1051 Atlantic Blvd elec permit S �S IyLyr rI
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
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ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-SS14
]OB INFORMATION:
lob ID: 17-ELEC-2966
lob Type: ELECTRIC ONLY
Description: repair overhead service mast pulled off wall
Estimated Value: $1,895.41
Issue Date: 1/10/2017
Expiration Date: 7/9/2017
PROPERTY ADDRESS:
Address: 1051 ATLANTIC BLVD
RE Number: 177411-0010
PROPERTY OWNER:
Name: DISCOUNT AUTO PARTS
Address: P O BOX 2710
GENERAL CONTRACTOR INFORMATION:
Name: Advanced Power Technologies, LLC
Archie Cullen Blackmon,Jr.,EC13004643
Address: 1500 North Powerline Road Pompano Beach, FL 33069
Phone: -
FEES:
Electrical Repairs $35.00
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845 1 -6L&-C— 39 (c
JOBADDRESS: IOSL 1"I TLJFIJTIC &Yb PERMIT#
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JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE
VALUE OF WORKS
NEW SERVICE ❑ Overhead ❑ Underground D Underground up Pole
❑Residentlal(Main)Service
00-100 arias D101-150amps ❑151-200amps []_amps #of Meters
❑Commercial(Main)Service
110-100 amps U101-150amps LJ 151-200amps O amps OCT Service_amps
Conductor Type Size
[]Multi-Family(Main)Service
[]0-100amps 11101-150amps LJ 151-200amps (l amps #of Unit Meters
❑Temporary Pole []_amps
SERVICE UPGRADE [] amps O CT Service mpg
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
O 100 amps 0150ampa 0200amps n amps OCT Service_amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches; 0-30amps 31-100amps 101-200=ps
Appliances: 0-30amps 31-100amps 101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: #circuits B kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
[]Swimming Pool 0 Sign []Smoke Detectors_Qty OTransfonners KVA []Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty_volts/amps VALUE OF WO/K$
REPAIRS/MISCELLANEOUS
[]Replace Bumt/Damaagrte�d Meter Can ( []Safety Inspection []Panel Change FIOH to UG L
AIOdter: IRC-.4 (J
1R. VMXbEAb JIYtO6_ Alobt AL41;h OAC &24tGe-
permit becomes void if wok does not commence within a six month period or work is suspended or abandoned fm six months. I hereby cetify that I haus
read this application and know the same to be true and correct. All provisions of laws and ordinsom governing this work will be complied with whether
specified or not. The permit does not give authority to violate the provisions of my other state or local low regulation construction or the performance of
conshuctim w n n
Property Owners Na(m�e h1-5d0 ,V^JT AILTO PA-72TS Sh/C Phone Number
Electrical Company lthJ//A-OQeb Pm,"c /EWAICIOGtGS kt-0 Offi Phone 9,6 - P/ax
Co.Address: /SLb N/,y 9tO6;P2p1A10— /EOr9� City 1 D Statel y- Zip -43
License Holder(Print): taA.Ll-L—N p[✓ICKMOt/ Stat gCertifi n/Registmtion# «' 13Q0q-6M
Noo razed Si natureo ice older 9-9= --'
BANBAMBDIg COPDILL Sworn and subscribed before m rides �/ y o a 20MY COM I �
SION'4neY FJ(PIRES Auausl 10,2016 Signature of Notary
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CUSTOMER COVI
CITY OF ATLWIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
PHONE (904) 247-5B26
Cashier Id: atlbcl Aatlbbda
Receipt Date: 1/10/2017 10:40:20 AM
Receipt Number: OS-72139
Job ID: 17-ELEC-2966 - repair overhead sery
ice mast pulled off wall ELIB - Electrical
Repairs $35.00
Job ID: 17-ELEC-2966 - repair overhead sere
ice mast pulled off wall EDBPR - State Elec
OBPR Surcharge $2.00
Job ID: 17{LEC-2966 - repair overhead sery
ice mast pulled off wall EOCA - State Elec
DCA Surcharge $2.00
Job ID: 17-ELEC-2%6 - repair overhead sery
ice mast pulled off wall TP - Trade Permit
Base Fee $55.00
Amount Due: $94.00
Tender Information: Cash $94.00
Tender Type: CC
Tender Mount: $94.00
Charge Due: $0.00