275 1st St. ERES18-0081 ELECT PERM ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
v CITY OF ATLANTIC BEACH ERES18-0081 4
ISSUED: 3/8/2019
800 SEMINOLE ROAD
EXPIRES: 9/4/2019
ATLANTIC BEACH. FL 32233
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • '
CODE, ' OF 'CH 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:
2)577CHANGE OUT DUAL METER 1ST ST ELECTRICAL RESIDENTIAL BANK $0.00
TYPE OF
• • GROUP:
172539 0000 ATLANTIC BEACH
TERRACE
COMPANY: ■ ADDRESS:
DAVID GRAY ELECTRICAL 6491 Powers AVE STE 1 JACKSONVILLE FL 32217
SERVICES INC
• ADDRESS:
MCCLAIN MARY 1825 OCEAN GROVE 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.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
ELEC REPAIRS AND MISC 4SS-0000-322-1000 0 $35.00
ELECTRICAL BASE FEE 455-0000-322-1000 0 $5S.00
STATE DBPR SURCHARGE 455-0000-208-0600 0 $2.00
STATE DCA SURCHARGE 45500002080700 0 $2.00
Issued Date: 3/8/2019 1 of 2
ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
J CITY OF ATLANTIC BEACH ERES18-0081
+� "!
800 SEMINOLE ROAD ISSUED: 3/8/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 9/4/2019
TOTAL:
Issued Date: 3/8/2019 2 of 2
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233 C (yes p
Ph(904)247-5826 Fax (904) 247-5845 8 "� I
JOB ADDRESS: ji S+ S� tV+t a c ,° c,c(, , t t- PERMIT#
32Z-33
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS Z°{0 VOLTS PHASE
VALUE OF WORK$ 1,100
NEW SERVICE LJ Overhead ❑ Underground ❑T Underground up Pole
iResidentialain Se �, /
❑O-100 amps ) ��
Cvt"01-150amps ❑botf-200amps CI amps #of Meters �---
1 1Commercial(Main) Service
❑0-100 amps 1110 1-I 50amps u 151-200amps ❑ amps OCT Service amps
Conductor Type Size
I]Multi-Family(Main)Service
1 10-100 amps 11101-150amps I 1151-200amps ❑ amps #of Unit Meters
❑Temporary Pole i i amps
SERVICE UPGRADE 1_I amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps 0200amps ❑ amps I ICT Service 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
I ;Swimming Pool _J Sign I ISmoke Detectors_Qty FTransformers KVA I (Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIR
"IISCELLANEOUS
14,Replace Burnt/Damaged Meter Can u Safety Inspection I ]Panel Change ❑OH to UG
11 Other: C k 1 ( ✓l
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. '/
Property Owners Name Ilei+t^ Su 5 aVI �� ( ne✓f i r� Phone Number g64'S2Srl 2 (3
Electrical Company L,(A 60. ( ec tcaA Office Phone ?Oq--?Zq-)ZII Fax
Co.Address: 4qt 'wys `e— City-r:;-A,>" State*FL- Zip 3221 ^]
License Holder(Print): r6r a,,.b-" G" (LS State Certification/Registration# 'C/300 1
Notarized Signature of License Holder
=o�Nt Pu,� Notary Public state of Florida Sworn and subscribed before me this�day of w1 a rc lq 20 l�
Shannon E Sholar
"Tp. My Commission GG 179832
d' Expires 01/2812022 Signature of Notary Public
r
J Cash
J 1'1 Register Receipt
City ofAtlanticBeach • •
DESCRIPTION
• CITY PAID
PermitTRAK $94.00
ERES18-0081 Address: 275 277 1ST ST APN: 172539 0000 $94.00
ELECTRICAL $90.00
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
ELEC REPAIRS AND MISC 455-0000-322-1000 0 $35.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0600 0 $2.00
STATE DCA SURCHARGE 45500002080700 0 $2.00
TOTAL FEES PAID BY RECEIPT: R8378 11
Date Paid: Friday, March 08, 2019
Paid By: DAVID GRAY ELECTRICAL SERVICES INC
Cashier: CT
Pay Method: CREDIT CARD 04786G
Printed: Friday,March 08,2019 3:02 PM 1 of 1
mwrr
INVOICE #
J S City of Atlantic Beach INV-3386
e.
800 Seminole Road Date Due:4/11/2018
Atlantic Beach, FL, 32233
Invoice Date:3/12/2018
Record# Record Type Fee Group Fee Description Quantity Amount
ERES18-0081 ELECTRICAL RESIDENTIAL ELECTRICAL ELEC REPAIRS AND MISC 0 $35.00
ELECTRICAL BASE FEE 0 $55.00
STATE SURCHARGES STATE DBPR SURCHARGE 0 $2.00
STATE DCA SURCHARGE 0 $2.00
Invoice Total $94.00
Please send your payment to this address:
Printed: Monday,March 12,2018 5:06 PM 1 of 1 h