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645 Ocean Blvd Temp Pole c•••ua:cuao 3o4cou3000 IM1.uitI Y PAGE 01/91 ELECTRICAL PERMIT APPLICATION 90(efjc-i CI Y OF ATLANTIC BEACH 800 Seminole Rd,Atlantic Beach,FL 32233 Ph(904)247-5826 Fax 1904)247-5845 JOB ADDRESS: 6 N.5 QC e_411 IM/vd PERMIT# YEA LNFORMATION REQUIRED ON ALL PERMITS 6 Q AMPS24O VOLTS PHASE VALUE OF WORK S NEW SERVICE ❑'Overhead ❑ Underground El Underground up Pole ❑Residential(Main)Service 00-100 amps 0101-150amps 0151-200amps 0 amps #of Meters ❑Commerclal(Main)Service 30-100 amps 0101-150amps 0151-200antps 0 amps OCT Service amps Conductor Type Size JMalti-Family(Main)Service 0-100 amps 0101-150amps C 151-200amps C amps iF of Unit Meters Remporary Pole 0 f,A amps SERVICE UPGRADE 0 amps 0 CT Service amps NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.) 100 amps 0150amps C200amps C amps CCT Service amps ADDITIO ODEI PAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC. Outlets/S 30amps 31-100amps 101-200amps Appliances: 0-30amps 31-100amps 101-200amps A/C Circuits: 0-60amps 61-I00amps Flcat Circuits: #circuits® kw Number of Lighting Outlets, Including Fixtures:_ ,• OTHER ELECTRICAL PROJECTS :Swimming Swimming Pool C Sign 0 Smoke Detectors Qty ❑Transformers KVA ❑Motors hp EIRE ALARM SYSTEM (Requires 3 sets of plans&Fire Alarm Checklist) Qty volts/amps VALUE OF WORK S REPAIRS/MISCELLANEOUS :Replace Bunt/Damaged Meter Can CSafety Inspection OPanel Change COH to UG 0Other. Permit becomes void if work doer not continence within a six month period or work is suspended or abandoned for six months. I hereby certify that f 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 76 C 'I-)fir!O JO Phone Number Electrical Company-'' C. ceLa,t.. hilL_.Office Phone?-442--744.9 Fax<9-404'441f' Co.Address: II fla 3 C. CU 1 v r''t�, • C i _ C State-.Zip,)-a•d4 License folder(Print): ma: • L• t-r r , ate Certifcation/Registration#t QiX7/S/4 D_ Notarized S nature o License Holder TAMMY PALL. ,•��:�••., [sworn and subscribed be.ore me this ..5 day of �'i'i 20L(� coo Notary Public•Slate of Florida 1. � My Comm Extlres Jul a.2016, t ignat Dommlaaron•EE 202003 ttre of Notary Public pet-01 ,_•i••• breed Runup national Notary sues. CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD r ATLANTIC BEACH, FL 32233 \ INSPECTION PHONE LINE 247 -5814 0131`>`' ELECTRICAL PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814 JOB INFORMATION: Job ID: 16 -ELEC -813 Job Type: ELECTRIC ONLY Description: TEMP POLE 60 AMPS Estimated Value: Issue Date: 4/6/2016 Expiration Date: 10/3/2016 PROPERTY ADDRESS: Address: 645 OCEAN BLVD RE Number: 170126 -0000 PROPERTY OWNER: Name: LACKIE, RAYMOND & AUDREY, * Address: 1300 FLORIDA BLVD GENERAL CONTRACTOR INFORMATION: Name: TRI COUNTY ELECTRICAL Address: 11637 E COLUMBIA PRK DR QA KEVIN LEE WEIR 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: $94.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. U4! Ul! LUl O U e . JO DU4.400000 I K I U J U N I Y PAGE 01, 01 , . ELECTRICAL PERMIT APPLICATION 0 (Av.._ CITY OF ATLAIrl'TIC$EACT:I 300 Seminole Rd, Atlantic Beach, FL 32233 Ph (904) 247 -5826 Fax (904). 247 -5845 „ _ _ n JOB ADDRESS: } ... CD C e' ez _..,,.. /v - T PERivuT # . AMTS VOLTS PtIASE JEA :INFORMATION R.rQ�U>cn ON ALL PERMITS L� �. T � . VALUE OF WORK NEW SERVICE 7 'sOverhead L] under D Underground up Pole ER.esidential (Main) Service 00 -1.00 amps ❑ 101- 150am.ps 01151- 200amps ❑ amps # of Meters IComrnercial (Main) Service ❑0 -1.00 amps ❑ 101.- 150a.mps [I151.- 200anips EL __ amps OCT Service amps Conductor Type Size ❑Mniti- Family (Main) Service • ❑0 -100 amps L1 l01- 150ainps I: 151 200arnps Q . amps 0 of Unit Meters temporary Pole 0 c. 1-, amps SERVICE 'UPGRADE 0 amps ❑ CT Service amps NEW FEEDER (ADDITIONS, ACCESSORY SSTRUCTLJR;ES, ETC.) _! 100. amps 0150amps E200arps 0 amps OCT Service atnps ADDITIONS . EMODET S. R ,PAIRS, BUILD -OUTS, ACCESSORY STRUCTURES, ETC. Outlets /Suet ei 30a:mps s 31- 100arnps 1.01- 200amps Appliances: ' 0- 30a.mps 31- 1.00amps 101- 200a.mps A/C Circuits; 0- 60amps 61- l00amps fTca.1: Circuits: 4 circuits @ lcw ;`dumber of Lighting Outlets, Including Fixtures: _ OTHER ELECTRICAL PROJECTS 7 Swimni.ng Pool' ❑ Sign 0 Smoke Detectors Qty ❑ Trans Conners • KVA Motors IZp FIRE ALARM SYSTEM,, (Requires 3 sets of plans & Fire Alarm Checklist) Qtv volts /amps ___ VAL OF WOR 5' REPAIRS/MISCELLANEOUS :Replace Burnt/Damaged Meter Can 0Safety Inspection EiPanel Change ❑OH to LTG 0 Other: Permit becomes void if work. does not commence within a six month period or work is suspended or abandoned for six months, i heroby certify that t have read this application and know the same to be true and correct, Ail provisions of laws and ordinances governing this worl< 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 rogulation construction or 1:110 performance of construction. J Property Owners Name O ._1/7 /7'0 Jo Phone Number Electrical Company r. to rig? 1 r FIQ Co I )A,,e.. _.- Office Pb.one ° G' h. (c9 Fax "* :,.a4& � 0 Co. Address: I t 6 3 ? L' . C Lv si � _.r 7 ,--„, State -� Zip r S r � License lfRoldler (PrilJitt) . in ,w L ' 'WA. c_ f Certification /Registration. i Fizoo / Notarized Signature c License Ho/der � .� ' ter_ .•,__ ,..� /9 < ..6 F� TAMMY PALL Worn and. subscribed be.'cre rtle'' this ..5 day of /7 r, 1 20_1_, :.0' - � r = , Notary Public - State of Flarlda µ • _ My Comm. Expires Jul 6, 2016; • t ' gnatUle Of Notary Public R, y � .« .! r,.-� ' . r -:, ,n s,, . I I l„ -. Commission # L•C 202003 ., r °' '''''' Bonded Through National Notary Assn.