1132 BEACH AVE - TEMP POLE S' tv/ J / \ ELECTRICAL TEMP POLE PERMIT PERMIT NUMBER
"'%. \ CITY OF ATLANTIC BEACH TEMP19-0006
o1� s
800 SEMINOLE ROAD ISSUED: 2/5/2019
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''EJ'`'" ATLANTIC BEACH. FL 32233 EXPIRES: 8/4/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
4 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.
1 JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
1132 BEACH AVE ELECTRICAL TEMP POLE TEMP POLE $100.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170279 0000 ATLANTIC BEACH
1 COMPANY: ADDRESS: CITY: STATE: ZIP:
CURRENT ELECTRICAL 11787 WORDSWORTH CT JACKSONVILLE FL 32223
CONTRACTORS
OWNER: ADDRESS: CITY: STATE: ZIP:
MOMS BEACH HOUSE LLC C/O SUSAN WEED MEMBER BRUSSELS BELGIUM
1200
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 •
L.
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 $35.00
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: $94.00
Issued Date: 2/5/2019 1 of 2
,STL�,� Electrical Permit Application **ALL INFORMATION
HIGHLIGHTED IN
Al 0 City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 -i r'h.�'�� - UCO
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: / "8-03b7
JOB ADDRESS: t I .2,2_ Ave, l PF-p. PROJECT VALUE$ 102, •°'°
JEA INFORMATION REQUIRED ON ALL PERMITS: (o 0 AMPS ?BYO VOLTS I PHASE
❑r NEW SERVICE: ❑ Overhead oUnderground oUnderground up Pole
oResidential(Main)Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps #of Meters
❑Commercial (Main)Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps ❑CT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps #of Unit Meters
TEMPORARY POLE: �Q b amps
/❑ SERVICE UPGRADE: o amps nCT Service amps
❑ NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES, ETC.):
❑100 amps n150amps o200amps o 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:
nSwimming Pool ❑Sign ❑Smoke Detectors (Qty) ❑Transformers KVA ❑Motors HP
n FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
n REPAIRS/MISCELLANEOUS:
oReplace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change DOH to UG
❑Other: 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.
Owner Name: MAR.t- N 'L-3-Nv4-4"4. Phone Number: ' O`k $`1l•'70SO
Electrical Company: CO n-1- e(at,4 it c,w(, Co,-. ffice Phone: 9a-1-7a4- ere ti3 Fax:
Co.Address: 117€7 t)O,&t st,Jpn-kL CT• City: ,1 f ILSs rt1e, State: FL- Zip: 32.2.2-3,
License Holder: M�An.a� N e-���v mei( State Certification/Registration#: L'225-69g
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this day of 1 '° I in the St to of Florida,County of
TONIGiNDLESPERGER Sig ture of Notary Public
My COMMISSION#FF 924951
- EXPIRES:October 6,2019 ] -rsonally Known OR[ ] Produced Identification
;' ` Bonded Thru hoary Public tlrdenrt'•
:: of Identification: