1962 FRANCIS AVE EMP23-0003 NEW ADDRESS io:c.),,,?_,I.,\.,9:--,-..,,, ELECTRICAL TEMP POLE PERMIT PERMIT NUMBER
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CITY OF ATLANTIC BEACHTEMP23-0003
800 SEMINOLE ROADISSUED: 2/7/2023
ATLANTIC BEACH. FL 32233 EXPIRES: 8/6/2023
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:
1962 FRANCIS AVE ELECTRICAL TEMP POLE TEMP POLE- 60 amp $500.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172168 0000 DONNERS R/P
COMPANY: ADDRESS: CITY: STATE: ZIP:
OCEAN CURRENTS S JACKSONVILLE
511 LOWER 8th ST FL 32250
ELECTRICAL LLC BEACH
OWNER: ADDRESS: CITY: STATE: ZIP:
THOMAS ELSIE LYNN 42 STANLEY RD ATLANTIC BEACH FL 32233-4328
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 FiNESEi
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 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$94.00
Issued Date: 2/7/2023 1 of 2
Electrical Permit Application **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 1E (Y\pZ -cX 3
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: i PROJECT VALUE $ SO 'o
s L.).)-/\ I O
JEA INFORMATION REQUIRED ON ALL PERMITS: GO AMPS 2-WVOLTS \ PHASE
NEW SERVICE: Overhead Underground Underground up Pole
uResidential (Main) Service:
L0-100 amps 101-150amps u151-200amps amps #of Meters
❑Commercial (Main)Service:
DO-100 amps 101-1SOamps u151-200amps amps CT Service amps
Conductor Type Size
uMulti-Family(Main)Service:
F-0-100 amps 101-150amps °151-200amps amps #of Unit Meters
jg TEMPORARY POLE: 6- ) amps
SERVICE UPGRADE: amps CT Service amps
I NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
100 amps 150amps t 200amps amps CT Service amps
I ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
Outlets/Switches: 0-30amps 31-100amps 101-200amps
Appliances: 0-30amps 31-100amps 101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
I I OTHER ELECTRICAL PROJECTS:
.Swimming Pool uSign ❑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 i_iOH 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: Chy-i41 1_c:reill1XTISo K.O Phone Number: CIO( 3 C1 280
Electrical Company: OCE `.UR.V.ErvTS EIEC • ClLc Office Phone: CRA - 4 "8023 Fax:
Co Address: 6 t1 Low e„),( iAJtz S City: State: Fl Zip: 3Z-Z50
License Holder: y\4 cn v`v\ State Certification/Registration#: ER Idol 5 Q S 3
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this ( day of ( ,20 t e State Florida,cf County of C j-�h j
Signature of Notary Public
tdMISION#SIGN#ERCER }'personally Known OR I Produced Identification
GG 35317& Type of Identification:
cXPIRES:October 6,2023
°` °' so,nied ihru Notary Pubiic Undewriters