363 ATLANTIC BLVD UNIT 12 ELPP21-0029 r',,, Electrical Permit Application **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 EL PP2 -o0a9
`" Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 3 t,3 fT LWT.L fhr'a -if /R PROJECT VALUE$ 0200. -
JEA INFORMATION REQUIRED ON ALL PERMITS: IS-0 AMPS ,051 VOLTS 3 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 ❑CT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
❑O-100 amps o101-150amps o151-200amps ❑ amps #of Unit Meters
I I TEMPORARY POLE: amps
I 1 SERVICE UPGRADE: ❑ amps oCT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps o200amps ❑ amps ❑CT Service amps
ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
Outlets/Switches: 0-30a m ps 31-100amps 101-200am ps
Appliances: 0-30amps 31-100amps 101-200am ps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS:
❑Swimming Pool oSign ❑Smoke Detectors (Qty) oTransformers KVA ❑Motors HP
FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
REPAIRS/MISCELLANEOUS:
oReplace Burnt/Damaged Meter Can oa afety Inspection oPanel Change o01-Ito 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.
Owner Name: go 55 KO G K Phone Number:
Electrical Company: Irvf Sly` L-Zb=GT‘66_, Li..._(- Office Phone: Q-Gq - 2'11- !a
i( i` Fax:
fir,.
Co.Address: W S Ii Pik .JG-4t City: )^k State: Ft Zip: 7-S1
License Holder: ' T Vt KwtS1' _ State Certification/Registration#: L./LI.JO( zt�3
Notarized Signature of License Holder - IVA
The foregoing instrument was acknowledged before me this�.6lay of VA�A 2 �in the to of Florida,County of
Signature of Notary Public
E.--
TONIGINDLESPERGER
MYCOMMISSION#GG353178 [ rsonally Known OR[ ] Produced Identification
e EXPIRES:October 6,2023 ype of Identification:
. Bonded Thru Notary Public Underwriters