1882 HICKORY LN ERES19-0019 ELECTRICAL PERMIT ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
ERES19-0019
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 1/16/2019
EXPIRES: 7/1S/2019
ATLANTIC BEACH. FIL 32233
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
that may be found in the public records of this county,and there may be additional permits required from other
governmental entities such as water management districts,state agencies,or federal agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
200 amps/240 volts/single-
1882 HICKORY LN ELECTRICAL RESIDENTIAL phase - panel change & $2000.00
remount can
I YPE OF REALESTATE BUILDING USE
ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
SELVA MARINA UNIT
1720201304 12B
----COMPANY: ADDRESS: CITY: STATE: ZIP:
AMERICAN ELECTRICAL 5065 ST AUG USTI N E RD #13 JACKSONVILLE FIL 32207
CONTRACTING, INC.
ADDRESS: CITY: STATE: ZIP:
ALLEN KATHLEEN ETAL 1882 HICKORY LN ATLANTIC BEACH FL 32233-4515
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.
LIST OF CONDITIONS
,Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
ELEC REPAIRS AND MISC 4SS-0000-322-1000 0 $35.00
ELEC SERVICE CHANGE 45S-0000-322-1000 200 $50.00
ELECTRICAL BASE FEE 4SS-0000-322-1000 0 $55.00�
Issued Date: 1/16/2019 1 of 2
Nil PERMIT NUMBER
ELECTRICAL RESIDENTIAL PERMIT
ERES19-0019
CITY OF ATLANTIC BEACH
ISSUED: 1/16/2019
800 SEMINOLE ROAD EXPIRES: 7/15/2019
ATLANTIC BEACH. FL 32233
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.101
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
44.10
TOTAL:$1
Issued Date: 1/16/2019 2 of 2
Electrical Permit Application "ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 eiLc-S k q - 00
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:k��Or3aq
JOB ADDRESS: lba2. J��UC)v-f_A PROJECTVALUE $ ?_D)QC9_
�j
JEA INFORMATION REQUIRED ON ALL PERMITS:2,X AMPS Z10 VOLTS PHASE
NEW SERVICE: E3 Overhead OUnderground ElUnderground up Pole
E311esidential(Main)Service:
[30-100 amps 0101-150amps [3151-200amps 0—amps #of Meters
MCommercial(Main)Service:
[30-100 amps [3101-150amps 13151-200amps amps OCT Service amps
Conductor Type Size
MMulti-Family(Main)Service:
OD-100 amps [3101-150amps [1151-200amps El_amps #of Unit Meters
TEMPORARY POLE: amps
EISERVICE UPGRADE:11 amps EXT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES, ETC.11:
r_]100 amps 13150amps [3200amps D amps E3CT Service amps
El 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:
DSwimming Pool l7lSign DSmoke Detectors (Qty) aransformers KVA []Motors HP
F]FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty -volts/amps
F1 REPAIRS/MISCELLANEOLIS:
OReplace,Burn Da aged Can 05afety Inspection tanel Change []OH to UG
.(: C
1 7118
rQther: VCA n�L N M
fA�Y7 LUPftVk1
Permit beco1nes 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 construction or the performance of
construction. ",N,�'e�'In �'\ _n
Owner Name: �ty') Phone Number: qo+
Electrical Company: (AYYU_AX'W'N (' Ctk —office Phone: Fax:
Co.Address: it State:
Ci"7 EL Z i p:
License Holder: ly ate Certification/Registration#: EC\?)C�-i
Notarized Signature of License Holder.
The foregoing instrument was acknowledged before me this Lra-day o�Lj"T�201A jinthe State of Florida,County of
Notary Public State of FWida Signature of Notary Public NOW
Angel N Brooks Ll
My Commisiiion 00 280614 Personally Known OR Produced Identification
Expires 10/1712022
6W6 Ay Pol of Identification:
Cash Register Receipt Receipt Number
City of Atlantic Beach R7852
DESCRIPTION ACCOUNT QTY PAID
PerrnitTRAK $144.10
ERES19-0019 Address: 1882 HICKORY LN APN: 172020 1304 $144.10
ELECTRICAL $140.00
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
ELEC SERVICE CHANGE 455-0000-322-1000 200 $50.00
ELEC REPAIRS AND MISC 455-0000-322-1000 0 $35.00
STATE SURCHARGES $4.10
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.10
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R7852 $144.10
CITY OF A-,ANTIC BEACH
600 SENNOLE RD
ATLANTIC B_-AC,FL 32233
01�16,2019 10:27:00
CREDIT CARD
MC SALE
Card XXXXXXXXXXXX1482
SEQ 2
Bath 772
INVOICE 4
Approval Code: 806403
Ent�Method: Manual
Mode: Online
Tax Amount: $0.00
Cust Code:
Card Code: M
SAIE AMOUNT $144.10
CUSTOtIER Copy
Date Paid: Wednesday,January 16, 201�,
Paid By: AMERICAN ELECTRICAL CONTRACTING, INC.
Cashier: BA
Pay Method: CREDIT CARD 4
Printed:Wednesday,January 16,2019 10:28 AM 1 of I