340 8th ST - TEMP POLE t--)1 `' , CITY OF ATLANTIC BEACH
,1 j 800 SEMINOLE ROAD
J _}
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ELEC-1930
Job Type: ELECTRIC ONLY
Description: temporary pole
Estimated Value: $100.00
Issue Date: 8/24/2016
Expiration Date: 2/20/2017
PROPERTY ADDRESS:
Address: 340 8TH ST
RE Number: 169928-0000
PROPERTY OWNER:
Name: MILLER, JOHN
Address: 340 8TH ST
GENERAL CONTRACTOR INFORMATION:
Name: SCHUMAN ELECTRIC INC.
Address: PO BOX 48171 QA JOHN JASPER SCHUMAN
Phone: 904-737-4040
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: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITII ALL CITY OF ATLANTIC BEACH ORDINANCES AND TIlE. FLORIDA
Ill'ILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax(904)247-5845 1 6.1.&(...._ 1 et 3�
JOB ADDRESS: �� 1 She-CA- PERMIT It
JEA INFORMATION REQUIRED ON ALL PERMITS 60 AMPS 'NO VOLTS I PHASE
VALUE OF WORK$ /00 '6(3
NEW SERVICE /:6 Overhead El Underground ❑T Underground up Pole.
[IResidential(Main) Service
00-100 amps ❑101-150amps 0 151-200amps 0 amps #of Meters
❑Commercial(Main)Service
00-100 amps 0101-150amps ❑151-200amps 0 amps OCT Service amps
Conductor Type Size
❑Multi-Family(Main)Service
00-100 amps 0101-150amps 151-200amps ❑ amps #of Unit Meters
'emporary Pole 0 amps
SERVICE UPGRADE 0 amps 0 CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
0100 amps 0150amps 0200amps 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
A Swimming Pool 0 Sign ❑Smoke Detectors_Qty _ Transformers KVA OMotors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can OSafety Inspection ❑Panel Change 0 O to UG
0Other:
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 o any other state or local law regulation construction or the performance of
construction. /fgx /`�- /
Property Owners Name eirl`l�''4►" ( MO tI"1,'ior ''. Phone Number '396-7 q ZC
Electrical Company_____ _11(1 02411 1fl Elect-KJ C Jr'Office P one 73-2-4/0-4 Fax 396- 4 /
Co.Address: 3606,0 54- iiS�-I - 1�• City State FL Zip 32207
i
License Holder(Print): . U 11 State.ertification/Registration#
4Q.,rolarized Signature of License Holder
t HOLLY MARIE WALDEN Sworn an s scribed before me th's ... 3
�'' day of Xt..1U5')""
`; • MY COMMISSION#EE853737
: *, EXPIRES November 25,2016 Signature of Notary Public
.0,)a€io.pi91 FloncallotaryServire.com