535 Atlantic Blvd temporary pole permit '�1 CITY OF ATLANTIC BEACH
N
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: TEMP17-0029
Description: 100 amps/120-240 volts/single-phase-temporary pole
Estimated Value: 200
Issue Date: 10/18/2017
Expiration Date: 4/16/2018
PROPERTY ADDRESS:
Address: 535 ATLANTIC BLVD
RE Number: 170684 0000
PROPERTY OWNER:
Name: GATE PETROLEUM COMPANY
Address: 9540 SAN JOSE BLVD
JACKSONVILLE, FL 32257
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: EAGLE ELECTRIC INC.
Address: 149 South St. Andrews Street
JACKSONVILLE, FL 32254
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$7,500.
ELECTRICAL ERMIT APPLICATION'
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax(904) 247-5845 Te W 0- 6_5
JOB ADDRESS: �'5,95 -An f 1 GF/ PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS IDS AMPfa yd VOLTS PHASE
VALUE OF WORK$ ��•�
NEW SERVICE ❑ Overhead ❑ Underground 01 Underground up Pole
Residential(Min) Service
0-100 amps : :101-150amps 151-200amps amps #of Meters
:Commercial(Main)Service
0-100 amps !101-150amps :151-200amps amps 'CT Service amps
Conductor Type Size
Multi-Family(Main)Service
'0-100 amps ;101-150amps 151-200amps amps #of Unit Meters
ATemporary Pole ' _amps
SERVICE UPGRADE amps : CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
100 amps 150amps : 200amps amps '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
Swimming Pool ' : Sign ."Smoke Detectors_Qty :Transformers KVA 'Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRSIMISCELLANEOUS
Replace Burnt/Damaged Meter Can :Safety Inspection Panel Change 'SOH 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 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 (T)Q}P �}e�rz��ll em �� Phone Number 90q 7'37— 79aU
y
Electrical Company L ale- Elee-Iric mr a _ks ij; I to Office Phone_?QV7T�-e)77 Fax 7B6-z//87
Co.Address: /t/23j.And rew-I& Sfree.f S, City kSon y;//,e State Fk Zip 3a25y
License Holder(Print): QArjf!rj State Certification/Registration# EC GYM/7V
Notarized Signature of License Holder
DARIE@f 63.
Sworn and subscribed before me this _day of ��, 20�
f{I�BERi'SON AA l
E
y * MY COMMISSION tFFM186 Signature of Notary Public �hf oo
`/"Y . -CZ
EXPIRES:August 1,2019
'fFua«cls' 86eded Thru 84el Nobry Servim
Cash Register Receipt Receipt Number
City of •
y
DESCRIPTION ACCOUNTQTY PAI D
PermitTRAK $427.13
ELPP17-0035 Address: 535 ATLANTIC BLVD APN: 170684 0000 $333.13
ELECTRICAL $325.00
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
ELEC NEW COMMERCIAL 455-0000-322-1000 1200 $270.00
STATE SURCHARGES $8.13
STATE DBPR SURCHARGE 455-0000-208-0600 0 $4.88
STATE DCA SURCHARGE 45500002080700 0 $3.25
TEMP17-0029 Address: 535 ATLANTIC BLVD APN: 170684 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: R3208 $427.13
CITY OF ATLANTIC BEACH
800 SEMINOLE RD
ATLANTIC BEAC,FL 32233
10/18,2017 15:44:41
CREDIT CARD
VISA SALE
Card XXXXXXXXXXXX1395
SEQ#; 6
Batch : 465
INVOICE 6
Approval Code: 018395
Entry Method: Manual
Mode: Online
Tax Amount: $0,00
Card Code: M
SALE AMOUNT $421,13
Date Paid: Wednesday, October 18, 2017
Paid By: EAGLE ELECTRIC INC. CUSTOMER COPY
Cashier: BA
Pay Method: CREDIT CARD 6
Printed:Wednesday,October 18,2017 3:46 PM 1 of 1 1*4