375 3rd St ERES19-0250 Elec Remodel ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
r '�� ERES19-0250
CITY OF ATLANTIC BEACH
v~ 800 SEMINOLE ROAD ISSUED: 8/27/2019
°i3»r ATLANTIC BEACH. FL 32233 EXPIRES: 2/23/2020
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL • 'K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • ' + BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL • • OF APPLY, PLEASE
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:
375 3RD ST ELECTRICAL RESIDENTIAL ELECTRIC REMODEL $1000.00
TYPE OF
ZONING: :D •
CONSTRUCTION: GROUP:
169824 0015 ATLANTIC BEACH
COMPANY: ADDRESS:
DUTCHER ELECTRIC INC 1122 NORTH 3RD AVE JACKSONVILLE FL 32250
BEACH
• ADDRESS:
GOLOMBEK ELLEN JOAN 2001 LINCOLN ST UNIT 1524 DENVER CO 80202
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.
CONDITIONS
'Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
LEES-
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
ELEC LIGHTING OUTLETS,INCLUDING FIXTURES 455-0000-322-1000 6 $3.60
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $62.60
Issued Date: 8/27/2019 1 of 2
Electrical Permit Application "ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 9
Phone: (904) 247-5/826 Email: Building-Dept@coab.us PERMIT#:RQSS /9/'Qoz'
JOB ADDRESS: 3 7S— � S 7i72e PROJECT VALUE $_ /�(i 06
JEA INFORMATION REQUIRED ON ALL PERMITS: AMPS VOLTS PHASE
❑ NEW SERVICE: ❑ Overhead ❑Underground Underground up Pole
i iResidential (Main)Service:
0-100 amps [j101-150amps o151-200amps ❑ amps #of Meters
LiCommercial (Main)Service:
❑0-100 amps o101-150amps ❑151-200amps ❑ amps ❑CT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
❑O-100 amps ❑101-150amps n151-200amps ❑ amps #of Unit Meters
❑ TEMPORARY POLE: amps
❑ SERVICE UPGRADE: ❑ amps ! !CT Service amps
❑ NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
100 amps 150amps 200amps ___amps ❑CTService amps
O ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS, ACCESSORY STRUCTURES, ETC:
Outlets/Switches: e� 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 iiSign ❑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
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. /
Owner Name: � P✓t (O(L[,/
(9A"jb -'� Phone Number:
Electrical Company: ��t,7z L'�� ��E���r/,'� �lL� Office Phone: LI/ Zk
Co.Address: e ` City:�if )( .1�C-4 State: Zip:
License Holder: 1,4L, ' t�StateCertification/Registration#:, /Q/3014!czk
Notarized Signature of License Holder r
The foregoing instrument was acknowledged before me this da 20l in th State of Florida,County of
ignature of Notary Public
TONIGINDLESPERGER
MY COMMISSION#FF 924951 personal)y Known OR[ ] Produced Identification
I '=
EXPIRES:October 6,2019 ype of Identification:
ta, FkC' Bondod Thm Notary PubCw Urde writers
S r �
f)
Cash Register Receipt Receipt Number
J _r
City of Atlantic Beach • ' I /
DESCRIPTION • QTY PAID
PermitTRAK $55.00
ERES18-0350 Address: 375 3RD ST APN: 169824 0015 $55.00
ELECTRICAL FINAL"02/22/2019 RBE $55.00
ELECTRICAL FINAL"02/22/2019 RBE 45500003221002 0 $55.00
TOTALCY RECEIPT: R10454 $55.00
Date Paid: Tuesday, September 24, 2019
Paid By: PHASE ONE ELECTRIC LLC
Cashier: CT
Pay Method: CREDIT CARD 02834G
Printed:Tuesday,September 24, 2019 3:25 PM 1 of 1
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