1855 Atlantic Beach Dr ERES19-0291 Generator Electrical Permit Application "ALLINFORMATION
HIGHLIGHTED IN
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, rt v City of Atlantic Beach Building Department GRAY IS REQUIRED.
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7 800 Seminole Rd, Atlantic Beach, FL 32233 ERR- ( C, _ oz l
�o1 hr Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT U:JOB
JOB ADDRESS:i i$'55 4AQX1-i`'1C.. a ---D(2— PROJECT VALUE $:,L{t0.OO
IEA INFORMATION REQUIRED ON ALL PERMITS: LOO AMPS t-{OVOLTS, I PHASE
El NEW SERVICE: ID Overhead ❑Underground ❑Underground up Pole
DResidential(Main) Service:
00-100 amps 0101-150amps 0151-200amps 0 amps #of Meters
OCommercial (Main)Service:
❑0-100 amps 171101-150amps 0151-200amps 0 amps OCT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
❑0-100 amps 1:1101-150amps 0151-200amps 0 amps #i of Unit Meters
El TEMPORARY POLE: amps
I SERVICE UPGRADE: 0 amps OCT Service amps
fI NEW FEEDER(ADDITIONS, ACCESSORY STRUCTURES, ETC.):
0100 amps 0150amps 0200amps 0 amps OCT Service amps
U ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
Outlets/Switches: 0-30amps 31-100amps 101-200amps1 �
Appliances: 0-30amps 31-100amps 101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: ## circuits @ kw
Number of Lighting Outlets, Including Fixtures:
1-1
OTHER ELECTRICAL PROJECTS:
❑Swimming Pool❑Sign ❑Smoke Detectors (Qty) Otransformers KVA OMotors HP
n FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can ❑Safety InspectionOPanel Change DOH to UG
12•ther: itL -4X\ PrL.3JV al erawi n_oG..
Pr1S- Updated10/17/18
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
giveg� authority to violate the provisions of any other state or local law regulation construction or the performance of
construction.
Owner Name:iN4Q;r. . �6-Rex. - Phone Number:'gD8
,2570-? 157
Electrical Company:AV-NO/2A ec,y, E\ 4^\`(l':�(';Ql ., Office Phone:iqb4-713171-11-b Fax:
Co.Address: �f�,...-; E-. -(./L( .},y.S-t-k]'k-Q. City:[�C+E? /tt(P State:��t- Zip:1311
License Holder:, � �- W `�.J ��,.�� State Certification/Registration tt:� ia�Q�31.!
Notarized Signature of License Holder, �,0"'7 '7A1�444.`
The foregoing instrument was ack .wledged before me this day of 20(9 , in the State of Florida, County of 111,11
4Notary Publm Stet$of Fipnda Signature of Notary Public
Angel N Brook$
My Comm,.s on 30 2ed614 [ ]Personally Known O Produced Identification
evil
Expr�s�OIt1lYo2Y
Type of Identification: