568 Timber Bridge Lane ERES21-0006 Pool Elec rs ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
J' 1
--... A...—_ Vis; ERES21-0006
CITY OF ATLANTIC BEACH
"-" ISSUED: 1/11/2021
K. �� 800 SEMINOLE ROAD
aa19.-' ATLANTIC BEACH. FL 32233 EXPIRES: 7/10/2021
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
JOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
hat may be found in the public records of this county, and there may be additional permits required from other
:overnmental entities such as water management districts, state agencies, or federal agencies.
JOB ADDRESS: PERMIT TYPE: i DESCRIPTION: VALUE OF WORK:
568 TIMBER BRIDGE LN ELECTRICAL RESIDENTIAL ELECTRIC FOR POOL $985.00
TYPE OF REAL ESTATE I ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: I GROUP:
169505 2135 ATLANTIC BEACH
COUNTRY CLUB UNIT 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
HAZOURI ELECTRIC, INC. 6142 Golden Oak Lane Keystone Heights FL 32656
OWNER: ' ADDRESS: CITY: STATE: ZIP:
ELIZABETH BISSELL LUCY 568 TIMBER BRIDGE LANE ATLANTIC BEACH FL 32233
TRUST
NARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT Ifs
'OUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
OUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
NTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
ECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
toll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
ELEC SWIMMING POOLS 455-0000-322-1000 0 $40.00
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$99.00
Issued Date: 1/11/2021 1 of 2
'�''''r ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
(-. "',' ERES21-0006
CITY OF ATLANTIC BEACH
kplf , ISSUED: 1/11/2021
800 SEMINOLE ROAD
o'ftr ATLANTIC BEACH. FL 32233 EXPIRES: 7/10/2021
Issued Date:1/11/2021 2 of 2
Electrical Permit Application **ALL INFORMATION
f-- HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 E_ R�� I - 006
Phone: (904) 247-5826 Email: Bu_ ilding-Dept@coab.us PERMIT#: 2-0 -O 3(
JOB ADDRESS: 5I�) / 71 -1_ci (' c- /.2.--i ,7 PROJECT VALUE $ 9,fj
JEA INFORMATION REQUIRED ON ALL PERMITS: 3') AMPS 2'1"VOLTS / PHASE
El NEW SERVICE: 0 Overhead ❑Underground ❑Underground up Pole
DResidential (Main)Service:
00-100 amps 0101-150amps 0151-200amps 0 amps #of Meters
❑Commercial (Main)Service:
❑0-100 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
❑ SERVICE UPGRADE: ❑ amps OCT Service amps
n NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
0100 amps 0150amps D200amps 0 amps OCT Service amps
❑ ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS, ACCESSORY STRUCTURES, ETC:
Outlets/Switches: 0-30amps 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:
n OTHER ELECTRICAL PROJECTS:
Wwimming Pool['Sign ❑Smoke Detectors (Qty) ❑Transformers KVA ❑Motors HP
n FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
n REPAIRS/MISCELLANEOUS:
['Replace Burgt/Damaged Meter Can ❑Safety Inspection ❑Panel Change DOH to UG
❑Jther: tt)i-,..- JU iJ L 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. �/_
J� / 33
1
Owner Name: /S ,- S S-L (- 3 Phone Number: l - 12 /
Electrical Comp/t `
anry //¢2ii/G �lC�h c[ /e c( (. Office Phone: T C/� - 3 �cl Fax:
Co.Address: Ol'1 . [f '.�-(C C-4-- City: / >7Z.--c- State: A Zip:3 e-1/Z
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License Holder: -- State Certification/Registration#: eCt 2CcJ 2`T
/
Notarized Signature of License Holder -
ThegfaimmaiagissibumaisAawmaiclamosiledged before me this day of , in the State of Florida, County of_(.
1 :.,;:ii►oB-. CHO ROBERTS I /y
' _- �� Notary Public State of Florida Signature of Notary Public
1 iii if. Commission#GG 211925
9 .?'oFrJ'' My Comm.Expires Aug 21,2022 I
Bonded through National Notary Assn.