201 MAGNOLIA ST - TEMP POLE f 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 INFORMATION:
Job ID: 16-ELEC-1610
Job Type: ELECTRIC ONLY
Description: ELECTRIC - TEMP POLE
Estimated Value: $500.00
Issue Date: 7/18/2016
Expiration Date: 1/14/2017
PROPERTY ADDRESS:
Address: 201 MAGNOLIA ST
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: PHASE ONE ELECTRIC LLC
Address: 2076 CORONA CT OLIVER VAN DE KAMP
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: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph(904)247-58 6 Fax (904(1247-5845
` \
JOB ADDRESS: aC r
\ �G \ }1-�' �— PERMIT# ��-7R- \�d(3
g
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE
VALUE OF WORK$ 5C ,CC)
NEW SERVICE ❑ Overhead ❑ Underground ❑1 Underground up Pole
❑Residential(Main)Service
U 0-100 amps ❑101-l 50amps ❑151-200amps 1: amps #of Meters
❑Commercial(Main)Service
00-100 amps ❑101-150amps ❑151-200amps ❑ amps CT Service amps
Conductor Type Size
0 Multi-Family(Main)Service
!!!!l40-100 amps LI 101-150amps 151-200amps D _ amps #of Unit Meters
emporary Pole ❑ .1:3J amps
SERVICE UPGRADE D amps U CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
0100 amps ❑150amps . ❑200amps amps ❑CT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-3 Damps 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
LI Swimming Pool 0 Sign 0 Smoke Detectors_Qty ❑Transformers KVA [1 Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can D Safety Inspection 0 Panel Change U OH to UG
El 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. 5 / t
\Property Owners Name \ee S Phone Number ciciA 9 SS 2-S9
Electrical Company RI1c6e Oe L
T0;,.. \ Lt-c Office Phone 3 -7683 Fax
Co.Address: QC-)7C G rrN a. C-)- City -'< State- Zip Q22
License Holder(Print): 01‘‘vP - \J e ,-,-N') State Certification/Registration# EC\300339
Notarized Signature of License Holder -
, t,fi..4.1
TONT GISa ESPERG 24 Before me this dayof $U :�
;,: ., ;= MY COMMISSION t FF 924951 , .�
•. EXPIRES:October 6,2019 4
;%q •d"�' Bo, ThruNoaryPubicUrderwriters Signature of Notary Public • f v
a. I