1753 LIVE OAK LN ERES20-0255 ER ES Z0 -- oz 55
1,...L,r" Electrical Permit Application **ALL INFORMATION
HIGHLIGHTED IN
t 1`` City of Atlantic Beach Building Department GRAY IS REQUIRED.
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800 Seminole Rd, Atlantic Beach, FL 32233
''-"''t', Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: t () -°C-) c.3
JOB ADDRESS: l 125-3 L t'(r 1)/4( 6-.-> PROJECT VALUE$ 7$' T
JEA INFORMATION REQUIRED ON ALL PERMITS: vgO7AMPS 1M-0VOLTS ( PHASE
I NEW SERVICE: o Overhead oUnderground ❑Underground up Pole
❑Residential (Main)Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps #of Meters
❑Commercial (Main)Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps nCT Service amps
Conductor Type Size
❑Multi-Family(Main) Service:
u0-100 amps o101-150amps o151-200amps ❑ amps U of Unit Meters
TEMPORARY POLE: amps
SERVICE UPGRADE: ❑ amps oCT 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: 0-30a m ps 31-100amps 101-200amps
Appliances: 0-30amps 31-100amps 101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: It circuits @ kw
Number of Lighting Outlets, Including Fixtures:
n OTHER ELECTRICAL PROJECTS:
Swimming Pool oSign oSmoke Detectors (Qty) oTransformers KVA ❑Motors HP
I I FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can oSafety Inspection ❑Panel Change DOH to UG
oOther: 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 ermit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of
construction. OL,tr E-- /�� �c Y-7-.1-7/-3 Y(j
Owner Name: !!!!"``���� yC / CT l��2-F� �,,at-- Phone Number: �r �
Electrical Company: 0 ' 0 l - "7Ct�C Office Phone: 70Y-5-7/1-3 yKt, Fax:
Co.Address: (�ji-1 L/60I 9.i-L( C4,....) City: `j ft/'- State: /CC Zip: 3 zl/ O
License Holder: ?SC_.yIr-- c...-�-� State Certification/Registration#: C Ad 0 03 29
Notarized Signature of License Holder' ,rte -/ ..
The foregoing instrument was acknowledged before me this day of Q c / ,20 Z`in the State of Florida,County of i(d1/4-/4-6--
SiArn
gnature of Notary Public `-'�
H0 R08ERTS Ilblic-State of Florida Iission k GG 211925 [1Yt ersonally KnownOR[ ] Produced Identification
.Expires Aug 21,2022 ` Type of Identification:h National Notary Assn.