2139 Seminole ERES18-0339 ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach,FL 32233
C Ph(904)247-5826 Fax(904)247-5845 '
.JOB ADDRESS: a k 3 -nn 5\ M n!AQ 1F �PJ . _ PERMIT#
3EA INFORMATION REQUIRED ON ALL PERMITS o76) AMPS —,)o VOLTS PHASE
' D
VALUE OF WORKS o70GY`�.o
NEW SERVICE ❑ Overhead ❑ Underground ❑I Underground up Pok
Residential(Main)Service
00-100amps ::101-150amps 0151-200amps - amps #of Meters_
❑Commercial(Main)Service
CO-100 amps .7101-150amps ❑151-200amps Damps OCT Service_amps
Conductor Type Size
CMu1&Family(Main)Service
C0-100 amps 0101-150amps 0151-200amps amps #of Unit Meters
OTemporary Pole :_amps
SERVICE UPGRADE O_smps CCT Service_amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
0100 amps O 150amps 0200amps Camps OCT Service_amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: XLO 0-30amps —_31.100ampa 101-200amps
Appliances: 0.30amps 31-I00amps 101-200amps
A/C Circuits: 0.60amps 61-I00amps
Heat Circuits: #circuits(a) kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
❑Swimming Pool CSign O Smoke Detectors_Qty OTransformers KVA 7,Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plana) wv
Qty,_volts/amps VALUE OF WORK S,XQ0,
REPAIRS/MISCELLANEOUS
El Replace Burnt/Damaged Meter Can ,iSafety,Inspection f-.Panel Change _:OH to UG
OOther.
Permit becamo void ifwoh does not commma within a sic north period or work is suspended or abandoned for six months. 1 hereby ceniy that 1 have
read this application and knew the same a 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 m violate the previsions of any other state or local law regulation construction or the perfomance of
construction, qq �
Property OwnersName &tP11IlY FhG1 .t;, Phone Number rrQ0-&3X]- (gig'
Electrical Company f) 1/n°� 'c'f1a' (I-A4d d1)6WLla .s 111C' OfficePhone*7 2l ? Felin7Go7 LSA
Co. Address: foo �I Y01 1 n` 7Y'• City—IlQfl/ State daZip 3XV
License Holder(Prbs*:--1&P2M4PButte Certification/Registration#F/'(30 0QaS
Notarized Signature afLieeme Holder - •-S/ pp
4�CMTNIALEEeOLMEa IV
Sworn end subsc before y of 20}Q-
1, Commlulonr Ff 9M7A6
EapinrApnd.7o7o Signature of Notary PLCublic
t. eo,aarwr rw�nwaan<.sa.maolt
ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH ERES18-0339
ISSUED: 10/15/2018
800 SEMINOLE ROAD EXPIRES:4/13/2019
•T ATLANTIC BEACH. FL 32233
MUST CALL • • • • • • • NEXT DAY INSPECTION.
ALL • . •CONFORM • • • • r OF • • •A BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
FNOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable tc this property
may be found in the public records of this county,and there may be additional permits required from other
rnmental entities such as water management districts,state agencies,or federal agencies.
2139 SEMINOLE RD ELECTRICAL RESIDENTIAL 200 Amp 240 Volt 1 Phase $2000.00
ZONING:TYPE OF REALESTATE BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169515 0500 SECTION LAND
COMPANY: rr •
Power& Control 6431 Pottsburg Or Jacksonville FL 32211
Installations, Inc
OWNER: STATE: ZIP:
tr •
Camille Adams 2139 SEMINOLE RD ATLANTIC BEACH FL 32233-5921
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR 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.
I LIST OF CONDITIONS
Roll off container company must be on City approved list. Container cannot be placed on City right-of-way.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
ELEC LIGHTING OUTLETS,INCLUDING FIXTURES
4550000.311-1000 17 $1010
ELECTRICAL BASE FEE
455-0000-322-1000 0 $5500
STATE DBPR SURCHARGE
455 0000-2080700 0 $��
STATE OCA SURCHARGE
45s- 0 -208-0600 0 $300
TOTAL:$69.20
Issued Date: 10/15/2018
Cash Register • • • -go
DESCRIPTION • CITY Al/
PermitTRAK $69.20
ERESSS-0339 Address: 2139 SEMINOLE RD APN: 169515 0500 $69.20
ELECTRICAL $65.20
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.W
ELEC LIGHTING OUTLETS,INCLUDING 455-0006322-1000 17 $10.20
FIXTURES
STATE SURCHARGES $C00
STATE DBPR SURCHARGE155-0000-208-0]0008-0500 0 $2.00
CA
STATE DSURCHARGE 455'0000'2 0 $2.00
TOTAL1 BY RECEIPT: R7058 $69.20
Date Paid: Monday,October 15, 2018
Paid By: Power&Control Installations,Inc
Cashier: CB
Pay Method: CREDIT CARD 4464
Printed:Monday,October 15,2018 4:12 PM 1 of 1
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