130 5TH ST TEMP19-0003 TEMP POLE ELECTRICAL TEMP POLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH TEMP19-0003
800 SEMINOLE ROAD ISSUED: 1/22/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 7/21/2019
MUST CALL INSPECTION • • • 1 PM FOR + INSPECTION.
ALL • ' K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • ' D+ BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL • • OF PERMIT 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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
130 5TH ST ELECTRICAL TEMP POLE TEMP POLE $1000.00
TYPE OF
ZONING: :D •
• • GROUP:
170168 0000 ATLANTIC BEACH
COMPANY: ADDRESS:
INTEGRITY FIRST ELECTRIC JACKSONVILLE
COMPANY 920 8TH AVENUE SOUTH, #D BEACH FL 32250
• ADDRESS:
DIAZ MICHAEL K 1305th ATLANTIC BEACH FL 32233
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
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
ELEC TEMP SERVICE 4SS-0000-322-1000 0 $35.00
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 4SS-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 4SS-0000-208-0600 0 $2.00
TOTAL: $94.00
Issued Date: 1/22/2019 1 of 2
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph(904)247-5826 Fax (904)247-5845 (��
JOB ADDRESS: 190 S -' S' t` I►Po( PERMIT#
JEA INFORMATION REQUIItED ON ALL PERMITS O(-) AMPS Z YO✓VOLTS PHASE
VALUE OF WORK$ /060 °✓
NEW SERVICE Overhead ❑ Underground ❑T Underground up Pole
❑Residential(Main) Service
00-100 amps 1110 1-I 50amps ❑151-200amps LI—amps #of Meters
❑Commercial(Main)Service
❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps OCT Service amps
Conductor Type Size
❑Multi-Family(Main)Service
110-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Unit Meters
Xemporary Pole ❑ 10 U amps
SERVICE UPGRADE []____amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
11100 amps 150amps 0200amps ❑ amps OCT 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$
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can -!Safety Inspection El Panel Change 0O to UG
❑Other: 1--P /Y-\ D 0(9
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 111 YN-L Phone Number
Electrical Company Sn (-rc+,c C Office Phone 7J((o-4,G IJ Fax
Co. Address: 92u () 2fti dst S. City 7,g4K l3GC State t"C Zip f_?2P
License Holder(Print): O 4-c- l vle State Certification/Registration�# LC 19606,W7
Notarized Signature of License Holder
fes' DAM EL,J 601140fore me this —da J'�`� 20 /
MY COMMISSION M FF947977
FX /
4.e ..V: pMs�„ry 05.2M gnature of Notary Public
l� SLA 3 Horb.nou