336 10TH ST TEMP POLE 0 yLvjr
Jai
, A '" )te> CITY O F ATLANTIC BEACH
800 SEMINOLE ROAD
3 ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ELEC-697
Job Type: ELECTRIC ONLY
Description: TEMP POLE
Estimated Value:
Issue Date: 3/22/2016
Expiration Date: 9/18/2016
PROPERTY ADDRESS:
Address: 336 10TH ST
RE Number: 170037-0000
PROPERTY OWNER:
Name: BULL, KATHLEEN & NIELS, *
Address: 336 10TH ST
GENERAL CONTRACTOR INFORMATION:
Name: UNITED ELECTRIC COMPANY OF
Address: 5716 ST AUGUSTINE RD QA JOHN E GRIFFIN JR
Phone: - -
FEES:
Trade Permit Base Fee $55.00
Temporary Electrical Service $35.00
State Elec DCA Surcharge $2.00
State Elec DBPR Surcharge $2.00
Total Payments: $94.00
PI?RA1I"I IS APPROV'I?D ON IN A((ORD:INCE N'ITII :U,I, (I"1'1" OF ATLANTI(: 13E1(II ORDINANCES AND THE FLORIDA
BUD DING('ODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845,
JOB ADDRESS: 33 L 1 0 'L S 4— Teo I PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS O AMPS a y a VOLTS I PHASE
,VALUE OF WORK$ So ° a
NEW SERVICE ❑ Overhead ❑ Underground flj Underground up Pole
:Residential (Main) Service
00-100 amps ❑101-150amps ❑151-200amps ❑ amps # of Meters
❑Commercial(Main) Service
00-100 amps ❑101-150amps ❑151-200amps ❑ amps OCT Service amps
Conductor Type Size
❑Multi-Family(Main) Service
0
0 0-100 amps ❑101-150amps ❑151-200amps ❑ amps # of Unit Meters
v Temporary Pole X (of) amps
SERVICE UPGRADE ❑ amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150ampt ❑200amps ❑ amps OCT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-30amps 31-100amps 101-200amps
Appliances: 0-3 Oamps 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 & Fire Alarm Checklist)
Qty volts/amps VALUE OF WORK$
REPAIRS/M1SCELLANEOUS
❑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. Co/I f r
Property Owners Name K A)i. I e t // v I I Phone Number Y 13
Electrical Company n i t C I 121l C7 c-, , Co 9 I SAX Office Phone 731-9 2- Fax 73) -$3 //
Co.Address: 5 714 5 71 , /J)Z--t City .3-6k State f - Zip 3?- o 7
License Holder (Print): Fl. l 1 iC,A tiG/ f� - State Certification/Registration#CL 130 0 536 7
Notarized Signature of License Holder JK .
ev.nr.+�rva►i-gran nr� nom, ,,�::Win.°, 6r
y r ` c.37-,..11-1,21
Sworn and subscribed before me this / day of M are2 20)G
3 lit + i .: i /`- /
MY CO R S: pit 7. ,1i'J?'S3 Signature of Notary Public ,,U/J.�/�—�
h}:i':� s pit 7.3, 0:8 /
`LWkt..X0,4%o'f;pt•. dirs9fi:-!:.vtiffs