120 MAYPORT RD TRAILER 52 ERES21-0088 Electrical Permit Application **ALL INFORMATION
f,r: �-I-p p HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
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'* 800 Seminole Rd, Atlantic Beach, FL 32233S*2_
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Phone: (,9n0'�4')),247-5826QEmail: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 12.0 1 ►U� '6-6S/ * 5q PROJECT VALUE $ a 6,-
JEA INFORMATION REQUIRED ON ALL PERMITS: Zoo AMPS Z'-D VOLTS I PHASE
❑ NEW SERVICE: 0 Overhead ❑Underground ['Underground up Pole
l3Residential (Main)Service:
00-100 amps 12101-150amps 0151-200amps 0 amps #of Meters
❑Commercial (Main)Service:
00-100 amps 0101-150amps 0151-200amps 0 amps OCT Service amps
Conductor Type Size
OMulti-Family(Main)Service:
❑0-100 amps 0101-150amps 1:1151-200amps 0 amps #of Unit Meters
❑TEMPORARY POLE: amps
❑SERVICE UPGRADE: ❑ amps OCT Service amps
❑ NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
0100 amps 0150amps 0200amps ❑ amps ❑CT Service amps
❑ ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS, ACCESSORY STRUCTURES, ETC:
Outlets/Switches: 0-30amps 31-100amps 101-200amps
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
n REPAIRS/MISCELLANEOUS:
['Replace Burnt/Damaged Meter Can Xafety 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
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Electrical Company:a� I (1 l Pli l/ 11.. Office Phone: 914'2_41- 56G ) fl."
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Co.Address: F.0• 5JI 4;/ City:0x Ua1Ih Stattee�^1T Zip:p�//,J, -0
License Holder: JOVIA K• 0,ra , a / /J State Certification/Registration#: L(if300s-Y
Notarized Signature of License Holder %% /l (�, r
TihP fnrP�inoinstrument_was acknowledged before me this (Q day of (,( , 2021 in the State of Florida, County of D1,(VQL
" HADLEY NELSON
,`o,�Y"OR° Signature of Notary Public
rl*:����_Notary Public-State of Florida
°=1 _ Commission # HH 46160 '
%;3•0,„„r. My Commission Expires t Y Personally Known OR [ ] Produced Identification
"u n" September 23, 2024 r e of Identification: