436 Beach Ave 2013 Temp Pole �t rL`l;rjv�
CITY OF ATLANTIC BEACH
s� 800 SEMINOLE ROAD
jATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00003824 Date 12/12/13
Property Address . . . . . . 436 BEACH AVE
Tenant nbr, name . . . . . . TP01
Application type description ELECTRIC ONLY
Property Zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 0
--------------------------------------------------------------
Application desc
temp pole
-------------------------------------------------------------
Owner Contractor
-
------------------------
-----------------------
POLISTINA, TERRY LEE ERICKSON ELECTRICAL CONTRACTOR
12101 2ND DR NW 2807 ST JOHNS BLUFF
CORAL SPRINGS FL 33071 JACKSONVILLE FL 32246
(904) 641-9090
---------------------------------------------------------
Permit . . . . . . ELECTRICAL PERMIT
Additional desc .
Permit Fee 90 . 00 Plan Check Fee . 00
Issue Date . . . Valuation 0
Expiration Date . . 6/10/14
----------------------------------------------------
Other Fees . . . . . . . . . STATE ELEC DCA SURCHARGE 2 . 00
STATE ELEC DBPR SURCHARGE 2 . 00
----------------------------------------------------
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
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
JJ // aa Ph(904) 247-5826 Fax (904) 247-5845
JOB ADDREESS: V rAC%-I ,A V�___1 ' PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS /D d AMPS o2 7 V VOLTS _� PHASE
��.��,,// VALUE OF WORK S
NEW SERVICE L�'Overhead ❑ Underground ❑T Underground up Pole
Residential(Main) Service
❑0-100 amps 101-150amps ❑151-200amps ❑ amps #of Meters
Commercial(Main) Service
-'0-100 amps 101-150amps 11151-200amps ❑ amps ❑CT Service amps
Conductor Type Size
Multi-Family(Main) Service
-0-100 amps101-150amps ❑151-200amps ❑ amps #of Unit Meters
Temporary Pole 10 0 amps
SERVICE UPGRADE ❑ amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps 7200amps El amps ❑CT Service amps
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:
OTHER ELECTRICAL PROJECTS
Swimming Pool ❑ Sign [I Smoke Detectors_Qty ❑Transformers KVA ❑Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans) VALUE OF WORK$
Qty volts/amps
REPAIRS/MISCELLANEOUS
_'Replace Burnt/Damaged Meter Can Safety Inspection El 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 other state or local law regulation construction or the performance of
construction.
Property Owners Name `bOsG CD Phone Number a 3�-
'�� 9�39
Electrical Company!%12/L!�Std �C�1 Office Phone��- 9Q�0 Fax >
Co. Address: / 3 6774 CH %3LL'� City -3 P->,-- State State Zip 3a -
License Holder(Print): ✓Z P n3 K (5_�-ie 1< S 9 State Certification/Registration# a0000-c4
Notari y ire of License o r //l� /�
ae4rPr T� V
*: B ore me thisaa
, io cIPLHit
Bonded ThN NOM Public UAW
Signature of Notary