576 Coastal Oak Ln temp pole permit CITY OF ATLANTIC BEACH
l 800 SEMINOLE ROAD
ii ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
ELECTRICAL PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
IOBINFORMATION:
Job ID: 16-ELEC-2231
Job Type: ELECTRIC ONLY
Description: ELECTRIC -TEMP POLE
Estimated Value:
Issue Date: 10/3/2016
Expiration Date: 4/1/2017
PROPERTY ADDRESS:
Address: 576 COASTAL OAK LN
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: INTEGRITY FIRST ELECTRIC CO
Walter Eugene Haynes, EC13003883
Address: 116 SEAGRAPE DR WALTER HAYNES
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: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach,FL 32233I IW—
JOB
L Ci _ z Z3
n Ph(904)247-5826 Fax(904)247-5845 C
JOB ADDRESS: S 7�0 eoa1k ( Q&k L V� PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS I C' AMPS Z yU VOLTS I PHASE
VALUEOFWOEK$ �� ya
NEW SERVICE ❑ Overhead Underground D Underground up Pole
[Residential(Main)Service
110-100 amps ❑101-150amps ❑151-200amps ❑ amps # of Meters
❑Commercial(Main)Service
❑0-100 amps 0101-150amps ❑151-200amps ❑ amps ECT Service amps
Conductor Type Size
❑Multi-Family(Main)Service
P0-100 amps ❑101-150amps [I151-200amps E1_____—amps #of Unit Meters_
emporary Pole q_100amps
SERVICE UPGRADE []____:amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps 0200amps ❑ amps ❑CT 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 61-100 mps
Heat Circuits: # circuits(a3 kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
[]SwimmingPool ❑ Sign ❑Smoke Detectors_Qty ❑Transformers KVA ❑Motorshp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAHLSIMISCELLANEOUS
❑Replace Bumt/Damaged Meter Can ❑Safety Inspection []Panel Change ❑OHto 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 nor The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of
construction. /s �� �
Property Owners Name Cal%/J'kA k n AILS �0AVtAkt*i� Phone Number
Electrical Company 11-I/ JR%sfyicexf C. Office Phone 2YL' W /J Fax
Co.Address: "o L' I�tK City » R— State JEL—Zip -f2-J"
License Holder(Print): State Certification/Registration#
Not a}EAG '¢areae or
yN' ay CoWISSIONOFK2 l
. ,; EXPIRES',October B,2019 afore mes day 2
s$ ✓ BaMeaiAry ro'2rv.to,6,2019aa
Signature of Notary Public
ATLANTIC BEACH
PERMIT RECEIPT
u �
October 3, 2016
PERMIT DESCRIPTION: ELECTRIC-TEMP POLE C41-
PERMIT NUMBER: 16-ELK-2231
3 iS3
ADDRESS:576 COASTAL OAK LN W "o
OWNER:
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Temporary Electrical Service $35.00
Trade Permit Base Fee $55.00
Totals: $94.00
PAID
OCT 0 3 2016
CITY OF ATLANTIC BEACH