130 5TH ST ERES19-0102 NEW SERV PERM ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH ERES19-0102
800 SEMINOLE ROAD ISSUED: 3/28/2019
EXPIRES: 9/24/2019
ATLANTIC BEACH. FL 32233
MUST CALL INSPECTION • i . BY 4 PM FORDAY • •
ALL • ' K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • ' ! + BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC +CH CODE OF ORDINANCES .
ALL i ! i 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: PERMITTYPE: DESCRIPTION: VALUE OF WORK:
130 5TH ST ELECTRICAL RESIDENTIAL NEW ELECTRIC SERVICE 300 $30000.00
AMPS
TYPE OF BUILDING
• • GROUP:
170168 0000 ATLANTIC BEACH
COMPANY: ADDRESS: '
INTEGRITY FIRST ELECTRIC 920 8TH AVENUE SOUTH, #D JACKSONVILLE FL 32250
COMPANY BEACH
• + D! • + '
DIAZ MICHAEL K 130 5th 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.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
ELEC NEW SINGLE FAMILY 455-0000-322-1000 300 $90.00
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.18
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $149.18
Issued Date:3/28/2019 1 of 2
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845 n
JOB ADDRESS: �O S S�✓ct �' PERMIT#.G REsfg —
a+Oz
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS ! PHASE
c�
VALUE OF WORK$ 3O cx icy
NEW SERVICEOverhead ❑ Underground PaUnderground up Pole
❑ResidentiaK(Main) Service '
❑0-100 amps ❑101-150amps ❑151-200amps ov amps #of Meters
❑Commercial(Main) Service
❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps OCT Service amps
Conductor Type Size
❑Multi-Family(Main)Service
❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Unit Meters
❑Temporary Pole ❑ amps
SERVICE UPGRADE ❑ amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps 0200amps ❑ amps OCT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-3 Damps 31-l 00amps 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 J Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change ❑OH 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 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 1 )f az Phone Number
Electrical Company �� c�✓ �( `�5� Itc�'�' Office Phone Z Y(s-G L !3 Fax
Co.Address: 9 2y 8 t-S Aie S, City SA-x �a` State l=l Zip 37ZSti
License Holder(Print): «,r-- 4 a vtt-S State Certification/Registration# �/?00
Notarized Signature of License Holder
SUTANNETHOMPSON efore me this g day of maYC-I^-, 20
Commission 9 GG 204797
'Expires April S,2022 ignature of Notary Public
E�►�`°•' 8aded Ttru T�q Fain Intun�ee E00Jw?019