1237 MAYPORT RD ELPP20-0045 ,y.Lyr , Electrical Permit Application **ALL INFORMATION
��, c HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
51.a ' 800 Seminole Rd, Atlantic Beach, FL 32233 LP P �O UOQ{ 5
``'�;'~ Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: i2--1,—.? ry\c,\( 4. Ii-. 6. PROJECT VALUE$ )C{3 . ne-1
JEA INFORMATION REQUIRED ON ALL PERMITS: .D AMPS'-(() VOLTS .2) PHASE
❑ NEW SERVICE: ❑ Overhead ❑Underground ❑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 ECT Service amps
Conductor Type Size
❑Multi-Family(Main) Service:
DO-100 amps o101-150amps o151-200amps ❑ amps #of Unit Meters
TEMPORARY POLE: amps
I SERVICE UPGRADE: ❑ amps DCT Service amps
I NEW FEEDER (ADDITIONS,ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps ❑200amps ❑ amps ❑CT Service amps
i ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
Outlets/Switches: 0-30a mps 31-100amps 101-200am ps
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 ❑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 ❑Panel1Change DOH to UG
❑Other: ( c 0cl� "C�> (-Irv, 3 ohci .e ck, SCCr-)n e -(- Updated10/17/18
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. - 6301 ` / a` -. " l"�
Owner Name: ii_ !��f/l�s�� � .� �� C i` j Phone Number: �l Co c0 J �C..
Electrical Company: V--11,"A4' 1-- -.\ -C C(I( Office Phone: at11 — qW8L-1 Fax:
Co.Address: "1OS ‘ \ th— 'P . S- City: "'a)( (j[f,--, State: ..C(, Zip: ---' 0c)0
License Holder: e.frt-i el I . State Certification/Registration#: )30 )a- 43
Notarized Signature of License Holder 5iwe\C__(_,k i Y`'� 1
The foregoing instrument was acknowledged before me thi day of 1JO�/ ZQ�,in the State of Florida,County of tit/U2,-1
'V\ 5D,r) Signature of Notary Public 14f
sAmorlbonenwlMon owio
non Jen gedsendx3 Pam ; ,s [ ] Personally Known OR[ Produced ldentificatioa.,i ` 7/(O a
86S46Jo#uolss[wwoo ` • Type of Identification: Lvi . / K>
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