320 10th St TEMP19-0016 temp pole permit ELECTRICAL TEMP POLE PERMIT PERMIT NUMBER
'
-�� CITY OF ATLANTIC BEACH
TEMP19-0016
800 SEMINOLE ROAD ISSUED:4/22/2019
T' ATLANTIC BEACH. FL 32233 EXPIRES: 10/19/2019
INSPECTIONMUST CALL •NE LINE (904
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITIONr OF • • • • BUILDING
CODE, AND CITY OF • • 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 maybe found in the public records of this county,and there maybe additional permits required from other
governmental entities such as water management districts,state agencies,or federal agencies.
• : • • r • • • OF • •
32010TH ST ELECTRICAL TEMP POLE TEMP POLE $250.00
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
-CONSTRUCTION: NUMBER: GROUP:
170032 0000 ATLANTIC BEACH
COMPANY: ADDRESS:
IMPULSE ELECTRIC 4271 YVONNE TER MIDDLEBURG FL 32068
• ADDRESS:
BRECHBILL ALAN 479 ENGLISH IVY CT HUMMELSTOWN PA 17036
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 $3500
ELECTRICAL BASE FEE 455-0000-322-1000 0 $5500
STATE GEER SURCHARGE 455-0000.206-07M 0 $200
STATE DCA SURCHARGE 455-0000208-0600 0 $200
TOTAL:$94.00
Issued Date:4/22/2019 1 of 2
' "ALL ON
Electrical Permit Application HIGHLIGHTEDIN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Build inR-Dept@coati.us PERMIT p:
JOB ADDRESS: 320 10th St PROJECT VALUE$250.00
IEA INFORMATION REQUIRED ON ALL PERMITS: inn AMPS Orin VOLTS 1 PHASE
❑NEW SERVICE: C1 Overhead OUnderground OUnderground up Pole
rResidential(Main)Services:
00-100amps 0101-150amps 0151-200amps 13 _amps it of Meters_
OCommercial(Main)Service: ,
00-100amps 13301-150amps 0151-200amps Oamps OCT Service amps
Conductor Type Size
OMUiti-Family(Mein)Service:
M-100 amps 0301-150amps 13151-200amps O amps If of Unit Meters_
Q TEMPORARY POLE: inn amps
❑SERVICE UPGRADE:❑ amps EICT Service_amps
❑ NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.):
Q100amps 13150amps ❑200amps D amps E TService_amps
❑ ADDITIONS,REMODELS, REPAIRS, BUILD-DOTS,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 ,r
Heat Circuits: a circuits @kw
Number of Lighting Outlets, Including Fixtures:
❑OTHER ELECTRICAL PROJECTS:
05wimming Pool❑Sign []Smoke Detectors_City) ❑transformers INA []Motors; HP
FIRE ALARM SYSTEM(Requires 3 sets of plans):
Qty volts/amps
REPAIRS/MISCELLANEOUS:
[]Replace Burnt/Damaged Meter Can []Safety Inspection (Panel Change QOH to UG
I]'Jther. upamee1alr/ia
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 compiled 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: Gh irl 'f Ere 12h II PhoneNumber.
Electrical Company: Imrndcc Pl>rfrir Office Phone: nn91 n-n99F Fax:
Co.Address: A971 Vunnnz,T<rrarc City: bAiArllehurn State: FI Zip: 19AAA
Umnse Holder. R,,Rq Rrnka certification/Registration R: FM gnn7gn7
Notarized Signature ft' Holder.
The foregoing instrument was acknowledged before me this "rdayof p�,20J�in the tate ylId ,/County of i 1 41/
, T,�y ,,,u ...... Signature of Notary
ZZK'[drengad 53dWX3 ;::?A,t }l"' -✓ n `-
et+c31�anol5yyrupo,vl ��$y',y I/Wersonally Known OR I I Produced Identification
/T.i JOI4lU ` '..":nd' Ype of Identification: