365 8th ST - TEMP POLE PERMIT (rlilf�r?�
CITY OF ATLANTIC BEACH
l,4 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814 ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION:247-5814
]OB INFORMATION:
Job ID: 15-ELEC-2006
Job Type: ELECTRIC ONLY
Description: TEMP POLE 100 AMPS
Estimated Value:
Issue Date: 8/25/2015
_.
Expiration Date: 2/21/2016 _
PROPERTY ADDRESS:
Address: 365 8TH ST
RE Number: 169974-0000
PROPERTY OWNER:
Name: FRISCH, BENJAMIN P
Address: 10758 WAVERLY BLUFF WAY
GENERAL CONTRACTOR INFORMATION:
Name: FRANKLIN ELECTRIC SERVICE
Address: 4 TALLWOOD RD QA JARRETT ADAM FRANKLIN
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: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904)247-5845
JOBADDRESS: 3&5' 'J>" UtMCI PERMIT# I2/ -
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE
VALUEOFWORK$
NEW SERVICE ❑ Overhead ❑ Underground nderground up Pole
❑Residential(Main)Service
❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Meters
❑Commercial(Main)Service
❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps ❑CT Service amps
Conductor Type Size
❑Multi-Family(Main)Service
1 0-100 amps ❑101-150amps Cl 151-200amps ❑ amps #of Unit Meters
Temporary Pole ❑ 100 amps
SERVICE UPGRADE ❑ amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑I50amps ❑200amps ❑ 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 ❑Smoke Detectors_Qty ❑Transformers KVA ❑Motorshp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
• ❑Replace Bumt/Damaged Meter Can :]Safety Inspection ( IPanel Change DOH to UG
❑Other:
Pertain 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 Ra3SKA0 (R 15 U4 Phone Number
Electrical Company 02s-arU0 E-LECTk1C 'SermcE OfficePhone Fax
Co.Address: Y. 0. Bo x 5 )23 ? City .�: Ax -5W State FL zip 3z2or)_
License Holder(Print): 3AVRerr State Certification/Registration# 6712130( eg9A
Notarized Signature of License Holder
;e N" :c ammns wA.Yrn - Before me this "_day of 6UA 20
EXPIRES: un r ?
fx�£ � .Iau uu3I>rs:, ignature of Notary Public