1600 W Park Terr temp pole permit ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph(904)247-5826 Fax (904)247-5845 P 1?- 00 ( 7
.TOB ADDRESS: ov pi pi f 4'-1.errw'e, Ve$cf-- PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS `ZAP AMPS 110 VOLTS _ / PHASE
VALUE OF WORK$ W
NEW SERVICE ❑ Overhead ❑ Underground ❑T Underground up Pole
I)Residential(Main)Service
00-100 amps LI101-I50amps 111151-200amps -1 amps #of Meters
I ICommercial(Main)Service
110-100 amps 01101-150amps r151-200amps amps UCT Service amps
Conductor Type Size
I Multi-Family(Main) Service
VO-100 amps 1.1101-150amps L 1151-200amps 11 amps #of Unit Meters
uTemporary Pole C7 '1D amps
SERVICE UPGRADE _l amps U CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES, ETC.)
11100 amps U 150amps ❑200amps J ____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
1Swimming Pool 11 Sign ❑Smoke Detectors_Qty :Transformers KVA CLMotors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
r]Replace Burnt/Damaged Meter Can L.Safety Inspection I Panel Change f1OH to UG
1 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. r /
Property Owners Name -Dr/44. 4Y1� ��
TMWS Phone Number Cc < g'r O5/7 /2
Electrical Company t`til4 poi 4I 8✓;4/1 titChf i L Office Phone .3U/ 66 g l Fax 3rll6. 36
Co. Address: 3 py S /tuyu‘ 7s.,_ /nil City x State ft Zip 37207
License Holder(Print): —S,44 5C/PA Stat Certification/Registration# tG'OOO 1795
Notarized Signature of License Holder 'ki
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KIRK L.HEDRICK Swo and subscribed before me/thi Z day of G.5+ 20 f7
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�,. •�ttCommission#FF 244831ki d T:1 Signature of Notary Public
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