763 ATLANTIC BLVD ELPP20-0043 t'jy�`� Electrical Permit Application **ALL INFORMATION
HIGHLIGHTED IN
4---);?,'
, City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 ELPP-0-0( }3
r jt'Y Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 7 6 -St-t. k L a--VP` PROJECT VALUE$ / 8 , o
JEA INFORMATION REQUIRED ON ALL PERMITS: 2..00 AMPS Z4r VOLTS I PHASE
❑ NEW SERVICE: ❑ Overhead ❑Underground ❑Underground up Pole
❑Residential (Main)Service:
❑O-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Meters
❑Commercial(Main)Service:
❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps ❑CT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
❑O-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Unit Meters
TEMPORARY POLE: amps
SERVICE UPGRADE: ❑ amps ❑CT Service amps
NEW FEEDER(ADDITIONS, ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps ❑200amps ❑ amps ❑CT Service amps
ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
Outlets/Switches: t Z— 0-30amps 31-100amps 101-200amps
Appliances: 0-30amps 31-100amps 101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ kw g
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS:
❑Swimming Pool ❑Sign ❑Smoke Detectors (Qty) ❑Transformers KVA ❑Motors HP
I I 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. pp
Owner Name: \&''r1'-I. G-1`^T ' Phone Number:
Electrical Company: W` c Lh.ti S ke a�,c\c /k I Office Phone: dko`A—23"7 --4-7o( Fax:
Co.Address: kN-2, 1 tNvC-pLne S 5 f-9• City: t--icn+ D •vF.. tck. State: it- Zip: 3Zo34
License Holder: g-- cc_1.....,g e_ -. r. State Certification/Registration#: ER-ooc- *o%A B
Notarized Signature of License Holder -................-.01111110 /
The foregoing instrument was acknowledg e ore me this ZQday .111! ,---e_4, ' the ate of Florida,County of�J(,j t/O-/(\
Signature of Notary Public 0. •4 ,EXPIRES:October 6,2023
_
t '.'�' TONI GINDLESPERGERrsonally Known OR[ ] Produced Identification
'iso " MY COMMISSION#GG 353178 Type of Identification:
.°,;•r�Q7..
�'•FOF FL?.` Bonded Thru Notary Public Underwriters