1679 ATLANTIC BEACH DR ERES21-0153 Electrical Permit Application **ALL INFORMATION
-.-0-44.1-4, HIGHLIGHTED IN
7 7:1City of Atlantic Beach Building Department GRAY IS REQUIRED.
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800 Seminole Rd, Atlantic Beach, FL 32233 C-- G.--- 1. -(J. ( =,�
on1Sfe Phone:7 g(9904) 247-5826 Email:� Building-Dept@coab.us PERMIT#: P6S•Z /-0/9O
JOB ADDRESS: /6 / I/AN l/-- i C/I ,PROJECT VALUE $ 7( 2,00 ' '14
JEA INFORMATION REQUIRED ON ALL PERMITS: 2'V AMPS ZYO VOLTS / 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 ECT Service amps
Conductor Type Size
❑Multi-Family(Main) Service:
❑0-100 amps E101-150amps o151-200amps ❑ amps #of Unit Meters
I I TEMPORARY POLE: amps
1 SERVICE UPGRADE: ❑ amps ❑CT 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: / 7 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: / a
❑ OTHER ELECTRICAL PROJECTS:
❑Swimming Pool ❑Sign ❑Smoke Detectors (Qty) ❑Transformers KVA ❑Motors HP
I I 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
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Owner Name:onstruction. �`+'i A.l e;d /' . Phone Number:
Electrical Company:Se",5- d ciec ( / � A/,rnifrce Phone: 50`, - S-1"t ^ err 35- Fax:
Co.Address: /26 20 3 64 �^ 14 27S City: J.�►c-4s-/- A.I(. State: FL- Zip: .r2Z 46
License Holder: (Wt./a< 61:---'-1,‘
`-f.5-5,4-',4-14.4—, State Certification/Registration#: Cf t 5" 13 5-7 8
Notarized Signature of License Holder . „ =�.
The foregoing instrument was acknowledged before me this i 8 day a k,_- r in t a State of Florida,County of
Signature of Notary Public i c'�-'
."tlpYPV-• TONIGINDLESPERGEP. Known OR P ced Identification„,*: MY COMMISSION#GG 353178 I Personally
”` "'u EXPIRES:October 6,2023 Type of Identification: Imo_
'''F.F•O Bonded Thru Notary Public Underwriters