332 4TH ST - TEMP POLE ,r .:',
, ,r�� ELECTRICAL TEMP POLE PERMIT PERMIT NUMBER
,Ar:
CITY OF ATLANTIC BEACH TEMP19-0005
op ISSUED: 1/30/2019
800 SEMINOLE ROAD
`=m'`'%- ATLANTIC BEACH. FL 32233 EXPIRES: 7/29/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS 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:
332 4TH ST ELECTRICAL TEMP POLE TEMP POLE $200.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169816 0000 ATLANTIC BEACH
1 COMPANY: ADDRESS: CITY: STATE: ZIP:
PHASE ONE ELECTRIC LLC 2076 CORONA CT JACKSONVILLE FL 32224
OWNER: I ADDRESS: CITY: STATE: ZIP:
JOOST STEPHEN 10743 WAVERLY BLUFF WAY JACKSONVILLE FL 32223
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 company must be on City approved list. Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
ELEC TEMP SERVICE 455-0000-322-1000 0 535.00
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$94.00
Issued Date: 1/30/2019 1 of 2
Electrical Permit Application **ALL INFORMATION
�� HIGHLIGHTED IN
•
City of Atlantic Beach Building Department GRAY IS REQUIRED.
// 800 Seminole Rd, Atlantic Beach, FL 32233 , -CLOG
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 33.D 1
1- PROJECT VALUE $ r,Y —
JEA INFORMATION REQUIRED ON ALL PERMITS: G0 AMPS ! C) VOLTS / PHASE
NEW SERVICE: Overhead !Underground 'Underground up Pole
Residential (Main) Service:
0-100 amps : 1101-150amps o151-200amps amps #of Meters
Commercial (Main) Service:
0-100 amps 101-150amps :_1151-200amps amps CT Service amps
Conductor Type Size
: 'Multi-Family(Main)Service:
10-100 amps 0/101-150amps ;151-200amps _ amps #of Unit Meters
TEMPORARY POLE: (. O amps
SERVICE UPGRADE: ❑ amps oCT Service amps
NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
ri100 amps i150amps .200amps amps CT Service amps
ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,ACCESSORY STRUCTURES, ETC:
Outlets/Switches: 0-30am ps 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:
I OTHER ELECTRICAL PROJECTS:
'Swimming Pool oSign oSmoke Detectors_ (Qty) ❑Transformers KVA riMotors HP
1-1 FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty—_ volts/amps
[ I REPAIRS/MISCELLANEOUS:
( 'Replace Burnt/Damaged Meter Can oSafety Inspection nPanel Change ❑OH to UG
'lOther: updated 10/17/18
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. 5+e.01e.0 c+ Oy 3-01 .
Owner Name: !'� �O,T Phone Number: ��ii 'TOS
Electrical Company: ?�'lt,5c. 6(le C (e,C1'c� c• 1�L. C Office Phone: (IO�'o�.3�}' .W1�LJ7 Fax:
Co.Address: c)0/ 6 c 6c t5 r'r\, (_4 City: 5a K State: PL Zip: .2-2-1-141
License Holder: /✓l;Cl' J L:n c C��� St�e Certificatio Registration#: EC r;00.5 i
Notarized Signature of License Holder �vC cam,
The foregoing instrument was acknowledged before me this ay o in the State of Florida,County of
Signature of Notary Public 6:k ✓ T�
"P TONT GINDLESPF-RGER
esx. MYCOMMISSIONtlF924951 [ ) Personally Known OR[ ] Produced Identi tcatio
LS 8 ( - �z4 -�
EXPIRES:October 6,2019 Type of Identification:
'�•,'',•4 Bonded- �'° d Thru rw:a:Y Public Underwriters
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