363 12TH ST - TEMP POLE (-----
' - �1 J CITY OF ATLANTIC BEACH
K _, . 800 SEMINOLE ROAD
;:. _.::.: ,___J,/, ATLANTIC BEACH, FL 32233
INSPF,CTION PHONE LINE 247-5814
ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ELEC-2118
Job Type: ELECTRIC ONLY
Description: ELECTRIC - TEMP POLE
Estimated Value:
Issue Date: 9/21/2016
Expiration Date: 3/20/2017
PROPERTY ADDRESS:
Address: 363 12TH ST
RE Number: 171917-0000
PROPERTY OWNER:
Name: Hand, Michael B
Address:
GENERAL CONTRACTOR INFORMATION:
Name: LORE ELECTRICAL CONTRACTORS
, ER13013026
Address: 210 N ROSCOE BLVD QA MICHAEL LEE LORE
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: $94.00
I
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BF!! DING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach, FL 32233
Ph(904)21,7-5826 (904)247-5845 i (.0 - CLC-2 i g
JOB ADDRESS: 3 4 3 Z- PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS f(T-D AMPS 2(4;0 VOLTS I PHASE
VALUE OF WORK$
NEW SERVICE Overhead n Underground T]J Underground up Pole
❑Residential(Main)Service
00-100 amps 0101-150amps 151-200amps amps #of Meters
❑Commercial(Main) Service
00-100 amps 0 101-150amps ❑151-200amps U amps OCT Service amps
Conductor Type Size
El Multi-Family(Main)Service
❑0-100 amps /❑101-150amps ❑151-200amps ❑ amps #of Unit Meters
❑Temporary Pole 51 /CI-Damps
SERVICE UPGRADE ❑ amps LI CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps 0200amps ❑ 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
❑Swimming Pool ! Sign ❑Smoke Detectors Qty ❑Transformers KVA ❑Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
[Replace Burnt/Damaged Meter Can ❑Safety Inspection Panel Change 1011 to UG
❑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.
Property Owners Name AVIA 60' Phone Number
Electrical Company /-7,1/-&—d6-17:4!co-� , J iC. Office Phone223 //t/3 I ax3 7) - .2f/
Co. Address: 2/6 /i gesc O C^ fJ(a 610• City 18C,,6 State 7?'f Zip 32,7z-
_
License Holder(Print): MI Gslid Z. a„t_` Sy e Certification/Registration#
No .,:.,.. ;747-71i–, 'older 7 —,C� �, -
f it ..:.MY XMMISSION t FF 924951 (� 4 f j�
_" ':€ M EXPIRES:October 6,2019 Before me this � day of iti A 0 ` "2
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Banded ThN Notary Pubic Underwriter I Mir'
- Signature of Notary Public i e