967 CAMELIA ST - ELECTRICAL TEMP POLE rJ`J r
\SS, CITY OF ATLANTIC BEACH
-�.,.. l 800 SEMINOLE ROAD
„,r ,yll/ Vr 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-738
Job Type: ELECTRIC ONLY
Description: ELECTRIC - TEMP POLE 100 AMPS. 120/ 240 VOLTS.
SINGLE PHASE
Estimated Value: $500.00
Issue Date: 3/28/2016
Expiration Date: 9/24/2016
PROPERTY ADDRESS:
Address: 967 CAMELIA ST
RE Number: 170967-0000
PROPERTY OWNER:
Name: BENNETT, KEVIN
Address: 4429 JIGGERMAST AVE
GENERAL CONTRACTOR INFORMATION:
Name: JOHN MANCINI ELECTRIC INC
Address: 2400 NE 10Th ST APT 402
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: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WI l'll ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach, FL 32233 QQ
Ph 4)/�247-5826 Fax(904) 247-5845 �'� '�3V
JOB ADDRESS: /1_7 G (90
`1 ! PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS \b 0 AMPS \ • vz VOLTS \ Ar. PHASE
VALUE OF WORK$ O a . c C
NEW SERVICE ❑ Overhead ❑ Underground I IJ Underground up Pole
❑Residential(Main)Service
00-100 amps 0101-150amps ❑151-200amps U amps #of Meters
[1Commercial(Main)Service
0 0-100 amps ❑101-150amps ❑151-200amps 0 amps OCT Service amps
Conductor Type Size
❑Multi-Family(Main)Service
00-100 amps ❑101-150amps 0151-200amps 0 amps #of Unit Meters
`,Temporary Pole 0 \b v amps
SERVICE UPGRADE 0 amps 0 CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps ❑200amps 0 amps OCT 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 0 Transformers KVA ['Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps • VALUE OF WORK$ J�PO
REPAIRS/MISCELLANEOUS
❑Replace Bumt/Damaged Meter Can ❑Safety Inspection 0 Panel Change n 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
-ead 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
:onstruction.
?roperty Owners Name I 6- le G-i tcv C Phone Number
3lectrical \ Office Phone clS.`-\S%'% 9 Fax •
.2o.Address:' .•-•\ \ \cS' City �,,, ,,.� State \ Zip ��O(co\
License Holder(Print State Certifica ' n/Registration# \
ONI GINDLES• RGER _�
Notarized Si:ir';"... of 5::
.r EXPIRES:October 6.
'•.��
.:127'
S sonded Thru Nowt Pub ey !!;�I this day of Il' .>,I L 20
.r�
Signature of Notary Public _rowan& 1�