120 JACKSON RD ELECTRIC PERM E
ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH ERES19-0056
800 SEMINOLE ROAD
ISSUED: 2/14/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 8/13/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • ' ♦ BUILDING
CODE, • AND OF ATLANTIC BEACH • OF • '
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:
120 JACKSON RD ELECTRICAL RESIDENTIAL NEW SERVICE $0.00
TYPE OF
CONSTRUCTION: NUMBER: GROUP:
172140 0000 DONNERS S/D PT LOT 2
17-
• ADDRESS: '
Service of Knights LLC 415 N 4th Avenue Jacksonville Beach FL 32250
• ADDRESS: CITY: STATE: ZIP:
AF AB VENTURE LLC 1738 SELVA MARINA DR ATLANTIC BEACH FL 32233
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 • •
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 NEW SINGLE FAMILY 455-0000-322-1000 200 $70.00
ELECTRICAL BASE FEE 45S-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 4SS-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $129.00
Issued Date: 2/14/2019 1 of 2
Electrical Permit Application "ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
F � 800 Seminole Rd, Atlantic Beach, FL 32233 (� 19 - ooSc4D
nin
Phone: 904 247-5826 Email: Building-Dept@coab.us PERMIT#: K .5
JOB ADDRESS: 12-0 SACK-SoN A� PROJECT VALUE$ 2-SR'0J
IEA INFORMATION REQUIRED ON ALL PERMITS:ZLXD AMPS hyo VOLTS 1 PHASE
❑ NEW SERVICE: ❑Overhead driderground []Underground up Pole
oResidential(Main)Service:
❑0-100 amps 0101-150amps p151-200amps ❑__amps #of Meters
❑Commercial(Main)Service:
❑0-100 amps 11101-150amps 11151-200amps ❑ amps []CT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
❑0-100 amps 0101-150amps E]151-200amps ❑_amps #of Unit Meters
❑TEMPORARY POLE: amps
SERVICE UPGRADE: ❑ amps OCT Service amps
❑ NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps ❑200amps ❑_ amps [ICTService 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
❑REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change []OH to UG
Updated 10/17/18
❑ether:
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 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. �� rC
Owner Name: `"1 tJ V l��C�C�S �1.� Phone Number:
Electrical Company: ery,Cr oe Kt-t.'gh15 &'fr%'c t;t Office Phone: 907 - 33y'ej31 q Fax:
Co.Address: Z`� (P�� �"`� /� City: S�� ? State: `L zip-.3'2 Z S J
License Holder: �-i N r .-f State Certification/Registration#: 130/'5-32-0)
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this h -day of FQ)ID ,"p2//0��� in the State of Florida,County of �A C
Signature of Notary Public'l;
BEVBiLYKBlRS [ errs Known OR[ ]Produced Identification
IAti'COWAMM#FF200B18 Type of Identification:
pMES:AO V-2D19
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