116 JACKSON RD ELECT PERMELECTRICAL RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
Cum 19 ATLANTIC BEACH. FL 32233
PERMIT NUMBER
ERES19-0055
ISSUED: 2/14/2019
EXPIRES: 8/13/2019
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:
+2 -&-JACKSON RD ELECTRICAL• 1• •1
172140 0000 DONNERS S/D PT LOT 2
17-
• ADDRESS: '
Service of Knights LLC 415 N 4th Avenue Jacksonville Beach FL 32250
• ADDRESS:
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 CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
Issued Date: 2/14/2019 1 of 2
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
45S-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
yS' �HIGHLIGHTED IN
fr i, City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 C O S
phone: (904) 247-5826 Email: Buildin -Det coab.us PER ITM W�5
— M
JOB ADDRESS: 4-< 3Ac-t: PROJECT VALUE $ Z
JEA INFORMATION REQUIRED ON ALL PERMITS: UO AMPS040 VOLTS I PHASE
❑ NEW SERVICE: ❑ Overhead
otesidential (Main) Service:
❑0-100 amps 0101-150amps
❑Commercial (Main) Service:
❑0-100 amps 0101-150amps
Conductor Type
❑Multi -Family (Main) Service:
❑0-100 amps 0101-150amps
❑ TEMPORARY POLE: amps
1210nderground []Underground up Pole
0151-200amps 0_amps # of Meters
11151-200amps ❑ amps ❑CT Service
Size
[]151-200amps []_amps # of Unit Meters
❑ SERVICE UPGRADE: ❑ amps OCT Service amps
❑ NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
11100amps ❑150amps ❑200amps []—_____.,amps ❑CT Service amps
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
❑Dther:
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 1 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. e r-�-o l
LL
Owner Name: l (—'s c V'/ `rE'S Phone Number:
Electrical Company: SC'ryk >: ��I i �jtif5 ['ec c LLC Office Phone: '7N - 33q -9 3 -1 5 Fax:
Co. Address: .32-q l0 /� AJ City. ,TAX gel State: V(- Zip-JZZ so
License Holder: K�.1 f A 14 n i1j' 9 H State Certification/Registration #: FW i-301 - -5'3z S
Notarized Signature of License Holder
v
j 1A Ir
The foregoing instrument was acknowledged before me this/ day of �� , 20��� in tohe-State of Florida, County of�u�'4 L
Signature of Notary Public i l 1 y \
.y=1AYFF2W8
[�j'�ersonally Known OR [ ] Produced Identification
' Type of Identification:
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