340 2nd St TEMP22-0004 ELECTRICAL TEMP POLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH TEMP22-0004
3' ISSUED:
800 SEMINOLE ROAD
ATLANTIC BEACH. FL 32233 EXPIRES:
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:
340 2ND ST ELECTRICAL TEMP POLE TEMP POLE $500.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169765 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
LORE ELECTRICAL PONTE VEDRA
210 N ROSCOE BLVD FL 32082
CONTRACTORS BEACH
OWNER: ADDRESS: CITY: STATE: ZIP:
D AND K WADE TRUST 7510 BRIARCLIFF DR ROSOE IL 61073
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 I
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
FEES
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 52.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $94.00
Issued Date: 1 of 2
Electrical Permit Application **ALL INFORMATION
AArti•'r"L'��i. HIGHLIGHTED IN
f City of Atlantic Beach Building Department GRAY IS REQUIRED.
778".
r 800 Seminole Rd, Atlantic Beach, FL 32233 (ENO' Z2 O004
Phone: (904) 247-5826. Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 3'I O 2-Nd a- ' PROJECT VALUE$ s---D-D
JEA INFORMATION REQUIRED ON ALL PERMITS: (w AMPSZ�j4 JOLTS r PHASE
NEW SERVICE: ❑ Overhead ❑Underground CI 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 ❑CT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps #of Unit Meters
TEMPORARY POLE: f/1-0 amps
❑ SERVICE UPGRADE: ❑ amps DCT Service amps
❑ NEW FEEDER(ADDITIONS, ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps ❑200amps ❑ amps ECT Service amps
ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
Outlets/Switches: 0-30a m ps 31-100amps 101-200a mps
Appliances: 0-30amps 31-100amps 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
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: I __ , y�,_ /�( Phone Number:
Electrical Company:L.O 1/ _ht-f 04( £ 4l. Tkic. Office Phone: 0 4t'Z 23-1/q Fax:
Co.Address:2/() M. /42SC OE (J(VCP• City: 0'4 VC 6249• State: ?/ Zip:
32g'2'
License Holder: I / L i C r ! State Certification/Registration#: I OO(o C
Notarized Signature of License Holder ��_.:!s��t�;Mk .�.
The foregoing instrument was acknowledged before me this'47 day,I'�'�!" he • ate of Florida,County o
�(•, •. TONIGINDLESPERGER Signature of Notary Public .
MY COMMISSION#GG 353178
.; ] Personally Known OR[ ] Produced Identification
;; EV'RES:October 6,2023 Type of Identification:
.404 Fo'•••• Underetritets