1370 CAMELIA ST TEMP POLE PERMIT CITY OF ATLANTIC BEACH
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 INFO MATION:
Job ID: 16-ELEC-1 585
Job Type: ELECTRIC ONLY
Description: TEMP POLE
Estimated Value:
Issue Date: 7/1412016
Expiration Date: 1/10/2017
PROPERTY ADDRESS:
Address: 1370 CAMELIA ST
RE Nurnber� None
GENERAL CONTRACTOR INFORMATION:
Name: DREAM ELECTRIC
Address: 11992 Chester Creek RD
Phone:904-534-9617
FEES:
State Ejec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Temporary Electrical Service $35.00
Trade Permit Base Fee $55.00
Total Payments: $94.00
rERMIT IS APPROWD ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845 L F-C-
JOB ADDREss:0-20 //;I. PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS —(Q-0_AMPS 2_5L& VOLTS MUSE
VALUE OF WORK$_
NEW SERVICE 0 Overhead Underground Underground up Pole
OResidential(Main)Service
110-100amps 0101-150amps 0 151-200mps
GCommercial(Main)Service -----,amps #Ofmctm-
00-100 amps 0101-150amps 0 151-200amps
Conductor Type Sin ------jamps EICTService_a,,ps
OMulti-Family(Main)Service —
Q
'Q-100 amps D101-150aarps 0151-200mps EJ
IdTemporary Pole Ojke) loops ------amps #of Unit Meters
SERVICE UPGRADE El------_amps 0 CT Service_=ps
VEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
0100amps E115(burps E1200hourps 0____amps OCTService_amps
LDDMONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/S�tchc�: 0-30mps 31-100amps 101-200amps
Appliances: — 0-30amps
A/C Circuits: —0-60amps ------31-100amps —101-200amps
Heat Circuits: — #circuits 9—61-100amps
Outlets, Including Fixtures:
Number of Lighting jW
-TBER ELECTRICAL PROJECTS
E1Swimm1ingP001 DSign 0SmokeDetectors_Qty 0Tuaat0m,,s_KVA OMutoca hp
ERE ALARM SYSTEM (Requires 3 sets of plans)
Qty—volts/amps VILUEOFWORK$—
EPAIRS/MISCELLANEOUS
01leplaceliumt/DamagedMeter Can OSafety Inspection DP=el Change ooff to UG
00ther:
,nit becomes vo
o'"work dress not cornmence within a six month pe7o or work is saspanded or abandoned for si. ontha. I—hmbyedfy that i have
I this application and know the sarne W be une and correct All p000mOm of laws and ordinerce,governing this wark will be complied with whether
�ified or not. ne parnit does not give authority to violate the Provisions of any other state ar lovad law regulation oastraction or the pefounance of
stran,fion.
perty Ovvners Name
-YIJ e-Lt P�L-�L( PhoncNurnber
ctrical Company DreqM eclg"" 160964i LL,�— Office Phonesat--s-3q�111ax_
Addr:,s:,,1p , & I
city State-ft Zip _V013
..H er(Print): re &N Waddof �1 State Certification/Registration e�l ej
arized Signature ofLicense Holder
,NjGjNDLesKRGER B remethis day o
MyC01AWSSIMOF924951
EXPRESOCtabeTS2019
4.i
lure of Notary Public
o�,