1720 Atlantic Beach Dr ERES21-0132Electrical Permit Application **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 r -J1 % O
full Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 1
JOB ADDRESS: f 0- � �r�-T ��,t �FetleROJECT VALUE $
JEA INFORMATION REQUIRED ON ALL PERMITS: `70 `''AMPS ` 4VOLTS " � PHASE
❑ NEW SERVICE: ❑ Overhead ❑Underground ❑Underground up Pole
❑Residential (Main) Service:
0-30amps
❑0-100 amps ❑101-150amps
o151-200amps
❑Commercial (Main) Service:
31-100amps 101-200amps
00-1O0.amps ❑101-15Oamps
D151-200amps
Conductor Type
Size
❑Multi -Family (Main) Service:
kw
110-100 amps ❑101-150amps
❑151-2O0amps
❑ amps
❑ amps
❑ amps
❑ TEMPORARY POLE: amps
❑ SERVICE UPGRADE: ❑ amps ❑CT Service amps
❑ NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps ❑2OOamps ❑ amps ❑CT Service amps
❑ ADDITIONS, REMODELS, REPAIRS, BUILD -OUTS, ACCESSORY STRUCTURES, ETC:
# of Meters
❑CT Service amps
# of Unit Meters
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:
❑ THER ELECTRICAL PROJECTS:
O� imming Pool ❑Sign ❑Smoke Detectors _ (Qty) ❑Transformers KVA ❑Motors
F—] FIRE
'ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
HP
❑ REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change ❑OH 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
construction. c VV
Owner Name: 4.2.4 Phone Number:
Electrical Company:._
Co. Address: 61YL- 66_(,L—
License Holder: Le_ `t " t"
Notarized Signature of License Holder
'ZczC ^2t r'( Office Phone: L 7 ` J Fax:
City: -..._ State: ?67C Zip:
E - r State Certi ication/Registration #: G tri r
The foregoing instrument was acknowledged before me t4day of )MXi.( . 20' ' in the State of Florida, County of
CHO ROBERTSSignature
of Notary Public
Notary Public - State of Florida
Commission p GG 211925
E
[�rsonally Known OR [ ] Produced Identification
°'` My Comm. Expires Aug 21, 2022
Type of Identification:
Bonded through National Notary Assn.