283 Belvedere - Temp Pole Permit r CITY OF ATLANTIC BEACH
� v
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: TEMP17-0032
Description: TEMP POLE
Estimated Value: 0
Issue Date: 11/6/2017
Expiration Date: 5/5/2018
PROPERTY ADDRESS:
Address: 283 BELVEDERE ST
RE Number: 170502 0000
PROPERTY OWNER:
Name: FEDERAL NATIONAL MORTGAGE ASSOCIATION
Address: 8950 CYPRESS WATERS BLVD
COPPELL, TX 75019
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: SCHUMAN ELECTRIC INC.
Address: PO BOX 48171 QA 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$7,500.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
'800 Serninole Rd,Atlantic Beach,-FL' 32233.
'`� } Ph(904)247-58261"Fax(90I4)d247-5845 ( EM P 1 -7- 00j S
..,JOB ADDRESS:.......n1 q.3 I�lf'-.�,\a Ac a t �7.T �t"tCi�.-�FC•. .��=PERMIT#
?12Z 3`3
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS�+ VOLTS PHASE
VALUE OF WORK$ 106 _0C
NEW SERVICE ❑ Overhead ❑ Underground ❑J Underground up Pole
❑Residential(Main)Service
00-100 amps 0101-150amps ❑151-200amps ❑ amps #of Meters
❑Commercial(Main)Service
00-100 amps 17101-150amps ❑151-200amps U amps OCT Service amps
Conductor Type Size
❑Multi-Family(Main)Service
❑0-100 amps �50amps F1151-200amps Ll amps #of Unit Meters
lTemporary Pole ❑ amps
SERVICE UPGRADE ❑ amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps ❑200amps ❑ amps OCT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-30amps 31-100amps 101-200ainps
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$
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can F1 Safety Inspection ❑Panel Change ❑OH to UG
❑Other: /` WJL—
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 el (a I'i 0)6 c CAlmles Phone Number AU - < }�- — 6 36 E
Electrical Company dl ucnan EAe_0- t C_ Office Phone '?3 I L1640 Fax 3C, fi
Co.Address: i(� I ( City _ k State L Zip-222Y?
License Holder (Print): cc State Certifieation/Registration#
No'
Molder - -----
:V HOLLY- WALDEN
My coMr�issloN n ccoaaat:rSworn and su scribed before me d
Signature of Notary Public
ay of ,1'�4i21Y3��°Y 20 }
EXPIRES November 25,2020
I
• �L`l
J'
y
Cash Register Receipt Receipt Number
City of Atlantic Beach • • '
DESCRIPTION ACCOUNTCITY PAID
PermitTRAK $94.00
TEMP17-0032 Address: 283 BELVEDERE ST APN: 170502 0000 $94.00
ELECTRICAL $90.00
ELEC TEM P SERVICE 455-0000-322-1000 0 $35.00
ELECTRICAL BASE FEE 1 455-0000-322-1000 0 $55.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0600 0 $2.00
STATE DCA SURCHARGE 1 45500002080700 0 $2.00
TOTAL : 1 $94.00
CITY OF ATLANTIC BEACH
800 SEMINOLE RD
ATLANTIC BEAC,FL 32233
11/06/2017 14:05:54
CREDIT CARD
VISA SALE
Card# XXXXXX WXX8459
SEQ#: 4
Batch#: 478
INVOICE 4
Approval Code: 002494
Entry Method: Maul
Mode: Online
Tax Amount: $0.00
Card Code: N
SALE AMOUNT94,0p
CUSTOMER COPY
Date Paid: Monday, November 06, 2017
Paid By: SCHUMAN ELECTRIC INC.
Cashier: BA
Pay Method: CREDIT CARD 4
//
Printed: Monday,November 06,2017 2:06 PM 1 of 1
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