1661 PARK TERR - TEMP POLE 'L`11
r
. r J'fJ�,
\s, CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
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-1329
Job Type: ELECTRIC ONLY
Description: ELECTRIC -TEMP POLE 60 AMPS
Estimated Value: $12,000.00
Issue Date: 6/10/2016
Expiration Date: 12/7/2016
PROPERTY ADDRESS:
Address: 1661 E PARK TER
RE Number: 172020-0216
PROPERTY OWNER:
Name: KETTERINGHAM ET AL, BARNEY B
Address: PO BOX 20229 PO BOX 20229
GENERAL CONTRACTOR INFORMATION:
Name: GREENSLADE ELECTRIC, LLC
Address: 311 S BAY ST
Phone: 386-263-2960
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
800 Seminole Rd, Atlantic Beach, FL 32233
I' I , Ph(904) 247-5826 Fax (904) 247-5845 G -"E LEC -13 Z1
.1()B ADDRESS: tOL)l � ' .. ., �/ , Al, PERMIT #
WA INFORMATION REQUIRED ON ALL PERMITS AMPS 240 VOLTS I I'ILAtill
VALUE OF WORK S I'2-1000:00
NEW SERVICE n Overhead 'derground n1 Underground up Pole
Residential (Main)Service
0-100 amps 101-150amps 151-200amps amps #of Meters
Commercial (Main)Service
0-100 amps I 0 I-150amps 151-200amps _amps CT Service amps
Conductor Type Size
Multi-Family(Main)Service
°J 0-100 amps 101-150amps 151-200amps amps # of Unit Meters
Temporary Pole (o[) amps
SERVICE UPGRADE amps CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
100 amps 150amps 200amps amps CT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES, ETC.
Outlets/Switches: 0-30amps 3 I-100atnps 101-200amps
Appliances: 0-30amps 31-I00amps 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)
Qty volts/amps VALUE OF WORK S
REPAIRS/MISCELLANEOUS
Replace Burnt/Damaged Meter Can Safety Inspection Panel Change OH to UG
Other: IU an') kparnisminsimminnifila
e1
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 he true and correct. All provisions of laws and ordinances governing this work will he complied with whether
specified or not. I he permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of
construction. V�A,, //
Property Owners Name d L Y d Ara5 Phone? Number
Electrical Company re�, l e. �U 1 L1—e_0ffice l o st)( 1244 hax 1V32 )
Co. Address: 205 W LaMbe(t 5k City t Ltir1(lea State R _Zip 3Z)) C
License Holder (Print): Jams)) er;' *`,,tE State Certification/Registration #
_
Not( ri;;, :'��+1�fafatur3�►dbilifte ffo� l
orlNr �' UtL'�.�
I '`; 'll Notay Public-State of Florida I A
ll :j My Comm.Expires May 8.20i'8\ ,Y)o' • d S: : t d before this
L� day of 20 1(0
( '•o';F„�;,o;:•' Commission I FF 121371 r ,�f�O�� /
— iisnature of Notary Public _
I
CITY OF ATLANTIC BEACH
BOO SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
PHONE (904) 247-5955
Cashier Id: atlbcid\atlbbja
Receipt Date: 6/10/2016 11:29:20 AM
Receipt Number: 0S-7007S
Job ID: 16-ELEC-1329 - ELECTRIC - TEMP POLE
6O AMPS EDBPR - State Elec DBPR Surcharge
$2.00
Job ID: 16-ELEC-1329 - ELECTRIC - TEMP POLE
6O AMPS EDCA - State Elec DCA Surcharge
$2.00
Job ID: 16-ELEC-1329 - ELECTRIC - TEMP POLE
60 AMPS EL6 - Temporary Services $35.00
Job ID: 16-ELEC-1329 - ELECTRIC - TEMP POLE
60 AMPS TP - Trade Permit Base Fee $55.0
0
Amount Due: $94.00
Tender Information: Cash $94.00
Tender Type: CC
Tender Amount: $94.00
Change Due: $0.00