1850 MAYPORT RD UNIT 3 - ELECTRIC SAFETYELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (90247-5845 E L EQ i 7 --b 0( 3
JOB ADDRESS: it.5 1/1/1/1F-3 fi7j ,4'ifl PERMIT#
IINFO 'i • TION OE 0 V 11'1 aD OCUG;y w to PERMITS fuv AMPS S. la V® `LIQ PH. S t
VALUE OF WORK$
a
NEW SERVICE Overhead n Underground TT Underground up Pole
Residential(Main) Service
00-100 amps 101-150amps 151-200amps amps of Meters
Commercial(Main) Service
00-100 amps 101-150amps 151-200amps amps OCT Service amps
Conductor Type Size
Multi-Family(Main) Service
00-100 amps 101-150amps 151-200amps amps of Unit Meters
El Temporary Pole amps
SERVICE UPGRADE amps CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
100 amps 150amps 0200amps amps CT 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 KVA Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
Replace Burnt/Damaged Meter Can 2`Safety Inspection Panel Change OH 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 oflaws 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 orthe performance of
construction.
frPropertyOwnersName lb1' Phone Number
Electrical Company 1.4-Z1,41 WG' Office Phone fiW— Fax_
Co. Address: :.. 3 C) -
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144i. fQQ Ct•-• City State Zip
License Holder(Print): OW ge,,!/G`aState Ce'rti9 ation/Registration1'0 7''
Notarized Signaturesake ise..HQlder 9y 'C_
t , •,',; TONT GINDLESPERGER f ci( 20 I 71:N."''''.5.:', MY COMMISSION t FF 924951 Before me this r day o
y }moo.; EXPIRES:October 6,2019
1' BondedThuNoi>ryPuhlicUnder+rdersNignature ofNotary Public — ill