278 Seminole TEMP18-0040 ELECTRICAL TEMP POLE PERMIT PERMITNUMBER
CITY OF ATLANTIC BEACH TEMP18-0040
800 SEMINOLE ROAD ISSUED:
ATLANTIC BEACH. FL 32233 EXPIRES:
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
CODE, NEC, IPIVIC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF APPLY, PLEASE READ CAREFULLY.
NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
that may be found in the public records of this county,and there may be additional permits required from other
governmental entities such as water management districts,state agencies,or federal agencies.
JOBADDRESS: PERMITTYPE: DESCRIPTION: VALUE OF WORK:
278 SEMINOLE RD ELECTRICAL TEMP POLE 200 Amp 240 Volt Temp Pole $1000.00
TYPE OF LESTATE • BUILDINGSUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170512 0000 SALTAIR SEC 01
COMPANY: ADDRESS:
Atlantic Coast Electrical P.O. BOX 272 HILLIARD FL 32046
Contractors, I
• ADDRESS:
LAGNER JENNIFER A 278 SEMINOLE RD ATLANTIC BEACH FL 32233-4143
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR 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.
LIST OF CONDITIONS
Roll off container tympany must be on City approved list. Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAIDAMOUNT
ELEC TEMP SERVICE 455-0000-322-1000 0 $35.00
ELECTRICAL BASE EEE 455-0000-322-1000 0 $55.00
STATE DEER SURCHARGE 455-0000-2080700 0 $200
STATEDCASURCHARGE 455-0000-208-0600 0 $2A0
TOTAL:$94.00
Issued Date: 1 of 2
ELECTRICAL TEMP POLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH TEMP18-0040
800 SEMINOLE ROAD ISSUED:
ATLANTIC BEACH. FL 32233 EXPIRES:
Issued Date: 2 of 2
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach,FL 32233 ([
` Ph(904)247-5826 Fax(90247-5845 ( r's ' 0d-[ c)
JOB ADDRESS: 7 �)vl� I PL OL e PERMrr#ReS 'T -0-3d(
JEA INFORMATION REQUIRED ON ALL PERMITS tJ-00 AMPS 1 40 VOLTS PHASE
�, `VALUE OF WOR%$ 10—
t'
NEW SERVICE ❑ Overhead underground [�Knderground up Pole
❑Residential(Main)Service
❑0-100 amps 0101-15(hmps ❑151-200amps ❑ amps of Meters
❑Commercial(Main)Service
❑0-100 amps 11101-150amps ❑151-200amps ❑ amps OCT Service amps
Conductor Type Sim
❑Multi-Family(Main)Service
❑0-100 amps ❑101-150amps - ❑151-200amps ❑ amps #of Unit Meters
DTemporary Pole 0_1_6 amps
SERVICE UPGRADE ❑ amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps 0200amps ❑ amps OCT Service amps
ADDITIONS,REMODELS,REPAIRS,BUHA-OUTS,ACCESSORY STRUCTURES,ETC.
Outleta/Switches: 0-30amps 31-100amps 101-200amps
Appliances: 0-30amps 31-100amps 101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits Q kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
❑Swimming Pool ❑ Sign ❑Smoke Detectors_Qty ❑Transformers KVA ❑Motorshp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRSMSCELLANEOUS
❑Replace Bumt/Damaged Meter Can []Safety Inspection ❑Panel Change ❑OH 10 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
consWction. rr��
Property Owners Name G,4 6d esZ , Senn t/t/t YT- Phone Number
Electrical Company /tT/-A41 r1C GO ftcV � 2c • Office�Plloney°r{ 1/p--9 /1' Fax
Co.Address: - City State Zip 3 /�o
License Holder(Print): p c ( m r State Certification/Registration#
Notarized Signature of License Holder I
R'="E)SCRES;8.pWftu5
M Sworn and subscr bed befo a thi#GG2=lder5,2023 Signature of Notary Publ6c0ala+mea