1757 ATLANTIC BEACH DR - TEMP POLE ,..;s .4' .r :<a 's.1..
CITY OF ATLANTIC BEACH
;, . I ,,_:,.;� 800 SEMINOLE ROAD
j ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814 V x
�1 01319?
ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ELEC-377
Job Type: ELECTRIC ONLY
Description: Electrical -Temp Pole 30 amps
Estimated Value: $100.00
Issue Date: 2/18/2016
Expiration Date: 8/16/2016
PROPERTY ADDRESS:
Address: 1757 ATLANTIC BEACH DR
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: RIVERSIDE HOMES OF N FL
Address: 414 OLD HARD RD STE 502 MATTHEW ROBERTS
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: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WI I'll ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION t_G_31
CITY OF ATLANTIC BEACH ).._
800 Seminole Rd, Atlantic Beach,FL 32233 \L9
Ph(904)247-5826 Fax (904) 247-5845
JOB ADDRESS: /-15-? 41-/o.--7-/c /3-ti ®✓ PERMIT# /5'SF/L l 7O
JEA INFORMATION REQUIRED ON ALL PERMITS ?O AMPS VOLTS PHASE
VALUE OF WORK$ /0 0. W
NEW SERVICE ❑ Overhead ❑ Underground ❑I Underground up Pole
:Residential(Main)Service
:0-100 amps t'!101-150amps 151-200amps ._ amps #of Meters
`L Commercial(Main)Service
710-100 amps %:101-15Oamps --151-200amps amps I-:CT Service amps
Conductor Type Size
Multi-Family(Main)Service
100 amps J 1 1-150amps _151-200amps amps #of Unit Meters
ii'emporary Pole 1 U amps
SERVICE UPGRADE amps r CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
100 amps - 150amps I'200amps amps LCT 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 E Sign ;Smoke Detectors Qty iTransformers KVA EiMotors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/M1SCELLANEOUS
7.Replace Burnt/Damaged Meter Can _Safety Inspection (Panel Change Ei 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. I1
Property Owners Name Rt i {0 (',s /c' ry ! Phone Number
Electrical Company /14 `/)dn)t-ict 1(-c-rre_, i Office Phone 3Sto' 3 Fax 2t96,-/19 9Y
Co.Address: 32-e/ CA"- c.v-v City J State I Zip 32 2 Stl
License Holder(Print): Z,,/- 15 / _ State Certification/Registration# :e--G J/?9y
Notarized Signature of License Holder si '= '
YIP y Ci+RiS M THOMAS .worn and subscribed before me this 16{= day of 1Ib;vr,..l 2011.
jp�� �e` 's Notary Public •State of Florida
.1 Commission S FF 943955
i ature of Notary Public / -'s> A:' My Comm.Expires Dec 15,2019 ' V _ /
-'-'1`*"" .‘ Bonded through National Notary Assn. /