800 Sherry Dr 2015 Temp Pole ... .. ...... . . .. .
CITY OF ATLANTIC BEACH
SJ 800 SEMINOLE ROAD
,j ATLANTIC BEACH, FL 32233
a INSPECTION PHONE LINE 247-5814
ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ELEC-209
Job Type: ELECTRIC ONLY
Description: 60 amp temp pole
Estimated Value:
Issue Date: 1/27/2015
Expiration Date: 7/26/2015
PROPERTY ADDRESS:
Address: 800 SHERRY DR
RE Number: 170393-0000
PROPERTY OWNER:
Name: EGGERS, WALTER E
Address: 800 SHERRY DR
GENERAL CONTRACTOR INFORMATION:
Name: IMPULSE ELECTRIC
Address: 4271 YVONNE TER QA RUSS TYLER BROKA
Phone: - -
FEES:
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Temporary Electrical Service $35.00
Trade Permit Base Fee $55.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax(904) 247-5845
JOB ADDRESS: it380 f441r l,9`C 1A. PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS _AMPS VOLTS ' PHASE
VALUE OF WORK$
NEW SERVICE ❑ Overhead ❑ Underground ❑T Underground up Pole
❑Residential(Main) Service
❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Meters
❑Commercial(Main)Service
00-100 amps ❑101-150amps ❑151-200amps El-amps ❑CT Service amps
Conductor Type Size
❑Multi-Family(Main)Service
00-100 amps ❑101-150amps ❑151-200amps []-amps #of Unit Meters
$Temporary Pole ❑ 4!�? amps
SERVICE UPGRADE ❑ amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps ❑200amps ❑ amps OCT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-3 Damps 31-100amps 101-200amps
Appliances: 0-30amps 31-100amps 101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
❑Swimming Pool ❑ Sign ❑Smoke Detectors_Qty ❑Transformers KVA ❑Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans) VALUE OF WORK$
Qty volts/amps
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection ❑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 Phone Number
Electrical Company Aftfl.'L.S EJ Office Phone'101*-2A x
Co.Address: 47-7 yC&-AJE� 2V11CLP City k IbD"LOF4, State_flc Zip 2-068
License Holder(Print)• l3SS - Certi cation/Registration#
Notarized Signature of License Holder n
CJ
r P e re me this 7 20�
a�Ja �iy^ Notary Public State of Florid
Shirley L Graham
_ �a� My Commission FF 086990 Si lature of Notary
?of rid` Expires 02/14/2018
(07- 34 - 6