292 16th St ERES19-0231 Pool Elec ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
�'is I
ERES19-0231
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 8/5/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 2/1/2020
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH 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:
292 16TH ST ELECTRICAL RESIDENTIAL SWIMMING POOL ELECTRIC $0.00
TYPE OF REALESTATE BUILDING USE
ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
ATLANTIC BEACH PRKWY
1703850000 #02
COMPANY: ADDRESS: CITY: STATE: ZIP:
HAZOURI ELECTRIC, INC. P 0 BOX 56559 JACKSONVILLE FL 32241
OWNER: ADDRESS: CITY: STATE: ZIP:
DAY JEFFREY E 292 16TH ST 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.
'Z 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 SWIMMING POOLS 4SS-0000-322-1000 0 $40.00
ELECTRICAL BASE FEE 455-0000-322-1000 0 $5S.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 45S-0000-208-0600 0 $2.00
TOTAL: $99.00
Issued Date:8/5/2019 1 of 2
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph(904)247-5-826 Fax (904) 247-5845 CRC� ( q - oz5q
JOBADDRESS: _ Z?t leel./� !L_ PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS Z PHASE
VALUE OF WORK S
NEW SERVICE 0 Overhead Underground Underground up Pole
DResidential (Main)Service
00-100 amps D 10 1-15 Oamps D 151-200amps EJ amps #of Meters
D Commercial(Main) Service
00-100 amps Ll 10 1-15 Oamps 0 151-200amps El amps 0 CT Service amps
Conductor Type Size
E]Multi-Family(Main)Service
El 0-100 amps El 10 1-I 50amps Ll 151-200amps 0 amps #of Unit Meters
F]Temporary Pole amps
SERVICE UPGRADE F-],_amps 0 CT Service_amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
0100amps E150amps E1200arnps amps [I CT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-30amps 3 1-1 00amps 10 1-200amps
Appliances: 0-30amps 31-100amps 10 1-200amps
A/C Circuits: 0-60amps 6 1-1 00amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
Awimming Pool -_ Sign El Smoke Detectors—Qty 0 Transformers KVA D Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty_volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
[J Replace Burnt/Damaged Meter Can []Safety Inspection Ll Panel Change OOH to UG
El Other: 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 Phone Number
Electrical Company Office Phone YY , -Fax
Co. Address: LLK .AA City /6" 5L�2� State_aZip
Stat e A/�fflcation/Registration# A-)04)
License Holder(Print): f e C
NotarizedS&t
Latyrw af-LLow [older
CHO ROBERTS
I " te of Florlide, Sworn and subscri��b`efore M&s �day 20
Notary Public-state of Florida
5
Commission#GG 211925
t022
my Comm.Expires Aug 21,202 2
Signature of Notary Public
ded through National Notary Assn.