367 Belvedere St elec permit replacing 16-ELEC-1938 r11
U CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
\ INSPECTION PHONE LINE 247-5814
ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEAT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-ELEC-3594
Job Type: ELECTRIC ONLY
Description: ELECTRIC -TRIM OUT REPLACE 16-ELEC-1938
Estimated Value: $400.00
Issue Date: 3/27/2017
Expiration Date: 9/23/2017
PROPERTY ADDRESS:
Address: 367 BELVEDERE ST
RE Number: 170703-0266
PROPERTY OWNER:
Name: MCPHERSON, JOHN K
Address: 1433 PONTE VEDRA BLVD
GENERAL CONTRACTOR INFORMATION:
Name: RIVER CITY ELEC CONTRACTORS
,ECA001795
Address: 12496 NE GATELY OAKS L QA JOHN MICHAEL
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
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach,FL 32233 7 _ � t c-•n_3 G :�/(_
pp 1-7 Q Ph(904)247-5826 Falx(904)247-5845 l..�i�/ —I
JOB ADDRESS: �V / VLILI Lr� S�1 PERMITrvol
JEA INFORMATION REQUIRED ON ALL PERMITS �.S O AMPS u/O VOLTS PHASE
VALUE OF WORK$_ '1119,do
NEW SERVICE ❑ Overhead ❑ Underground ❑1 Underground up Pole
❑Residential(Main)Service
00-100 amps E1101-150amps 11151-200amps ❑ amps #.of Meters
❑Commercial(Main) Service
00-100 amps 11101-150amps ❑151-200amps ❑ amps ❑CTServiceamps
Conductor Type Sim
❑Multi-Family(Main)Service
00-100 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 ❑200amps ❑ 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
❑Swimming Pool ❑ Sign ❑Smoke Detectors_Qty ❑Transformers EVA ❑Motorshp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volls/amps VALUE OF WORK$
REPAH2S/NHSCELLANEOUS
❑Replace Burat/Damaged Meter Can
` ❑Safety Inspection []Panel Change ❑OHto UG `
Other: �t`e,r.n � t5t Z j'S.,r.} C�ndS l Y- � .fir
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for sin 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.
Property Owners Name `` ` Phone Number
Electrical Company Qli-44XcA-Ix_ Vnn-�e11c • S✓lt-. Office Phone 51 `005_Fax
Co.Address: vASZ5' City OrQ . State zip SUZY
License Holder(Print): 30k�rl Q—�Cc00%e, St e Certification/Registration# Ec-cat,058
Notarized Signature of License Holdkr vlp�•� -
w xlm coog Swo subscribed before me this �'Z d of (`��c r 5..� 20 rf
Notary Public-State of Floon
}A commissloa •FF 920346 Signature of Notary Public on--�
Uy Comm.Expires Jan 15.2020
?oa add au9h aaiaW Wary Assn.
March 24,2017
Please let this serve as notice that DSM Renovations LLC does hereby release Phase One Electric, LLC
from the property located at 367 Belvedere Street as the electrical contractor of record. Building Permit
number 16-RAAR-1507
DSM Ren ' sL K
LC y
Print Name: Q. 4-1 -
STATE OF FLORIDA,COUNTY OF OucVO A
Sworn to(or affirmed)and subscribed before me this aW* dayof Aarch .20_G
NotarOublic Signature (Pr' or Type Commissioned Name Below)
(affix Seal below)
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MY COMMISSIONXOOUM1
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