545 CLIPPER SHIP LN - ELECTRICr
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`'3 ' CITY OF ATLANTIC BEACH
7.5v 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
r st INSPECTION PHONE LINE 247-5814
ELECTRICAL RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: ERES17-0085
Description: ELECTRIC REMODEL
Estimated Value: 0
Issue Date: 8/1/2017
Expiration Date: 1/28/2018
PROPERTY ADDRESS:
Address: 545 CLIPPER SHIP LN
RE Number: 170703 0220
PROPERTY OWNER:
Name: FARACE NORA LEE
Address: 545 CLIPPER SHIP LN
ATLANTIC BEACH, FL 32233-4112
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: DREAM ELECTRIC
Address: 11992 Chester Creek RD
JACKSONVILLE, FL 32218
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
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
I
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233 �
Ph(904) 247-5826 Fax(904)247-5845 E RE S i 7-OO C�
JOB ADDRESS: 5415 C f1 p pe( S hi'p LG(1 e _ PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS 0 0 AMPS 04 v VOLTS \ PHASE
a
VALUE OF WORK$ g, s-00
NEW SERVICE ❑ Overhead ❑ Underground J Underground up Pole
Residential(Main)Service
❑0-100 amps ❑101-150amps ❑151-200amps amps # of Meters
11 Commercial(Main)Service
00-100 amps C 101-150amps 0151-200amps amps OCT Service amps
Conductor Type Size
❑Multi-Family(Main) Service
00-100 amps ❑101-150amps C 151-200amps a amps #of Unit Meters
❑Temporary Pole ❑ amps
SERVICE UPGRADE ❑ amps h CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps 0200amps 0 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 @ 10 kw
Number of Lighting Outlets, Including Fixtures: i 8
OTHER ELECTRICAL PROJECTS
❑Swimming Pool ❑ Sign ❑Smoke Detectors Qty Transformers KVA Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK S
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can CI Safety Inspection LiPanel Change LOH to UG
❑Other:
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 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 B; t.1- Q i`�e Phone Number Q Oil-a 3S- 1310Q
Electrical Company ceAM E ec\ ICG\ C(5(1�IC C�OIS I-1-C-- Office Phone I� —5311149/Pax
Co. Address:c C1 Qe'SeN Shia City —5 aX. State 1- t zip 39 a t 1
License Holder(Print): AGYeem •a•e \ St e Certification/Registration# R-/30/1/6g/
Notarized Signature o Licen . , 'Ider' AO/Y) Z/O2Id Ai
�;�Y
\ D !1EIii
PERGER rF 924361 this i..I day if a 20ber 6.2019Signature of Notary Publi tblic L'ndervrr.;ers `
J$ i
3ti� Recei t Number
ft Cash Register Receipt p
51
'w "� City of Atlantic Beach R2169
DESCRIPTION ACCOUNT QTY I PAID
PermitTRAK $94.00
ERES17-0085 Address: 545 CLIPPER SHIP LN APN: 170703 0220 $94.00
ELECTRICAL $90.00
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
•
ELEC REPAIRS AND MISC 455-0000-322-1000 0 $35.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0600 0 $2.00
STATE DCA SURCHARGE 45500002080700 0 $2.00
TOTAL FEES PAID BY RECEIPT: R2169 $94.00
Date Paid:Tuesday, August 01, 2017
Paid By: DREAM ELECTRIC
Cashier: LE
Pay Method: CREDIT CARD 4
Printed:Tuesday,August 01, 2017 1:34 PM 1 of 1
iwauT
CITY OF ATLANTIC BEACH
800 SEMINOLE RD
ATLANTIC BEAC,FL 32233
08,01:2017 13:31:10
MID:XXXXXXXXXXXX815 TID:XXXXX791
CREDIT CARD
VISA SALE
CARD r; XXXXXXXXXXXX8628
INVOICE 0006
SEQ n: 0006
Batch u: 000615
Approval Code: 030072
Entry Method: Manual
Mode: Online
Tax Amount: $0.00
Card Code: M
SALE AMOUNT $94,00
I agree to pay above total amount
accoding to card issuer agreement.
(Merdrant agreement if Credit Vouches)
X
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