560 Sherry Drive ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach,FL 32233G� (� _
Ph(904)247-5826 Fax (904)247-5845 t
JOB ADDRESS: j5(00 ShcR�Rlv4 Aijill 13c" FL 3111.l PERMIT N
JEA INFORMATION REQUIRED ON ALL PERMITS _200 AMPS: 1201240 VOLTS :Single PHASE
VALUE OF WORKS 1,500
NEW SERVICE Overhead ❑ Underground []Underground up Pole
Residents (Main)Service #of Meters,_
E0-100 amps E1101-150amps X151-200amps ❑ amps
Commercial(Main)Service am a ❑CTService_amps
0-100 amps ❑101-150amps ❑I51-200amps ❑_ p
Conductor Type Size
Multi-Family(Main)Service ams #of Unit Meters
_]0-100 amps 0101-150amps ❑151-200amps O—MPS
::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,BUHA-OUTS,ACCESSORY STRUCTURES,ETC-
outlets/Switches: 2_0-30amps 31-100amps 101-200amps
Appliances: `_0-30amps 211-100amps _101-200amps
A/C Circuits: / 0-60amps _61-100amps
Heat Circuits: �_ # circuits Q kw
Number of Lighting Outlets, Including Fixtures: 5
OTHERECTRICAL PROJECTS
❑S aiming Pool ❑ Sign ❑Smoke Detectors_Qty ❑Transformers KVA ❑Motors_hp
FIRE SYSTEM (Requires 3 sets of plains) VALUE OF WORK S
votts/amps
REPAIRS/MISCELLANEOUS
Replace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change DOH 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 ime and correct. All provisions of laws and ordinances governing this work will be complied with whether
specified or not. Tpermit
he does not give authority to violate the Provisions of any other state or local dew regulation constrnmion or the performance of
construction.
d,� Pho N ber goy) cog-
Property - 8�2
Owners Name A't
Electrical Company
Office Ph ne -9Z
Co.Address: 177S 4i City EA. A State XL Zip 2OSc/
License Holder(Print): State Celli atio gi [ration# AM2,901298
T
Notarized Sikens o its°Zt
%n '? `MEy pE5.c' °P`u�a subscribed before me this y CTa h e 20 Y
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Signature of Notary Public
Application
--ALL INFORMATION
Electrical Permit A
^'4 Pp HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY 15 REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Deot@coab.us PERMIT#:
JOB A RESS: 560 Sherry Or PROJECT VALUE$$2.300.00
iy JEA INFORMATION REQUIRED ON ALL PERMITS: 200 AMPS m VOLTS 1 PHASE
❑NliW SERVICE: C1 Overhead ❑underground ❑Underground up Pole
I Residentlal(Main)Service:
00-100 amps [3101-150amps 0151-200amps 171 amps If of Meters_
[3Commercial(Main)Service:
00-100amps 13101-150amps [3151-200amps amps ❑CTSemice_amps
Conductor Type Size
0multi-Family(Main)Service:
00-100amps [3101-150amps []151-200amps ❑_amps #of Unit Meters_
❑TEMPORARY POLE: amps
❑SERVICE UPGRADE: ❑_amps EICT Service_amps
❑ NEW FEEDER (ADDITIONS,ACCESSORY STRUCTURES,ETC.):
❑100amps ❑150amps )]200amps ❑_amps Q'TService_amps
❑ ADDITIONS,REMODELS,REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES,ETC:
Outlets/Switches:15 0-30amps _31-100amps _101.200amps
Appliances: 0-30amps 31-100amps _101-200amps
C Circuits: 0-60amps 61-100amps
at Circuits: _# circuits @_kw
tuber of Lighting Outlets, Including Fixtures: 10
❑
A IER ELECTRICAL PROJECTS:
wimming Pool OSign ❑Smoke Detectors (City) ❑rransformers KVA []Motors HP
FIRE ALARM SYSTEM(Requires 3 sets of plans):
Qty volts/amps
REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can ❑.Safety Inspection OPanel Change []OH to UG
Other: uvdoream/vrye
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 compiled 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
consmictiOn.
Owner N me: William Faver Phone Number: (9041)3134-M
Electrical mpany: Owen Ekario Office Phone: )6240910 Fax:
Co.Addr 1Tr5 takevde Ave C Rti /Registrationg:
State: FI Zip; 32054
License eP tate i E0oo00993a
Norah rtctureo/lkmaelblder
The force i g instrument was acknowledged before me th da ofli� 20 the State of 0 glfJa
sig Lure of Notary Public ¢'"#"+ ^cAM�1t 111021
"s E%PIRE 'tom,
I Personally Known OR l I Produced Identifies n
&n
i Type of Identification:
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