835 Atlantic Blvd TEMP19-0014 temporary pole permit ELECTRICAL TEMP POLE PERMIT PERMIT NUMBER
TEMP19-0014
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 4/8/2019
ATLANTIC BEACH, FIL 32233 EXPIRES: 10/6/2019
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:
100 amps/208 volts/single-
835 ATLANTIC BLVD ELECTRICAL TEMP POLE phase-temporary pole for $100.00
car wash
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1776020010 SECTION LAND
COMPANY: ADDRESS: CITY: STATE: ZIP:
MUNSON & BRYAN 3434 ST AUG USTI N E RD JACKSONVILLE FL 32207
ELECTRICAL CO.
OWNER: ADDRESS: CITY: STATE: ZIP:
FEIGLEY LESLIE LYON 724'S WASHINGTON AVE GREENVILLE IVIS 38701-5831
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.
0
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
Issued Date:4/8/2019 1 of 2
ELECTRICAL TEMP POLE PERMIT PERMIT NUMBER
TEMP19-0014
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 4/8/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 10/6/2019
TOTAL:$94.00
Issued Date:4/8/2019 2 of 2
"ALL INFORMATION
Revision Request/Correction to Comments HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: TEMP19-0014
Revision to Issued Permit OR M Corrections to Comments Date:04/3012019
Project Address: 83S Atlantic Blvd
Contra ctor/Conta ct Name: Brad Seelbinder
Contact Phone: (904)396-6689 Email: brad@munsonandbryan.com
Description of Proposed Revision/Corrections:
Please change the voltage from 240 to 208 per JEA's request
I Brad Seelblnder affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
Will proposed revision/corrections add additional square footage to or iginal submittal?
MNo r7 Yes (additional s.f.to be added:
e Will proposed revision/corrections add additional increase in building value to original submittal?
E]No r7*Yes(additional increase in building value:$ )(contractor must sign if increase In valuation)
*Signature of Contractor/Agentr,2-- �������
(Office Use Only)
ElApproved El Denied Not Applicable to Department Permit Fee Due
Revision/Plan Review Comments
Department Review Required:
Building
Planning&Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services updated 10/17118
ELECTRICAL TEMP POLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH TEMP19-0014
800 SEMINOLE ROAD ISSUED: 4/8/2019
EXPIRES: 10/5/2019
ATLANTIC BEACH. FIL 32233
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:
100 amps/240 volts/single-
835 ATLANTIC BLVD ELECTRICAL TEMP POLE phase-temporary pole for $100.00
car wash
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1776020010 SECTION LAND
ZIP:
COMPANY: ADDRESS: CITY: STATE:
MUNSON & BRYAN 3434 ST AUGUSTINE RD JACKSONVILLE I'L 32207
ELECTRICAL CO.
OWNER: ADDRESS: CITY: STATE: ZIP:
FEIGLEY LESLIE LYON 724 S WASH I NGTON AVE GREENVILLE IVIS 38701-5831
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 A 0 NT
ELEC TEMP SERVICE 455-0000-322-1000 0 $3S.00
ELECTRICAL BASE FEE 4S5-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 45S-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 4SS-0000-208-0600 0 $2.00
Issued Date:4/8/2019 1 of 2
PERMIT NUMBER
ELECTRICAL TEMP POLE PERMIT
CITY OF ATLANTIC BEACH TEMP19-0014
ISSUED: 4/8/2019
800 SEMINOLE ROAD
ATLANTIC BEACH. FL 32233 EXPIRES: 10/5/2019
TOTAL: $94.00
Issued Date:4/8/2019 2 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 T&P4,P
Phone: (904) 247-5826 Email: Building-Deptftcoab.us PERMIT#:
JOB ADDRESS: 835 Atlantic Blvd PROJECT VALUE S. $100-00
JEA INFORMATION REQUIRED ON ALL PERMITS: 100 AMPS 240 VOLTS 1 PHASE
El NEW SERVICE: El Overhead OUnderground []Underground up Pole
Mesidential(Main)Service:
00-100 amps 0101-150amps [3151-200amps []_amps #of Meters
ElCommercial(Main)Service:
[10-100 amps 171101-150amps [1151-200amps 0-amps OCT Service amps
ConductorType Size
[3Multi-Family(Main)Service:
EID-100 amps 0101-150amps 0151-200amps O_amps #of Unit Meters
ED TEMPORARY POLE: 100 amps
0 SERVICE UPGRADE: El_amps EICT Service_amps
F-1 NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES, ETC.):
[]100 amps [3150amps []200amps 0—amps OCT Service_amps
El 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 E]Sign []Smoke Detectors--- - (Qty) OTransfornw4-&— WVA DWton HP
FIRE ALARM SYSTEM (Requires 3 sets of plans):
C.ty volts/amps
F—]REPAIRS/MISCELLANEOUS:
E]Replace Burnt/Damaged Meter Can OSafety Inspection OPanel C.hange E]OH to UG Updoted 10/17118
EI)t h e r:
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: Feigley Leslie Lyon Phone Number:
Electrical Company: Munson and Bryan Electric Co Inc Office Phone: (904)396-CM9 Fax:
Co.Address: 3434 St Augustine Road Citv: Jacksonville State: FIL Zip: 32207
License Holder: John Sciolino 11) �Z State Certification/Registration#: EC-00001795
Notarized 5ignature of License Holder
The foregoing instrument was acknowle Zged before me this d a y�o f .20aiintftest e of Florida,County of
........ KIRK L.HEDRICK Signature of Notary Public
rC-XA Cornrnission#FF 244831
Expires July 7,2019 Poersonally Known OR Produced Identification
B-rAW Thn�Tncy Fain bsw�SDO-3845,7019 kype of Identification:
Cash Register Receipt Receipt Number
City of Atlantic Beach R8685
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $94.00
TEMP19-0014 Address: 835 ATLANTIC BLVD APN: 177602 0010 $94.00
ELECTRICAL $90.00
ELEC TEMP SERVICE 455-0000-322-1000 0 $35.00
ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R8685 $94.00
Date Paid: Monday, April 08, 2019
Paid By: MUNSON & BRYAN ELECTRICAL CO.
Cashier: CT
Pay Method: CREDIT CARD 45884G
Printed: Monday,April 08,2019 2:28 PM 1 of 1