84 Nicole Ln ERES20-0051 9 Fixtures j' '''\'\ ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
��'�� ERES2NUMB
�kr,:4 �� CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD 0-0051
ISSUED: 2/21/2020
~v''iwr ATLANTIC BEACH, FL 32233 EXPIRES: 8/19/2020
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:
84 NICOLE LN ELECTRICAL RESIDENTIAL ELECTRIC - 9 FIXTURES $1300.00
TYPE OF i REAL ESTATE ,
ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: I NUMBER: GROUP:
169519 0725 TIFFANY BY THE SEA
COMPANY: ADDRESS: CITY: I STATE: ZIP:
CURRENT ELECTRICAL 11787 WORDSWORTH CT JACKSONVILLE FL 32223
CONTRACTORS
OWNER: ADDRESS: I CITY: STATE: i ZIP:
FORTUNE SCOTT THOMAS 84 NICOLE LN ATLANTIC BEACH FL 32233-5978
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 CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way. 1
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
ELEC LIGHTING OUTLETS,INCLUDING FIXTURES 455-0000-322-1000 9 $5.40
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:$64.40
Issued Date: 2/21/2020 1 of 2
ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH ERES20-0051
800 SEMINOLE ROAD ISSUED: 2/21/2020
�-
ATLANTIC BEACH, FL 32233 EXPIRES: 8/19/2020
Issued Date: 2/21/2020 2 of 2
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Electrical Permit Application **ALL INFORMATION
A' HIGHLIGHTED IN
;, City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
;' ; lI
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERM�T#S ?O._ (z)sl
JOB ADDRESS: g.41 /41 C• o):z t.i,,` PROJECT VALUE $ \ 3 `~
JEA INFORMATION REQUIRED ON ALL PERMITS: .)-ci AMPS )-4o VOLTS I PHASE
NEW SERVICE: ❑ Overhead ❑Underground ❑Underground up Pole
❑Residential (Main) Service:
❑0-100 amps X101-150amps o151-200amps ❑ amps #of Meters
❑Commercial (Main) Service:
00-100 amps o101-150amps o151-200amps ❑ amps ECT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps #of Unit Meters
n TEMPORARY POLE: amps
❑ SERVICE UPGRADE: ❑ amps , 'CT Service amps
❑ NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps ❑200amps amps ❑CT Service amps
VADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
Outlets/Switches: '1 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: 5
❑ OTHER ELECTRICAL PROJECTS:
❑Swimming Pool LiSign ❑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 nOH to UG
❑Other: updated 10/17/18
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 give authority to violate the provisions of any other state or local law regulation construction or the performance of
construction.
Owner Name: rOnv1-1)nQ. Phone Number:
Electrical Company: C,n•R,.,•�+ £(ec44.1c.o( lv-,4ri.mefen•c. Office Phone: cV -"Mt)-$';t 3 Fax:
Co.Address: (1-19,1 LOrc.dsy�pn.{L Cr. City: Gcsory ilte State: FL._ Zip: 3 Lx.t 3
License Holder: `MAnu. iwe-L.. Lt State Certification/Registration#: Ea 1303 's e
Notarized Signature of License Holder rAa._� �a--���)
The foregoing instrument w s ledged before me this'Z ( day f 20L`in tie State of Florida,County of
�P':;i TONI GINDLESPERGEP, Signature of Notary Public ._.c. /"-
�°. •
,.,•••;; MY COMMISSION#GG 353178
;�;. ...e'....?: EXPIRES:October 6,2023 [ ] Personally Known OR[ ] Produced Ident' ication
'�rFodF°!:' Bonded ThruNotary Public Underwriters Type of Identification: (-.