUE OF WORK
REPAIRS/MISCELJ,ANEOUS
F1,Replaoe Burnt/Damaged Meter Can ESafety,Inspection -Rancl Change FIOH to UG
k,7 A4
[30ther: PlAoje,
Pcrenit begsonves void if work does not within a six nounth period or work is suspended or abandoned for six manths. I hereby cartify that I have
read this application and know the saarte to be finue end wroset. All provisions of laws and ordinances governing this work will be compiled with whether
specifiedranot The perunit does not give authority to violate the provisions ofany other state or local law regulation construction or the perrournance or
eonstrucurs..
Property Owners Name di-4 PhoneNumber
Electrical Company Af"A�017 9Ad B�64!2 Req�� — Office Phone M41689 FaX
Co. Address: 5,t Axxifm, city :!�-d Statef/-- Zip 77M
License Holder(Print) -"Oh-1 Se;a 41atejCartificattomiRegistration
NotarizedSignalaune-ffLiewe Holder
JOSEPH GUY CAUCHUPi Svvor�Zd subscribed before me this day of R"�" 20_L7
Gowlssion#FF244825
-`lEPiWJWYl6,70r9 Signature of Notary Public
7MI Op ATLkMTIC BEACH
CITI 4T RN
8m000 SoLGMTOILCE RD
pLAWIc REAC,FL 32233
CREDIT CARD
mc SALE
Cad 4 xww)om0451
SEQ#� 6
Batch#1 307
INVOICE i
AWoval C4&. 49639K
Eno WhDd: mnw
Mok Onh
Tax kud: $0.00
3
045
3
63
OA
$0
2
1
6
07
i
9K
I
00
Card CA: m
SALE AMOUNT
CusTOlfRCOpV
CITY OF ATLANTIC REACH
000 SEMINOLE ROAD
ATLANTIC BEACH, Fl- 32233
PHONE (904) 247-5926
Cashier Id: atlbcld\atlbbja
Receipt Date: 2/23/2017 3:00:36 PM
Receipt Munster: OS-72454
J,b ID: 17-ELEC-3321 - ELECTRIC - NEW SUB P
J,b ID: 17-ELEC-3321 - ELECTRIC - NEW DUM P
J,b ID: 17-UC-3321 - ELECTRIC - NEW SUB P
Job ID: 17-ELEC-3321 - ELECTRIC - NEW SM P
Amount Due: $94.00
Tender Informati..: Cash $9q.00
Tender Type: CC
T,rds, Amount: $94.00
Change Due: $0.00