133 Belvedere St temporary pole permit TS y-1T1
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
o' INSPECTION PHONE LINE 247-5814
ELECTRICAL TEMP POLE -
MUST CALL BY4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: TEMP17-0020
Description: 150 amps/240 volts/single-phase-temp pole
Estimated Value: 1000
Issue Date: 9/22/2017
Expiration Date: 3/21/2018
PROPERTY ADDRESS:
Address: 133 BELVEDERE ST
RE Number: 170587 0000
PROPERTY OWNER:
Name: SALT AIR HOMES INC
Address: 228 TALLWOOD RD
JACKSONVILLE BEACH, FL 32250
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: SCHUMAN ELECTRIC INC.
Address: PO BOX 48171 CIA JOHN JASPER SCHUMAN
JACKSONVILLE, FL 32247
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$7,500.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach,FL 32233
rPh(904)247-5826 Fax (904)247-5845
JOB ADDRESS: 133 1.J�-1 V�.de rd PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS I6_�AMPS 210 VOLTS PHASE
VALUE OF WORK$JW0 .C�
NEW SERVICE ❑ Overhead Underground 0Underground up Pole
CResidential(Main)Service
0-100 amps )VOI-150amps ❑151-200amps ❑ amps #of Meters
❑Commercial(Main)Service
00-100 amps C101-150amps ❑151-200amps ❑ amps ❑CTService amps
Conductor Type Size
❑Multi-Family(Main)Service
00-100 amps ❑ 01-150amps 11151-200amps ❑ amps 9 o Unit Meters_
❑Temporary Pole Oamps
SERVICE UPGRADE ❑ amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
0100amps 0150amps 0200amps ❑ amps [ICT 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
[]SwimmingPool ❑ Sign []Smoke Detectors_Qty ClTmnsfouners KVA ❑Motors_hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/AUSCELLANEOUS
❑Replace Bumt/Damaged Meter Can ❑Safety Inspection ❑Panel Change ❑OH to UG
[10ther:
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 prop' iio�ns of any other state or local law regulation construction or the performance of
construction. /� $C1�.� R'//' HOmer +t,G/�
Property Owners Name C_I,-FYYIQr iCQY1 ��QCS is i- ny-s Phone Number;���o'
Electrical Company 6r_hU yyr-n F-16& "[C/ ;EM Office Phone '7,�7-144110Fax 6� 16
Co.Address: O GX �!.� l City C jolt Stater zip A2 47
License Homer(Print): Oh `JG State Certification/Registration# - )��<o8'S1/
Notarized Signature of License Holder
1101.1.1-WALDlN 0171 bscribed before me this day of kar 20 1-J
r'49 My COMMISSION x GGa,,,9 gnature of Notary Public
E%PIRES No_aat 2G .2a30 —
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