381 5th St elec permit t
CITY OF ATLANTIC BEACH
r 800 SEMINOLE ROAD
J - ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
-oil 1
ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
I0B INFORMATION:
Job ID: 17-ELEC-3604
Job Type: ELECTRIC ONLY
Description: ELECTRIC - NEW SERVICE 200 AMPS, 240 VOLTS,
SINGLE PHASE
Estimated Value: $10,000.00
Issue Date: 3/28/2017
Expiration Date: 9/24/2017
PROPERTY ADDRESS:
Address: 381 5TH ST
RE Number: 169676-0000
PROPERTY OWNER:
Name: MORRISSEY, MELISSA
Address: 381 5TH ST
GENERAL CONTRACTOR INFORMATION:
Name: HART ELECTRIC COMPANY
, ER 13015151
Address: 11084 Ker Del RD
Phone: 904-219-5896
FEES:
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
New Single Family Electrical $70.00
Trade Permit Base Fee $55.00
Total Payments: $129.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH 17 _ G_�LF_C—j(p(lT
800 Seminole Rd,Atlantic Beach,FL 32233
_ Ph(904)247-5826 Fax(904)247-5845 — 3069
JOB ADDRESS: s �� . PERMIT#�9 R
SEA INFORMATION REQUIRED ON ALL PERMITS 20 D AMPS A YO VOLTS PHASE
/ VALUEOFWORK$ 4/O, 00r�
NEW SERVICE LJ Overhead ❑ Underground 0 Underground up Pole
❑Residential(Main)Service .!
❑0-100 amps ❑101-150amps Lwin I-200amps ❑ amps #of Meters
❑Commercial(Main)Service
00-100 amps 0101-150amps 0151-200amps ❑ amps ❑CTService amps
Conductor Type Sin
[]Multi-Family(Main)Service
❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Unit Meters
❑Temporary Pole ❑ amps
SERVICE UPGRADE ❑ amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
0100amps 11150amps 0200amps ❑ amps ❑CTService 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 Q kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
❑Swimming Pool [] Sign ❑Smoke Detectors_Qty ❑Transformers KVA ❑Miitorshp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAHISAIISCELLANEOUS
❑Replace Bumt/Damaged Meter Can 0 Safety Inspection ❑Panel Change ❑OH to UG
❑Other:
Permit becomes void if work does not commence within a is 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 berms 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. /�'��
Property Owners Name
d�(// r 'L-yI..) R,(, • ti�1 Phone Number
Electrical Company 77 A�1 ��c CJ r�t1C � , Offices Phone y I�
Co.Address: P- o • n C y / City �1''C"t1J.Metal, '1=1 Zip q2 �
License Holder(Print): M e 1 cation/Registration#
Notaa ngtuNS b>Od�r er
s. �.YCg1:.M SIGN kfF 924951
�'2$;;.;, -oEMamN xow-vvbe¢un°tea efore this oda f Q 20
Signature of Notary Publi