363 Atlantic Blvd Unit 10 ERES21-0162 Serene Med Spa s t' ' '~it, ELECTRICAL RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH ERES21-0162
800 SEMINOLE ROAD ISSUED: 7/12/2021
v/' ATLANTIC BEACH. FL 32233 EXPIRES: 1/8/2022
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
that may be found in the public records of this county,and there may be additional permits required from other
governmental entities such as water management districts, state agencies, or federal agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
EIec:PRIVATE PROVIDER-
363 ATLANTIC BLVD 10 ELECTRICAL RESIDENTIAL INTERIOR BUILDOUT for $8500.00
SERENE MED. SPA
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169730 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
INFINITY ELECTRICAL 4786 RAYFORD ST JACKSONVILLE FL 32254
CONTRACTNG
OWNER: ADDRESS: CITY: STATE: ZIP:
NSHORE LLC P.O.BOX 357742 GAINESVILLE FL 32606
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
ELEC LIGHTING OUTLETS,INCLUDING FIXTURES 455-0000-322-1000 45 $27.00
ELEC SWITCH AND RECEPTACLE OUTLETS 455-0000-322-1000 0 $18 60
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
Issued Date: 7/12/2021 1 of 2
,,,,,:51..,,,i„:t,, RESIDENTIAL PERMIT PERMIT NUMBER
.--... ..4„--- �
. ♦„J �; ERES21-0162
CITY OF ATLANTIC BEACH
�� ISSUED: 7/12/2021
�J / 800 SEMINOLE ROAD i
",0;a�r EXPIRES: 1/8/2022
ATLANTIC BEACH, FL 32233
STATE DCA SURCHARGE 1 455-0000-208-0600 f 0 $2.00
TOTAL:$104.60
Issued Date: 7/12/2021 2 of 2
Electrical 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 : ? - 2�- Ooo 7
JOB ADDRESS: 363 ALA- r 3Lv #/O PROJECT VALUE $ ��06
JEA INFORMATION REQUIRED ON ALL PERMITS: a 00 AMPS .162s VOLTS 3 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 ❑101-150amps D151-200amps ❑ amps ❑CT Service amps
Conductor Type Size
;Multi-Family(Main) Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps #of Unit Meters
n TEMPORARY POLE: amps
SERVICE UPGRADE: L amps DCT Service amps
I I NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps i 200amps amps CT Service amps
tDDITIONS, REMODELS, REPAIRS, BUILD-OUTS, ACCESSORY STRUCTURES, ETC:
Outlets/Switches: Jl 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: 'y- --
OTHER ELECTRICAL PROJECTS:
Swimming Pool ❑Sign nSmoke Detectors (Qty) ❑Transformers KVA :,Motors HP
p1 FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change LION to UG
❑Other: Updated l0/17/18
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.
Owner Name: f i'NQ AthA-G&--1.---, t yij 4-A6— Phone Number: ?O y Sl g— /OS-7
Electrical Company: �r Fes,. H-y Etc-Emco-.l c.d-u.4rc.-et ffice-Phone: c/O�535—•-•c'3�7 Fax:
Co.Address: -Y786 � r�t'�j-l5-( �a¢'c �C- 3z 0...5-5` City: State: Zip:
License Holder: —%�./ �T-c4—as`�!_ .te Certification/Registration#: 6- jai—So/S-3147
Notarized Signature of License Holder
e f.re•sin: instrument was acknowledged before me this 1/ day of 3 v L 1 , 20 2 1,in the Stat o Florida,County of 1)01/4-L
«?Ye CHRISTIAN GILES r
:�.•• . `•"•�.-;- Signature of Notary PublicC
�u •t: MY COMMISSION#HH 117153
EXPIR6S:ApriI13,2025 [ ] Personally Known ORroduced Identification
"•S. " Bonded Thru Notary Public Underwrite`
__ E� Type of Identification: FL {D L