1120 Ocean Blvd ERES19-0171 20 FixturesELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH
ERES19-0171
800 SEMINOLE ROAD ISSUED: 6/6/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 12/3/2019
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.
1120 OCEAN BLVD ELECTRICAL RESIDENTIAL 20 ELECTRIC FIXTURES $20000.00
170285 0000 ATLANTIC BEACH
LORE ELECTRICAL 210 N ROSCOE BLVD PONTE VEDRA FL 32082
CONTRACTORS BEACH
• ADDRESS:
JEFF CHARTRAND 1120 OCEAN BV ATLANTIC BEACH FL 32233-5740
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.
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 LIGHTING OUTLETS, INCLUDING FIXTURES
455-0000-322-1000
20
$12.00
ELECTRICAL BASE FEE
45S-0000-322-1000
0
$55.00
STATE DBPR SURCHARGE
455-0000-208-0700
0
$2.00
STATE DCA SURCHARGE
455-0000-208-0600
0
$2.00
TOTAL: $71.00
Issued Date: 6/6/2019 1 of 2
Electrical Permit Application
City of Atlantic Beach Building Department
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800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Buildin -De 1
JOB ADDRESS:
2.� Oc&6v
"ALL INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED.
ERES�q-01*7(
coab.us PERMIT#:
_ PROJECT VALUE $ )�O , 0_�
JEA INFORMATION REQUIRED ON ALL PERMITS: ✓�t!AMPS 2— `O VOLTS PHASE
❑ NEW SERVICE: ❑ Overhead
❑Residential (Main) Service:
❑0-100 amps o101-150amps
❑Commercial (Main) Service:
❑0-100 amps o101-150amps
Conductor Type
❑Multi -Family (Main) Service:
❑0-100 amps ❑101-150amps
❑Underground ❑Underground up Pole
❑ TEMPORARY POLE: amps
❑ SERVICE UPGRADE: ❑ amps
❑ 151-200a m ps
❑ 151-200a m ps
Size
❑ 151-200a m ps
❑CT Service
❑ amps
❑ amps
❑ amps
amps
❑ NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps ❑200amps ❑ amps ❑CT Service amps
# of Meters
❑CT Service amps
# of Unit Meters
❑ 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 7
Number of Lighting Outlets, Including Fixtures:
❑ OTHER ELECTRICAL PROJECTS:
❑Swimming Pool ❑Sign ❑Smoke Detectors _ (Qty) ❑Transformers KVA ❑Motors
❑ FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
HP
❑ REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change ❑OH to UG
Updated 10/17118❑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. 1 /lam
Owner Name: ,/a j2 N Phone Number:
Electrical Company: 4--V/46--
Co. Address: 2_ () C.
License Holder:
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this day
Office Phone: Fax:
City /LQ State: 71 Zip:
State Certification/Registration #: C�, 3y SQ
Signature of Notary Public
°a.sa TON] GINDLESPERGER
2� F NlyCOMMISSION#FF924951 ersonally Known OR [ ] Produced Identification
`�: •a` EXPIRES: October 6, 2019 Type of Identification:
Bonded Th Notary Public underwriters
the $tate of Florida, County of