115 DONNER RD TEMP POLECITY OF ATLANTIC BEACH
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-2061
Job Type:
ELECTRIC ONLY
Description:
TEMP POLE 40 AMPS
Estimated Value:
Issue Date:
9/1/2015
Expiration Date:
2/28/2016
PROPERTY ADDRESS:
Address:
115 DONNER RD
RE Number:
172150-0000
PROPERTY OWNER:
Name:
THOMAS, ELSIE LYNN
Address:
1964 FRANCIS AVE
GENERAL CONTRACTOR INFORMATION:
Name:
KNIGHT ELECTRIC LLC
Address:
908 S 11TH AVE QA MARK STEVEN KNIGHT
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 / 461
800 Seminole Rd, Atlantic Beach, FL 32233 0-6441
Ph (9014) 247-5826 Fax (904) 2475845
JOB ADDRESS: f l KUt • PERMIT #� l!
JEA INFORMATION REQUIRED ON ALL PERMITS WV AMPS Zqd VOLTS / PHASE
NEW SERVICE ❑ Overhead
Residential (Main) Service
I. 10-100 amps ❑ 101-150arnps
)Commercial (Main) Service
0-100 amps i. i 101-150amps
Conductor Type
]Multi -Family (Main) Service
—0-100 amps i';101-150amps
ifemporary Pole I (O _amps
VALUE OF WORK S
❑ Underground ❑T Underground up Pole
Size
151-200amps ❑ amps # of Meters
151-200amps amps LCT Service amps
1,151-200amps amps
SER'V'ICE UPGRADE Ii CT Service amps
NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.)
L 100 amps L 150amps 1..1200amps i.1 amps aCT Service
# of Unit Meters
amps
ADDITIONS, REMODELS, REPAIRS, BUILD -OUTS, ACCESSORY STRUCTURES, ETC,
Outiets/Switches: 0-30amps 31- 100amps 101-200amps
Appliances: 0-30amps 31-100amps 101-200amps
AIC Circuits: 0-60amps 61-100amps
)"-teat Circuits: # circuits ct 1cw
Number of Lighting Outlets, Including Fixtures -
OTHER ELECTRICAL PROJECTS
Swimming Pool I 'I Sign JSmoke Detectors _Qty ("I Transformers
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps
KVA J Motors
VALUE OF WORK S
REPAIRS/MISCELLANEOUS
J Replace Burnt/]damaged Meter Can 0 Safety Inspection I Panel Change ION to UG
i=; Other:
hp
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. 1 hereby certify that 1 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
Electrical Company KW fi r L,L Cr
Co. Address: Py 1114- A<_
License Holder (Print):
�G frn.'• f !/�
Notarized Signature of License Holder
Phone Number
_Office Phone`, 7.-'11,-
(' 91 PaxZjP/7 Q
City W FI State irt. Zip 3?7%
State Certification/Registration # 0170(2 S2 -7
Before me this day of Atr-7U
• � ' i�'d� , SHEARi l,, STEPP
s
Notary Public - State of Florida Signature of Notary Public
• `-My Comm, Expires May 31, 2016
W
Commission * EE 209904
Bonded TArouph National lyotary Assn..
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