1721 Atlantic Beach Dr TEMP19-0036 Temp ELECTRICAL TEMP POLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH TEMP19-0036
'11_ ISSUED: 12/30/2019
� 800 SEMINOLE ROAD
�!u;t», EXPIRES: 6/27/2020 I
ATLANTIC BEACH. FL 32233
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:
1721 ATLANTIC BEACH DR ELECTRICAL TEMP POLE TEMP POLE $350.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169505 1435 ATLANTIC BEACH
COUNTRY CLUB UNIT 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
PAGEMASTERS ELECTRICAL 45102 MUSSLEWHITE RD CALLAHAN FL 32011
INC
OWNER: ADDRESS: CITY: STATE: ZIP:
GREGORY A NELSON 523 SELVA LAKES CIRCLE ATLANTIC BEACH FL 32233
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 TEMP SERVICE 455-0000-322-1000 0 $35.00
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $94.00
Issued Date: 12/30/2019 1 of 2
rSLA``'f,� ELECTRICAL TEMP POLE PERMIT PERMIT NUMBER
,�ri�` � TEMP19-0036
�, CITY OF ATLANTIC BEACH
ISSUED: 12/30/2019
800 SEMINOLE ROAD
\ `'s»r ATLANTIC BEACH. FL 32233 EXPIRES: 6/27/2020
Issued Date: 12/30/2019 2 of 2
ftL/r-
'
Electrical Permit Application **ALL INFORMATION
,f HIGHLIGHTED IN
j -", City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 >
-,4,2.41. ~ Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: / .7 a / /f/AA/TIC f3-‘4*-t% Q r- PROJECT VALUE$ 3 50 c'
JEA INFORMATION REQUIRED ON ALL PERMITS: /d 0 AMPS ?7'L2 VOLTS / PHASE
❑ NEW SERVICE: ❑ Overhead ❑Underground ❑Underground up Pole
❑Residential (Main)Service:
❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Meters
❑Commercial (Main)Service:
❑O-100 amps ❑101-150amps ❑151-200amps ❑ amps ❑CT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
�
,� ❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Unit Meters
I "I I EMPORARY POLE: i 0 0 amps
SERVICE UPGRADE: ❑ amps ❑CT Service amps
❑ NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps ❑200amps ❑ amps ❑CT Service amps
❑ ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
Outlets/Switches: 0-30a m ps 31-100amps 101-200a m ps
Appliances: 0-30amps 31-100am ps 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
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
construction.
Owner Name: G l-L30 r`' A. iv0.-1so N Phone Number:
Electrical Company: p0.)errl1rST^42.t. £ l le-C'11-i'CAL Vi/( ffice Phone: "p(f —fig?- 7 3)L/ Fax:
Co.Address: 'f5'/0;L ni LI SSB I t,✓ 1.,..-1 t1`'4 City: (-F- /1.441 State: 1--[ Zip: 30 I
License Holder: / 1 rvt 64—tk / k . P di 3 L State Certification/Registration#: CA 130 IA-9 51
Notarized Signature of License Holder 0
The foregoing instrument was acknow edged before met is Z7 d., •f De P0 C in th State of Florida, County of
' tiRYP� TONIGINDLESPERGER Signature of Notary Publ._ __IL_ I c.�
e, )
11 `':,1`71,....'1.'";: MY COMMISSION#GG 353178
[ ] Personally Known OR[ ] Produced Identification
t l: �,,.1 .-t.c71 EXPIRES:October 6,2023
,.. BondedThruNotaryPubficUndetwrite� Type of Identification: t� C_.