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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