2061 Beach Ave 2012 elec temp pole i
f � , CIT OF ATLANTIC BEACH
800 SEMINOLE ROAD
r3 ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
12-00000913 Date 7/19/12
Application Number . . AVE
Property Address . • • • • . T 2061 BEACH CH
Tenant nbr, name . . . . . .
Application type description ELECTRIC ONLY
Property Zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 0
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Application desc
temp pole
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Owner Contractor
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SHAW RICHARD AND MIMI TRUST ADKINS ELECTRIC INC.
2061 BEACH AVE 10477 NEW KINGS RD
ATLANTIC BEACH FL 322335934JACKSONVILLE 6 L 32219
622
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Permit ELECTRICAL PE MIT
Additional desc . . . 00
Permit Fee . . . . 90 . 00 Plan Check Fee
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 1/15/13
--------------------------------
Other Fees . .
. STATE ELEC DCA SURCHARGE 2 . 00
STATE ELEC DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----- ---------- ----------
Permit Fee Total 90 . 00 90 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 94 . 00 94 . 00 . 00 . 00
II
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY O ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODS.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlanti Beach, FL 32233
Ph(904) 247-5826 F (904)247-5845
JOB ADDRESS: C ` LSE 1u u-JE PERMIT#
NEW SERVICE ❑Overhead ❑ Underground ❑ Underground up Pole
❑Residential(Main) Service
❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Meters
❑Commercia) (Main)Service
❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps ❑CT Service amps
Conductor Type Size
❑M am
❑0-100 amps ❑101-150amp ❑151-200amps 11 amps #of Unit Meters
%Temporary',Pole ❑ /Do amps
S RVICE UPGRADE ❑ amps ❑ CT Service amps
NE EEDER ,ACCESSORY STRUCTURES, ETC.)
❑1 amps ❑150amps ❑200amps ❑ —amps ❑CT Service amps
ADDITIONS, REMODELS,REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-30amps 31-100ams 101-200amps
Appliances: 0-30amps 31-l 00am s 101-200amps
A/C Circuits: 0-60amps 61-100am s
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
El Swimming Pool ❑ Sign ❑Smoke Detectors_Qty ElTransformers KVA ❑Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans & Fire A arm Checklist)
Qty volts/amps VALUE OF WO $
REPAIRS/MISCELLANEOUS
Replace Burnt/Damaged Meter Can ❑Safety Inspection []Panel Change ❑OH to UG
❑Other:
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 of ier state or local law regulation construction or the performance of
construction.
Property Owners Name Phone Number
Electrical Company Office Phone 7 �ax
Co.Address: S City Jey L State Zip
License Holder(Print): State Certiflc n/Registration#
Notarized Signature''of License Holder
Notary Public Stats Of
worn and subscribed before th's day of 20 Q-
Florida
Angela M Williams
ig nature of NotaryPublic /Yh
My Commission DD908784
Qf
�� Expires 09/27/2013