374 4th St ERES21-0200 App Electrical Permit Application **ALL INFORMATION
pp HIGHLIGHTED IN
ifrAllitNixCity 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#: EFVOc`
2I' 0200
JOB ADDRESS: 3 74/ '! 741- ✓ PROJECT VALUE $
JEA INFORMATION REQUIRED ON ALL PERMITS:.; AMPS : U VOLTS / PHASE
❑ NEW SERVICE: El Overhead ❑Underground ❑Underground up Pole
Dtesidential (Main)Service:
00-100 amps 1:101-150amps 0151-200amps ❑ amps #of Meters
❑Commercial (Main)Service:
00-100 amps 0101-150amps 1:1151-200amps ❑ amps OCT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
❑0-100 amps 0101-150amps 0151-200amps ❑ amps #of Unit Meters
❑TEMPORARY POLE: amps
❑SERVICE UPGRADE: ❑ amps ❑CT Service amps
❑ NEW FEEDER (ADDITIONS,ACCESSORY STRUCTURES, ETC.):
0100 amps 0150amps 1:1200amps ❑ amps OCT Service amps
❑ ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
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:
1-11 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
Ither: 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.
Owner Name: Ho/% + CJ Phone Number: 847-63-/--5/
Electrical Company: JAL `6.4,7-€ , �ivG�7ph! /'tV�7e'SOffice Phone: cit*-- ??..--.5"..3_5'S Fax:
Co.Address: If 7442 � Y� 1/circe h cam. City: iCA—C//.tll��/t,' State: c2-Zip: . .
License Holder: JCd4r,G!- sG ' L.,' rte State Certification/Registration#: (-/3cc /,Z-a
•
Notarized Signature of License Holder �� � _Zdifr • /
The foregoing instrument was ackno i .ged before me this j (p day of AU&US?20 'jl, in the State of Florida,County of
CHRISTIAN GILES Signature of Notary Public 0.114/t/ .1g1
. * MY COMMISSION#HH 117153
��:* EXPIR6S:Ap.4113,2025 [ ] Personally Known OR[ oduced Identification
?ofRP.• Bonded � Type of Identification: �L p L