345 1st St ERES19-0206 3 Fixtures '''�% , ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH ERES19-0206
v 800 SEMINOLE ROAD ISSUED:
ATLANTIC BEACH. FL 32233 EXPIRES:
MUST CALL INSPECTION PHONE • 1 / 247-5814 BY / PM FORINSPECTION.
ALL WORK • • ' TO THE CURRENT 6TH EDITION1 OF • '
CODE, OF • OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ
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: ALUE OF WORK:
345 1ST ST ELECTRICAL RESIDENTIAL ELECTRIC - 3 FIXTURES $250.00
TYPE OF
• • GROUP:
169766 0000 ATLANTIC BEACH
COMPANY: ADDRESS:
INTEGRITY FIRST ELECTRIC 920 8TH AVENUE SOUTH, #D JACKSONVILLE FL 32250
COMPANY BEACH
• ADDRESS: CITY: STATE- ZIP:
AVENS MARK 345 1ST ST ATLANTIC BEACH FL 32233-5227
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 LIGHTING OUTLETS,INCLUDING FIXTURES 4SS-0000-322-1000 3 $1.80
ELEC SWITCH AND RECEPTACLE OUTLETS 455-0000-322-1000 0 $0.00
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 4SS-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 4SS-0000-208-0600 0 $2.00
TOTAL: $60.80
Issued Date: 1 of 2
(R� C(9 -oz Z
Electrical Permit Application **HIGHLIALL HIGHLIGHTED
ON
HIGHLIGHTED IN
J ' City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 (
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: L��� s+ S� . PROJECT VALUE $
JEA INFORMATION REQUIRED ON ALL PERMITS: AMPS VOLTS PHASE
❑ NEW SERVICE: ❑ Overhead ❑Underground ❑Underground up Pole
❑Residential (Main)Service:
❑0-100 amps ❑101-150amps o151-200amps ❑ amps #of Meters
❑Commercial (Main)Service:
❑0-100 amps ❑101-150amps o151-200amps ❑ amps ❑CT Service amps
Conductor Type Size
❑Multi-Family(Main) Service:
❑0-100 amps �J101-150amps o151-200amps ❑ amps #of Unit Meters
❑ TEMPORARY POLE: amps
❑ SERVICE UPGRADE: ❑ amps ❑CT Service amps
❑ NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps ❑200amps amps ❑CT 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:
❑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
❑Other: updated so/v/is
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.
Owner Name: Phone Number:
Electrical Company: Tn4CCV'- ji Fes
es f/c c iok- Office Phone: _Fax:
Co.Address: [an2-0 () �,��y� s� City: State: ) C-Zi Z sb
License Holder: C. �T-�✓ ` v�o$ State Certification/Registration#:
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this jZda 0
2dj in th e of Flori a,Co n y of C. `
Signature f Notary Public
LIE
TO=7Ed
Rersonally Known OR[ ] Produced Identification
CO4951 PI2019 T e of Identification:
er�rters YPed T