2233 SEMINOLE RD ERES18-0242 POOL ELEC ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH � R Est cJ� ����/j`'t L
800 Seminole Rd,Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax(904) 247-5845 i ,Ziitfrike,1
JOB ADDRESS: 2. 2-S'-' Se....,--,'I v\ a1 C- tzoa� PE•MIT #
JEA INFORMATION REQUIRED ON ALL PERMITS 1 b b AMPS (4d VOLTS X PHASE
VALUE OF WORK$ V5Das
NEW SERVICE ❑ Overhead ❑ Underground ❑1 Underground up Pole
Residential(Main)Service
0-100 amps 10l-150amps 151-200amps amps #of Meters
Commercial(Main)Service
0-100 amps 101-150amps 151-200amps amps CT Service amps
Conductor Type Size
Multi-Family(Main) Service
0-100 amps 101-150amps 151-200amps amps #of Unit Meters
Temporary Pole amps
SERVICE UPGRADE amps CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
100 amps 150amps 200amps amps CT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC. (,,\,./
Outlets/Switches: 0-30amps 31-100amps 101-200ampsAppliances: 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 Safety Inspection Panel Change OH to UG n
Other: .c-t,..);ta klc.W pop ( CT,;Dncr.-1' .•.k' Corr ...,, :Ai rook
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 ha%e
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. 96'4
Property Owners Name QC ea" \t l�� Co oS Phone Number -7/L- 4-13 `l
Electrical Company 1-1,yry C .-4- -IeCf-,:c..
Office Phone /b`�`�(� �/}y Fax Z3 3 o cg
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Co.Address: Z?g 7 C -octAa K``. f)a cL City J eviAsoAv,t I fL State li- Zip . Z L-`-
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License Holder(Print): / lD h La S ' ta.=4::?. ;ficat (� gj,�t t n
°. �= Notary Public-State of Fiona,'
—
airier
I n a My Comm.Expires Oct 2E.2017
_� 4 -,:,,-.....--.4 Commission N ff 041129
Cash Register Receipt Receipt Number
City of Atlantic Beach R5776
DESCRIPTION I ACCOUNT QTY PAID
PermitTRAK $99.00
ERES18-0242 Address: 2233 SEMINOLE RD APN: 169519 0101 $99.00
ELECTRICAL $95.00
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
ELEC SWIMMING POOLS 455-0000-322-1000 0 $40.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R5776 $99.00
CITY OF ATLANTIC BEACH
800 SEfrINOLE RD
ATLANTIC BEAC,FL 32233
07 202018 11:18:12
CREDIT CARD
VISI,SALE
Card; XXXXXXXXXXXX6497
SEQ R: 4
Batch#: 652
INVOICE 4
Approval Code: 04382G
Entry Method: Manual
Mode: Online
Tax Amount: $0.00
Card Code: M
SALE AMOUNT $99.00
CUSTOMER COPY
Date Paid: Friday, July 20, 2018
Paid By: HAPPY CAT ELECTRIC INC.
Cashier: JDS
Pay Method: CREDIT CARD 04382G
Printed: Friday,July 20,2018 11:26 AM 1 of 1 r
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