1763 E PARK TER TEMP22-0011 ,,..1
rI %, ELECTRICAL TEMP POLE PERMIT PERMIT NUMBER
' _ \ TEMP22-0011
CITY OF ATLANTIC BEACH
E.,'
800 SEMINOLE ROAD
ISSUED: 5/11/2022
\�`''; V ATLANTIC BEACH, FL 32233 EXPIRES: 11/7/2022
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:
1763 E PARK TER ELECTRICAL TEMP POLE TEMP POLE $200.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172020 0412 SELVA MARINA UNIT 08
COMPANY: ADDRESS: CITY: STATE: ZIP:
QUALIFIED ELECTRICAL OF
JAX LLC 849 Depaul DR JACKSONVILLE FL 32218
OWNER: ADDRESS: CITY: STATE: ZIP:
WILLIAMS DANIEL 1763 PARK TERRACE EAST 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.
.. FEES AlliNii.
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:$94.00
Issued Date:5/11/2022 1 of 2
tr LiElectrical Permit Application **ALL INFORMATION
'r c'';‘,f) HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
�S'r Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: t CMP ZZ—OO I (
JOB ADDRESS: /-7 OS Park .T�Ccc, c. C Li PROJECT VALUE$ 20 0
e*JEA INFORMATION REQUIRED ON ALL PERMITS: Lek AMPS 2-11c. VOLTS f 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 o101-150amps o151-200amps ❑ amps ECT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
❑0-100 amps D101-150amps o151-200amps ❑ amps #of Unit Meters
TEMPORARY POLE: 6 e amps
❑ SERVICE UPGRADE: ❑ amps ❑CT 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: 0-30amps 31-100amps 101-200a m ps
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
n FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
n REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change ❑OH 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. ) , L
Owner Name: (f'�►t(b ! t,,.-t ..r) Phone Number: `ley—Pa. e— tr 0 to Z.--
Electrical
�Electrical Company: GIL;..t,fl gi 0 c cJ. v oz-74 x Office Phone: Fax:
Co.Address: Say y De- PC..1 1I Pr. City: —TPax._ State: Ft-- 'Z
Zip: 3 21,
License Holder: tJ%(b14" t- g°.&`;r, \I J State Certification/Registration#: a--I3 G 14 Ret
Notarized Signature of License Holder W_/e
The foregoing instrument was acknowledged before me this / I day oft( fP i @ the State of Florida,County of
4
Signature of Notary Public J2___ 1 c
;:;,? P,,*: TONI GMLESPERGER
2MY COMMISSION#GG 353178 [ ] Personally Known OR[ ] Produced Identification
;;'.;,. :e; EXPIRES:October 6,2023 Type of Identification:
�`"°c" Bonded Thai Notary Public Underwriters