50 Ocean Breeze Dr electrical panel change permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ELECTRICAL RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: ERES17-0183
Description: PANEL CHANGE
Estimated Value: 0
Issue Date: 11/8/2017
Expiration Date: 5/7/2018
PROPERTY ADDRESS:
Address: 50 OCEAN BREEZE DR
RE Number: 168908 8245
PROPERTY OWNER:
Name: GROSSBERG MICHAEL
Address: 50 OCEAN BREEZE DR
ATLANTIC BEACH, FL 32233-0494
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: SCHUMAN ELECTRIC INC.
Address: PO BOX 48171 QA JOHN JASPER SCHUMAN
JACKSONVILLE, FL 32247
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.
Nov, 7, 2017 11 : 36AM No. 5039P. 1/1
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC 113E ACH
.80.0 Sernin6le.
Ph(904) 247-5826 Fax (904) 247-5845
JO]3,ADDRESS:,_, ...........
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE
VALUE 0,PWORKS 9W -00
NEW SERVICE 0 Overhead ❑ Underground Underground up Pole
DResidential(Main)Service
LO-100 amps 0101-150amps D 151-200amps 0 amps #of Meters
0 Commercial(Main) Service
0 0-100 amps 0101-150amps 3 1.51-200amps []-amps DCT Service amps
Conductor Type Size
[]Multi-Family(Main)Service
00-100 amps C1101-150amps U 151-200amps n amps #of Unit Meters
OTemporary Pole D amps
SERVICE UPGRADE 0 amps L CT Service_amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
0100amps 0150amps F1200amps 0_amps LCT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches- -0-30amps 31-100amps 101-200amps /( 0
Appliances; 0-30amps 31-100amps 101-200amps
A/C Circuits: 0-60amps 6 1-I 00amps
Heat Circuits-. # circuits
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
Swimming Pool [] Sign L Smoke Detectors_Qty [1Transfbrmers_KVA F.lMotors_hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty-volts/amps VALUE OF WORK S
REPAIRS/MISCELLANEOUS
F Replace Burnt/Damaged Meter Can 0 Safety Inspection nel Change 0OHtoUG
00ther- c_�o na c,r\ e-�A r L e- 4
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 00rISTrUctiOn or the performance of
construction.
Property Owners Name NAidNad r-9 Phone Number IN- -737-1/0YQ
Electrical Company abowe"n UeLlric_ Office Phone qoq- 73?-..qO
*4x_S_'?(o YJ_Q_q
Co.Address: 130'x qy)l I City J State R, zip 322 9
License Holder(Print):
)Qbn ' rnrid! State Certification/Registration#
Notarized Signature of LicensCH der 5
HOLLY- WALDEN $w subscribed before
MY COMMISSION 0
worn �su
EXPIAIjS November 25,202t.S'gnature of Notary Public
rt�Ulr
'S Receipt
Cash Register Receipt
City of
�JF3 9'r
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $94.00
ERES17-0183 Address: 50 OCEAN BREEZE DR APN: 168908 8245 $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: R3405 $94.00
CITY OF ATLANTIC BEACH
800 SEMINOLE RD
ATLANTIC BEAC,FL 32233
11,r08 2017 15:47:09
CREDIT CARD
VISA SALE
Card# XXXXXXXXXXXX8459
SEQ#: 5
Batch#: 480
INVOICE 5
Approval Code: 028415
Entry Method: Manual
Mode: Onlhe
Tax Amount: $0.00
Card Code: M
SALE AMOUNTg4,pp
CUSTOMER COPY
Date Paid: Wednesday, November 08, 2017
Paid By: SCHUMAN ELECTRIC INC.
Cashier: BA
Pay Method: CREDIT CARD 5
/%
Printed:Wednesday, November 08,2017 3:48 PM 1 of 1 1
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