89 Dewees Ave ERES21-0135 App_. Electrical Permit Application "ALL INFORMATION
`* HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Vitt" Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT #:
JOB ADDRESS: ; �' PROJECT VALUE
JEA INFORMATION REQUIRED ON ALL PERMITS: D AMPS 'V-0 VOLTS PHASE
❑ NEW SERVICE: ❑ Overhead ❑Underground ❑Underground up Pole
❑Residential (Main) Service:
110-100 amps o101-150amps
❑Commercial (Main) Service:
❑0-100 amps ❑101-150amps
Conductor Type
❑Multi -Family (Main) Service:
❑0-100 amps ❑101-150amps
❑ TEMPORARY POLE: amps
❑ SERVICE UPGRADE: ❑ amps
E1151-200amps ❑ amps # of Meters
u151-200amps ❑ amps . ❑CT Service 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 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:
❑ OTHER ELECTRICAL PROJECTS:
Swimming Pool ❑Sign ❑Smoke Detectors (Qty) ❑Transformers KVA ❑Motors HP
❑ FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
❑ 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. Th41(_-If
mit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of
construction.
Owner Name: —T L.— 2 Phone Number: L
Electrical Company: Gly ,Y6i Office Phone: Fax:
Co. Address: Z_ i6t,(�l-y—L 4'2'� (.0 6' City: s State: Zip: t"1
License Holder:r" - State Certification/Registration #: C
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this day of ,rte 20 �J n the State of Florida, County of
CHO ROBERTS
Notary Public - State of Florida
o`i Commission ft GG 211425
?crM My Comm. Expires Aug 21,2022
9onded through National Notary Assn.
Signature of Notary Public
[Versonally Known OR [ ] Produced Identification
Type of Identification: