603 Selva Lakes Cir temp elec permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ELECTRICAL TEMP POLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: TEMPI 7-0003
Description: 60 amp temp pole for 597 Selva Lakes Circle
Estimated Value: 485
Issue Date: 5/16/2017
Expiration Date: 11/12/2017
PROPERTY ADDRESS:
Address: 603 SELVA LAKES CIR
RE Number: 172027 5544
PROPERTY OW NER:
Name: WATTS ANN C
Address: 603 SELVA LAKES CIR
ATLANTIC BEACH, FL 32233-4378
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: BACCK ELECTRIC LLC
Address: P O BOX 6053
JACKSONVILLE, FL 32236
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500.For HVAC work,a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach,FL 32233
Ph(904)247-5826 /Fax(904A)247-5845 TLM Pl ? — C)C)o
1/a3
JOB ADDRESS:. � / I/J(n4 l J/1 e L O PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS _60 AMPS 240 VOLTS 1_PHASE
N¢ed tmpfd li @ ri�✓no�mnrn�mn @ 54-) T,dua. �ulceo CNcQo
VALUE OF WORK$ 485.00
NEW SERVICE ❑ Overhead ❑ Underground IN Underground up Pole
Residential(Main)Service
)(0-100 amps ❑101-150amps ❑151-200ampsamps #of Meters
❑Commercial(Main)Service —
110-100=ps 0101-150amps ❑151-200amps ❑ amps DCT Service amps
Conductor Type S —
❑Malti-Family(Main)Service
❑0-100 amps ❑101-15oamps 0151-200amps 0smps #of Unit Meters
❑Temporary Pole ❑_amps
SERVICE UPGRADE ❑_amps ❑ CT Service—ships
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
0100amps ❑150amps D200amps II—amps ❑CTService—ships
ADDITIONS,REMODELS,REPAIRS,BUHA-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_Qly ❑Tmosformers KVA ❑Motors_hp
FIRE ALARM SYSTEM (Requires 3 sets of plana)
Qty_volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
❑Replace Bumt/Damaged Meter Can ❑Safely Inspection ❑Panel Change ❑OH to UG
❑Other:
Permit becomes wsid ifwmd do not commence within a six month period or work is suspended or abandoned for six months I hereby artily thaz 1 have
read this application and know the same re be We and cermtt All provisions of laws and ordinances goveming this work will be complied wiN whether
specified or not The permit does not give authority to viola the provisions of any other smte or Iocai law regulation constmction or the perfooranee of
construction. `^
Property Owners Name()'l/)'1 �� f l� /1 Phone Number
Electrical Company Bacck Electric LLC Office Phone 904-781-5050 Fair
Co.Address 532 Locust St City Jax State FI Zip 32254
License Holder(Print): a State Certification/Registration# 3Q 04q
Notarized Si nature ajLJcense Holder
"til, KMIBERLY OLMO S inn and subscribed before tpis day Of Y( 20�7
MY rAMMISagN a FFtsaaao n
plass F.w.,,u.zataS gnanae of Notary Publi In
rim
,' 9Cash
Register Receipt Receipt • '•
City
f Atlantic Beach R1562
DESCRIPTION ACCOUNT CITY PAID
PermitTRAK $94.00
TEMP17-0003 Address: 603 SELVA LAKES CIR APN: 172027 5544 $94.00
ELECTRICAL $90.00
ELEC TEMP SERVICE 455-0000-322-1000 0 $35.00
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
STATESURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-06M 0 $2.00
STATE OCASURCHARGE 455-0000-208-0]00 0 $2.00
TOTAL • 4E
Date Paid:Tuesday, May 16, 2017
Paid By: BACCK ELECTRIC LLC
Cashier:CT
Pay Method: CREDIT CARD 118661
Printed:Tuesday,May 16,201712:26 PM 1 of 1