680 MAYPORT ELPP20-0040 Electrical Permit Application **ALL INFORMATION
i�Li, HIGHLIGHTED IN
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City of Atlantic Beach Building Department GRAY IS REQUIRED.
kopv r 800 Seminole Rd, Atlantic Beach, FL 32233 _ L Pi�Z _Oc.
r Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: b 0 0 /'�i�0-pof f G , PROJECT VALUE$ ?9, —
JEA INFORMATION REQUIRED ON ALL PERMITS: AMPS VOLTS PHASE
❑ NEW SERVICE: ❑ Overhead ❑Underground ❑Underground up Pole
❑Residential (Main)Service:
❑0-100 amps D101-150amps D151-200amps ❑ amps #of Meters
❑Commercial (Main)Service:
❑O-100 amps o101-150amps D151-200amps ❑ amps ECT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
❑0-100 amps o101-150amps D151-200amps ❑ amps #of Unit Meters
TEMPORARY POLE: amps
SERVICE UPGRADE: ❑ amps ❑CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps ❑200amps ❑ amps DCT Service amps
ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
Outlets/Switches: A 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:
El OTHER ELECTRICAL PROJECTS:
❑Swimming Pool ❑Sign ❑Smoke Detectors (Qty) ❑Transformers KVA ❑Motors HP
FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
I I REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change ❑OH 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: L/5 4.14149V 5',4, C/it''Si' as li-[. Gie Phone Number:
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Electrical Company: N.`ve/- 'Cs, k0 `!e ifT,' fa/ Office Phone: goy- 9,3 S - 3 2o '2-Fax: �/
Co.Address: j ?i-f'et 6 6 a Tom-(y 0 1 < /Z( e - City: .TO4 State:��L Zip: 3 2-Z LZ
License Holder: D,),_'� (j,5 /• • G'`d/,'tiz State Certification/Registration#: . Z..-::"C /3 0 o 6 03
Notarized Signature of License Holder �,
The foregoing instrument was acknowledge befor me this 2 day f n ,20Z Q e State of Florida,County of
Signature of Notary Public
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GINDLESPERGERMISSION#GG353178 Personally Known OR[ ] Produced Identification
ES:October 6,2023 Type of Identification:
u Notary Public Underwriters