45 DONNER RD TEMP22-0022 t'-.A','f,,. ELECTRICAL TEMP POLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH TEMP22-0022
\J v~ 800 SEMINOLE ROAD ISSUED: 10/19/2022
�`='';�~
jATLANTIC BEACH. FL 32233 EXPIRES: 4/17/2023
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:
45 DONNER RD ELECTRICAL TEMP POLE TEMP POLE $500.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172067 0000 SECTION LAND
COMPANY: ADDRESS: CITY: STATE: ZIP:
Felco Electric Co. Inc 4893 Vanzant Road Hilliard FL 32046
OWNER: ADDRESS: i CITY: : STATE: ZIP:
MAREK RERUCHA 1784 12th AVE N JACKSONVILLE FL 32250
BEACH
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 j
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:$94.00
Issued Date:10/19/2022 1 of 2
Electrical Permit Application **ALL INFORMATION
i HIGHLIGHTED IN
-/� City of Atlantic Beach Building DepartmentIrE.
—GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 ��
.-,0' Phone: (99,j) 247-5826 Email: B ilding-Dept@coab.us PERMIT#: S --dill;
JOB ADDRESS: 4s ow1.e-�' PROJECT VALUE$ Ste'
JEA INFORMATION REQUIRED ON ALL PERMITS: AMPS VOLTS PHASE
❑ NEW SERVICE: e(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 E151-200amps ❑ amps ECT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
�}I /
❑0-100 amps o101-150amps o151-200amps ❑ amps #of Unit Meters
p� TEMPORARY POLE: (P 0 amps
❑ SERVICE UPGRADE: ❑ amps ❑CT Service amps
❑ NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps n200amps ❑ amps ❑CT Service _ amps
❑ ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
Outlets/Switches: 0-30am ps 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
❑ 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: p v �a-IF IL Phone> Number: �d 4i) SC}S-S,, 12
Electrical Company: �cei/Co P��f"-}")rIL Office Phone: e_oG ) c c-So/Z Fax: ,�/
Co.Address: �_C�t 3 `( R,i 1?0. OLl City: H I,l.I D1 Lc State Zip: �wl�
License Holder: �'Yck''1\(.- i , y. U State Certification/Registration#: EC (300 I20 t
Notarized Signature of License Holder ,'41:.)
i
The foregoing instrument was acknowledged before me this( CI) day of 9
_ 0.410 the Stat of Florida,County of .2_02,_._ 1
`'iN,.-:;% 1Ci41 G,�NL,:a3cL:N�=F-: Signature of Notary Public i / -
:° `" MY COMMISSION#GG 353178
v=' r�a' I'' PersonallyKnown OR Pried
‘i, .-1:';',.9'.1474* EXPIRES:October 6,2023 [ ] [ ] r ced dentification
Bonded Thru Notary Public Underwriters Type of Identification: