1089 B ATLANTIC BLVD - ELPP20-0041 **ALL INFORMATION
/:' ,iii,.. Electrical Permit Application HIGHLIGHTED IN
l�, r' City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
�% c= �F��z 6--ooh
= Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: /0 439 �3 4/Lr,//t/TjC_ j3/ttc/ PROJECT VALUE$ ZU6.OJ
JEA INFORMATION REQUIRED ON ALL PERMITS: 200 AMPS el Lid VOLTS 3 PHASE
11 NEW SERVICE: 0 Overhead ❑Underground ❑Underground up Pole
❑Residential (Main)Service:
00-100 amps 0101-150amps 0151-200amps 0 amps #of Meters
❑Commercial (Main)Service:
00-100 amps 0101-150amps 0151-200amps 0 amps OCT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
❑0-100 amps 0101-150amps 0151-200amps ❑ amps #of Unit Meters
n TEMPORARY POLE: amps
D SERVICE UPGRADE: ❑ amps OCT Service amps cl
n NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.): .� j
0100 amps 0150amps ❑200amps 0 amps OCT Service amps 1
I=1 ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
c)())
Outlets/Switches: 0-30a mps 31-100amps 101-200am
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❑Sign OSmoke Detectors (qty) ['Transformers KVA OMotors HP
n FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
❑ REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can Safety Inspection ❑Panel Change DOH 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. / L7 2_y'
Owner Name: (-4`J)'/� �irr�t��e" �f 7`i C S Phone Number: 00 v
Electrical Company: A/C '1 r4Gg4 t`,.✓`j 9 I l L-L C Office Phone: 914 ' 3 3Y-cJ 3 75 Fax:
Co.Address: l City: -3'9), State: /L Zip:3 0 J
License Holder: "�ON,,,f go�L-7L/'( State Certification/Registration#: EC / 3 U 0 61513
Notarized Signature of License Holder . / 7e„c,,,(4,..3
The foregoing instrument was acknowl_.: •d before me thisiAday of t.2c t ,20 20 in the ate of Florida,County of D v L'•4L
12,,f.ap �F � Signature of Notary Public
. Beverly K Elias /
‘',,.. MY Commleaion GG 315109 i VJ rersonally Known OR [ ] Produced Identification
1%'oai
1o23 Type of Identification: