1089 Atlantic Blvd #8 elec safety permit CITY OF ATLANTIC BEACH
�- 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
ELECTRICAL COMMERCIAL OR MULTIFAMILY SEPARATE ELECTRIC PLANS -
MUST CALL BY 4111M FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: ELEC17-0003
Description: 125 amps/240 volts/single phase-safety inspection
Estimated value: 50
Issue Date: 6/13/2017
Expiration Date: 12/10/2017
PROPERTY ADDRESS:
Address: 1089 ATLANTIC BLVD B
RE Number: 177616 0000
PROPERTY OWNER:
Name: ASHLANDINVESTMENTSINC
Address: 7880 GATE PKWYSUITE 300
JACKSONVILLE, FL 32256
GENERAL CONTRACTOR INFORMATION!
Name:
Address:
Phone:
Name: PHASE ONE ELECTRIC LLC
Address: 2076 CORONA CT OLIVER VAN DE KAMP
JACKSONVILLE, FL 32224
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
52,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
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ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach,FL 32233
/n1 , Ph(904)247-5826 Fax(904)247-5845
JOB ADDRESS:_ /i O�q / 1 At"r-
nm �)UCI PERMIT#
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J19A INFORMATION REQUIRED ON ALL PERMITS IZ5 AMFS2 VOLTS —L PHASE
VALUE OF WORKS S' Z)
NEW SERVICE 0 Overhead 0 Underground D Underground up Pole
OResidential(Main)Service
❑0-100 amps [1101-150amps 0151-200amps 0_amps #of Meters
❑Commercial(Main)Service —
00-100 amps 0101-150amps 0151-200amps ❑_amps OCT Service amps
Conductor Type Sire
OMulti-Family(Main)Service
00-100 amps 0101-150amps 0151-200amps ❑
OTemporary Pole amps #of Unit Meters
Damps —
SERVICE UPGRADE O_amps 0 CT Service—amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
0100amps 0150amps 0200amps ❑_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
OSwmming Pool OSign ❑Smoke Detectors_Qty ❑Transformers KVA OMomm_hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty_volts/amps VALUE OF WORK S
REPAIRS/MISCE T NEOUS //
OReplace Bumt/Damaged Meter Can I 1fety Inspection ❑Panel Change OOH to UO
❑Other:
Permit 6 d if work does not commence within a six month penod or work b suspended ora1w doped fors,month_ 1 hereby certify that i have
reed this application and know the same to be nue and moot. All provisions of laws and ordinances governing this work will be complied with whethn
Specified Or not The permit does not give authority to violate the Provisions of my other mate or local law regulation construction orthe performance of
construction.
Property Owners Name P%&A cop r{ " S Phone Number 904-CIe12-9000
Electrical Companyy� leAPite LLC- Office Phone 04.33 9 3 .1
c1 N- 375 Fax 22t
Co.Address:_ aDMr rc.2C.'A CT Citylt�F.KSOhi[JS I.tG State FL Zip
License Holder(Print): - l..l—Ul,2 qt,j r%-F State
�Certification/Registration# Fc-/3005'33
Notarized Signature of License Holder L "? i.0 r_0109
f,I R. Rv�trKr3us Before me this�day of a u.wa< 20 I -7
�yOrNN Signature of Notary Public°gerwi.A.
s+ eere*mwar�ur.no
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Cash Register Receipt
City of Atlantic
R1760
DESCRIPTION1 CITY
PermitTRAK
$109.0t0�
ELEC17-0003 Address: 1089 ATLANTIC BLVD B APN: 177616 0000 $109.00
ELECTRICAL $105.00
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
SAFETY INSPECTION 455-0000-322-1000 0 $50.00
STATE SURCHARGES $4.00
STATE DEER SURCHARGE 455-0000-208-0600 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0700 0
1TAL FEES , BY RECEIPT: 1 $109.00
Date Paid:Tuesday,June 13, 2017
Paid By: PHASE ONE ELECTRIC LLC
Cashier: BA
Pay Method: CREDIT CARD 8
/\
Printed:Tuesday,June 13,201711:42 AM 1 of 1 ��•
CITY OF ATLANTIC BEACH
BN SEMINOIF RD
ATLWTIC BEAC,R 32233 11:41:50
O6I1312017 CREDIT CARD
VISASAIF
WAW=3900
Cad p g
SEQ p'• 384
W A'• g
INVOICE 905566
ARproval Code'. mal
EnhyMegwd: Ott °.
Mode• �p,00
Tax woo M
Cad Cok'.
SALE AMOUNT $1O9.W
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