616 Timber Bridge Ln ERES21-0133 AppElectrical Permit Application "ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT #:
JOB ADDRESS: r, 11-5cl--'c' ,%+ eta=�� 4C PROJECT VALUE $ �
JEA INFORMATION REQUIRED ON ALL PERMITS: 10dAMPS Y' )VOLTS f PHASE
❑ NEW SERVICE: ❑ Overhead
❑Residential (Main) Service:
❑0-100 amps ❑101-150amps
❑Commercial (Main) Service:
❑0-100 amps ❑101-150amps
Conductor Type
❑Multi -Family (Main) Service:
❑0-100 amps ❑101-150amps
❑ TEMPORARY POLE: amps
❑Underground ❑Underground up Pole
❑ SERVICE UPGRADE: ❑ amps
❑151-200ampsr ❑ amps
❑151-200amps ❑ amps
Size
❑151-200amps ❑ amps
❑CT Service amps
❑ NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps ❑200amps ❑ amps ❑CT Service amps
❑ ADDITIONS, REMODELS, REPAIRS, BUILD -OUTS, ACCESSORY STRUCTURES, ETC:
# of Meters
❑CT Service amps
# of Unit Meters
q.
Outlets/Switches:
0-30amps
31-100amps 101-200amp�
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:
mming Pool ❑Sign ❑Smoke Detectors _ (Qty) ❑Transformers KVA ❑Motors
❑ FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
L, ,
IJ%
❑ REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change ❑OH to UG
Updated 10/17/18
❑Other:
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
ermit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of
construction.
Owner Name: _ Phone Number:
Electrical Company:',
Co. Address:
License Holder:
Notarized Signature of License Holder
It
'! Office Phone: Fax:
City: State: Zip P
State Certification/Registration #: '
The foregoing instrument was acknowledged before me this IT day of 20 Z °, in the State of Florida, County of
db
E
CHO ROBERT$ Signature of Notary Public
Notary ►ublicState of Florida
Commission# GG 211925 [�rsonally Known OR [ I Produced Identification
?My Comm. Expires Aug 21, 2022
8onded through National Notary Assn. Type of Identification: