381 5th St temp pole permit YSI
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: 17-ELEC-3603
Job Type: ELECTRIC ONLY
Description: ELECTRICAL-TEMP POLE
Estimated Value: $600.00
Issue Date: 3/28/2017
Expiration Date: 9/24/2017
PROPERTY ADDRESS:
Address: 381 5TH ST
RE Number: 169878-0000
PROPERTY OWNER:
Name: MORRISSEY, MELISSA
Address: 381 5TH ST
GENERAL CONTRACTOR INFORMATION:
Name: HART ELECTRIC COMPANY
,ER 13015151
Address: 11084 Ker Del RD
Phone: 904-219-5896
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: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH 1-7 _ELFT-3 Co0-3
800 Seminole Rd, Atlantic Beach, FL 32233
['TyPh(904)247-5826 Fax(904)247-5845
JOB ADDRESS: - V S_ ' PERMTT#
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE
VALUE OF WORK$ UV
NEW SERVICE L9 Overhead ❑ Underground D Underground up Pole
❑Residential(Main)Service
110-100 amps 0101-150amps 0151-200amps ❑ amps 4 o Meters
❑Commercial(Main) Service
❑0-100 amps E1101-150amps 0151-200amps ❑ amps ❑CTService amps
Conductor Type Sim
❑Multi-Family(Main)Service
00-100 amps �0�Ai 150amps 0151-200amps ❑ amps 4 o Unit Meters
❑TemporaryPole L3A_-_O amps
SERVICE UPGRADE ❑ amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
0100amps 0150amps 0200amps ❑ amps OCT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switchm: 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 -
❑SwimmingPool ❑ Sign ❑Smoke Detectors_Qty ❑Transformers KVA ❑M�rshp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty—volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
❑Replace Bumt/Damaged Meter Can OSafety Inspection []Panel Change ❑OH 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 some to be tme 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 stake or local law regulation construction or the performance of
construction.
Property Owners Name • r11 ,j j15L
V ^�r�rn'� Phone Number /
Electrical Company ��'T /GCf r L l �• OT,,,Ph...
Co.Address: .� City �19C A u //iStateolo_Zip 2 Z
License Holder(Print): - .L Star CLr cat ion/Registration#
NotLau=
ed Sn - older 7
qqFFsearbt Before in �s_ day of
r 6,2019cu'"""""" Signature of Notary Public