825 SHERRY DR - TEMP POLE \s ri l;.1�yi'10
i �� CITY OF ATLANTIC BEACH
Ss� 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: TEMP17-0011
Description: TEMP POLE
Estimated Value: 0
Issue Date: 7/25/2017
Expiration Date: 1/21/2018
PROPERTY ADDRESS:
Address: 825 SHERRY DR
RE Number: 169983 0000
PROPERTY OWNER:
Name: GRAY ADAM R
Address: 826 9TH AVE N
JACKSONVILLE BEACH, FL 32250
GENERAL CONTRACTOR INFORMATION:
Name:
IAddress:
Phone:
Name: OWEN ELECTRIC CO INC
Address: 1775 LAKESIDE AVE QA MICKY GERALD OWEN
ST.AUGUSTINE, FL 32084
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TORR TWICE RD A TICE C OF
COMMENCEMENT MAY RESULT IN YOU ENG
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED YOPOSTED ENDO O N THE
JOBN
SITE BEFORE THE FIRST INSPECTION. IF
FINANCING, CONSULT WITH YOUR LENDER O AN
ATTORNEY
BEFORE RECORDING YOUR NOTICE OF
* 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$7,500.
ELECTRICAL PERMIT APPLICATION kt(tv.,,,« 3,..,Id'"5 Pt,''"+
CITY OF ATLANTIC BEACH No. RES 17 - 0o'3
800 Seminole Rd, Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904)247-5845 TEM
Cm P1 7 - 001 (
JOB ADDRESS: 8 2 5 S h w e'y O.-. A l-1 c-R he- 3Ca c.4, Ft_ 32-233 PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS I do AMPS 2-14' VOLTS i. PHASE
VALUE OF WORK$ 50O
NEW SERVICE ❑ Overhead ❑ Underground ❑1 Underground up Pole
Residential (Main)Service
I 0-100 amps I 101-150amps I 151-200amps _._ amps #of Meters
Commercial(Main)Service
I '0-100 amps i l 01-150amps i 15 I-200amps amps CCT Service amps
Conductor Type Size
Multi-Family(Main)Service
) 0-100 amps I 101-150amps 151-200amps I ' amps #of Unit Meters
IlTemporary Pole I✓ 10 0 amps
SERVICE UPGRADE I amps I : CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
I 100 amps l 150amps 1200amps I . amps I :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 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
L_LSwimming Pool .J Sign H Smoke Detectors Qty _::Transformers KVA iMotors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps_ VALUE OF WORK$
REPAIRS/MISCELLANEOUS
I Replace Burnt/Damaged Meter Can L.Safety Inspection _]Panel Change L. to UG
LI 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 Acca.+, 6.-0.y Phone Number cloy- 562 - 2 9 39
Electrical Company Owen C h. LO,b^po >y Inc_ Offic, P'o . 5H-92Y-(15-10 Fax*Li-S26-1 SER
Co. Address: 1 775 L-akes,d� Ave. r City • } ''µ•tAsI-ine: State FL Zip 3208`1
License Holder (Print): t t_k Cr. O en b. State C-rtifi ' ion,'Registration# Et.0060g6 3
'1.- ••1\"1
Notariz .!._i nature of License Holder �'"� \ 'AA C \
y � � 2017
'��'"iSF. °��•� t+rn and subscribed efore e this / a f T
,.: ,. :.L MY COMMISSION i FF 077574 \ ,
i '•T71��ias EXPIRES:Dece,nN nd Pr) nature of Notary Public (
R
t Number
Cash Register Receipt Receipt
City of Atlantic Beach R2104
DESCRIPTION I ACCOUNT I QTY I PAID
PermitTRAK $223.00
ERES17-0075 Address: 825 SHERRY DR APN: 169983 0000 $129.00
ELECTRICAL $125.00
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
ELEC NEW SINGLE FAMILY 455-0000-322-1000 200 $70.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0600 0 $2.00
STATE DCA SURCHARGE 45500002080700 0 $2.00
TEMP17-0011 Address: 825 SHERRY DR APN: 169983 0000 $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
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0600 0 $2.00
STATE DCA SURCHARGE 45500002080700 0 $2.00
TOTAL FEES PAID BY RECEIPT: R2104 $223.00
Date Paid:Tuesday,July 25, 2017
Paid By:ADAM GRAY
Cashier: CT
Pay Method: CREDIT CARD 046308
Printed:Tuesday,July 25,2017 4:50 PM 1 of 1
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