811 PARADISE LN ERES21-0148 ,f-L,e i,,,, Electrical Permit Application **ALL INFORMATION
e ill'ilik' \ �� HIGHLIGHTED IN
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City of Atlantic Beach Building Department GRAY IS REQUIRED.
� 800 Seminole Rd, Atlantic Beach, FL 32233 PO i
Phare: (904 247-5826 Email: IBuildiin^g-Dept@coab.us PERMIT#:
JOB ADDRESS:
C. t - LQ) Y PROJECT VALUE $ a��
JEA INFORMATION REQUIRED ON ALL PERMITS: AMPS VOLTS PHASE
04NEW SERVICE: 0 Overhead Underground ['Underground up Pole
I:Residential(Main)Service: 1
00-100 amps 0101-150amps 0151-200ampsQ33 amps #of Meters t
DCommercial (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
El TEMPORARY POLE: amps
El SERVICE UPGRADE: ❑ amps ❑CT Service amps
❑ NEW FEEDER (ADDITIONS,ACCESSORY STRUCTURES, ETC.):
0100 amps 1:1150amps ❑200amps 0 amps ❑CT Service amps
❑ ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
Outlets/Switches: 0-30a mps 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 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
construction.
4...3r 1Owner Name: \y \ r- ��: LAI c��r� Phone Number:
Electrical Company: cWr(1/4II�1 C--`e C�r 1(� `sOffice Phone:C�-CI14? -r6 »N QF✓axcvt_� L1 Ll s:
Co.Address: 1'. \k l 1` ---Q C. . w C City: CC&N-\v11 i State: f ( Zip: le1( 1
License Holder: -M ,_S,rn�{'� S Ce egistration#- C,: ) �eaQ
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Notarized Signature of License Holder ! r
----.--=•-• ----`-•-----71---•—• ,.r� .. • ow edge. •-fore me this / day f-----. 17 ,20�i in the State of Florida, County of I�vS 1
�;I;vPo .. B•
'_ , , MY COMMISSION#GG 248197 Signature of Notary Publi LA QQQ \ ) r
*:
mak.o EXPIRES:December 11,2022
FOF6°; Bonded ThruNotary Public Undenvritors Personally Known OR [ ] Produced Identification
"��°' y e of Identification: