201 MAYPORT TEMP POLE =, CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
30B INFORMATION:
Sob ID: 15-ELEC-1232
Sob Type: ELECTRIC ONLY
Description: TEMP POLE 200 AMPS
Estimated Value:
Issue Date: 5/26/2015
Expiration Date: 11/22/2015
PROPERTY ADDRESS:
Address: 201 MAYPORT RD MAIN
RE Number: 177649-0000
PROPERTY OWNER:
Name: BEACHES HABITAT FOR HUMANITY
Address: 797 MAYPORT RD
GENERAL CONTRACTOR INFORMATION:
Name: LIMBAUGH ELECTRICAL CONTRAC
Address: 42 WEST 8TH ST QA ALEX S. LIMBAUGH
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: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BE,
800 Seminole Rd, Atlantic Beach, FL 47-5 45 3 �l� �3�
Ph (904) 247-5826 Fax(904 247-5
f _
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JOB ADDRESS: PERMIT
IF,A INFORMATION REQUIRED ON ALL PERMITS
AMTS VOLTS -.. PHASE
VALUE OF WORK$
NEW SERVICE ❑ Overhead
[] Underground ❑T Underground up Pole
❑Residential(Main) Service ❑151-200amps ❑ amps # of Meters
❑0-100 amps 0101-150amps
CCommercial (Main) Service s OCT Service amps
GO-100 amps o101-150amps ❑151-200amps ❑ amp
Conductor Type Size
❑Multi-Family (Main) Service # of Unit Meters
-100 amps 0101-150amps 0151-200amps ❑ amps
i rernporary Pole 0 Z�amps
SERVICE UPGRADE ❑_amps 0 CT Service amps
NEW F;EDER(ADDITIONS, ACCESSORY STRUCTURES,ETC.)
' ' ams CT Service amps
100 amps 0150amps ❑200amps` ❑ p
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
31-1OGamps 101-200amps
Outlets/Switches: 0-30arnps 101-200amps
Appliances: 0-30amps 31-100amps
m
0-6amps 61-100aps
A/C Circuits: ]cw
Heat Circuits: # circuits @
Number of Lighting OL4ets, Including Fixtures:
OTHER.ELECTRICAL PR OJECTS ❑Transformers ICVA ❑Motors ISP
❑Swimming Pool ❑ Sin ❑Smoke Detectors_Qty
FIRE ALARM SYSTEM (Requires 3 sets of plans) VALUE OF-WORK$
Qty volts/amps
REPAIRS/MISCELLANEOUS
❑Safety Inspection ❑Panel Change OOH to UG
❑Replace Burnt/Damaged Meter Can
OOther:
Permit bfcomes void if work does not commence within a six month Pour'°d or work is suspended ons f laws and ordinances governing g thised for lwork x m, �wtill be compliedrtvf thlwhetl whether
e
read this'mptication and know the same to be true and correct. A p
s ecified 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
P
construe Ilion. `' , _
Phone Number 'Z`L � �---
Propel Owners Name,
ce Phone 22
Electri al Company�1 1� ;� 1 Zip
h C
Co. A�dress:
tate Certification/Regi��.t,�gn,�C��`��
Uceust Holder (Print):
• � �State of Flo'ha '-'-
Notarized Signature y
My Commission EE 884631 20
Expi"@*�9M e tl i I
Signature of Notary Public