380 12th St TEMP19-0017 ELECTRICAL TEMP POLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH TEMP19-0017
800 SEMINOLE ROAD ISSUED: 5/8/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 11/4/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT ISTH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPIMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
N C, n add. . n the requirements of this permit,there may be additional restrictions applicable to this property
OT' I "'o to 'equ" FIT 's of t spe
u d ne , Is
that may be found in the publU:record,of this county,and there may be additional permits required from other
P. c. c"
go
�v.mment'l'm ties S., asw
UE at , ..age,
governmental entities such as water management districts,state agencies,or federal agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
380 12TH ST ELECTRICAL TEMP POLE TEMP POLE $0.00
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1719300000 SELVA MARINA LINIT01
COMPANY: ADDRESS: CITY: STATE: ZIP:
T
T& M ELECTRIC INC 200 College DR ORANGEPARK FL 32065
OWNER: ADDRESS: CITY: STATE: ZIP:
PETER &AMY POLLAK 380 12TH ST ATLANTIC BEACH FL 32233-5514
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 ORAN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OFCONDITIONS
Roll off container company must be on City approved list. Container cannot be placed an City right-of-way.
DESCRIPTION ACCOUNT QUANTITY _OUNT
ELEC TEMP SERVICE 455 OOW 322-1000 a
$55M
ELECTRICAL BASE FEE 455-0000 372-1000 0 —
STATE DEIPR SURCHARGE 455 DOUG 208�070D 0 $2.00
STATE FICA SURCHARGE 455 000�208-06(0 0 52M
TOTAL:$94.00
Issued Date:5/8/2019 1 of 2
ELECTRICAL TEMP POLE PERMIT PERMITNUMBER
-0017
TEMP19
CITY OF ATLANTIC BEACH
ISSUED: 5/8/2019
800 SEMINOLE ROAD EXPIRES: 11/4/2019
-)F"E.7-
-7-7� ATLANTIC BEACH. FIL 32233
Issued Date:5/8/2019 2 of 2
yay. 02 .2019 02 :35 PM I & M ELECTRIC 9042767689 PAGE. 1
Electrical Permit Application HALE D
City of Atlantic Beach Building Departm
800 Seminole Rd, Atlantic Beach, FL 32233 bms I C)o I
Phone: (904) 2' 826 Email: Build Ing-Deot@co PERMIT li.
JOB ADDRESS! PROJECT VALUE
JEA INFORMATION REQUIRED ON ALL PERMITS:M2&,AMPS&L VOLTS� 4j&PHASE
300 2,10
NEW SERVICE: 13 Overhead OUnderground E3Underground up Pole
isittesidentlat(Main)Service:
c3fi-100 amps M01-1SOamps 131SI-200amps M.e mps 9 of Meters
ClCommercial (Main)Service;
cio-itioamps 13101-150amps [3151-200amps 11 amps OCTSemIce—ImPs
Conductor Type—Size_
CIMuki-Family(Main)Service:
130-100 amps E3101-150amps [31.51-200amps 171 amps If of Unit Meters
El TEMPORARY POLE: 60 amps
0SERVICE UPGRAOE�D_amps EICT Service_amps
F-1 NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES, ETC.):
[3100amps E3150amps [32008mps 13 amps EXTService—ar`95
ADDITIONS,REMODELS,REPAIRS, BUILD-OUTS,ACCE55ORY STRUCTURES, ETC;
outlets/Switches: ......0-30amps 31-100amps —101�200amps
Appliances: .....0-30amps 31-100amps 101-200amps
A/C Circuits: .61-100amPs
Heat Circuits: —# circuits 0 kw
Number of Lighting Outlets, Including Fixtures;
OTHER ELECTRICAL PROJECTS:
a5vilmming Pool[]Sign Bmoke Detectors_(City) []Transformers.KVA []Motors HP
FIRE ALARM SYSTEM (Requires 3 sets of plans):
city_volts/amps—
REPAIRS/MISCELLANEOUS! 13Safety inspection DPanel Change 0OHtoUG
ORepla ce burnt/DamaFed Meter Can Updated107112
he
ended or—abandoned for hs. i he by dandify that I have
Permit 44 rvr d if work does not commence within a si,month period or work Is su;p �ttmlk2l mmphed with whether
.ad this pPlIcation and know the ame to be true and correct. All proulwom,of law,and ordinances governing thl lit be do
specified or not. The permit does net give authority to violaw the provisions of any other state or local law regulatfon construction or the performance of
vonstluckoo Phone Number;
owner Name: F11;1m)21--aa
Electri0l Company: ffics Phone:MOMMENESORM
State:"f, 'ZIP4111111IM&
W. Co.Address ----- ity
License Holder: Certification/Knistration#:
Notarized Signatum deLicimse Holder
The foregoing instrument was acknowl ged efore me this jf_day of A 20 !nine tate of Florida,County ofLLA.�(
TI—NA L. BURT I ture of Notary Public
state of Nori &-Not ly Puibliol 0 ly Known OR[ I Produced Identification
commi.110 400 06696 .�era.nal
_r.�
FCash Register Receipt Receipt Number
City of Atlantic Beach R8977
DESCRIPTION
PermitTRAK $243.18
ERES1"131 Address: 380 12TH ST APN: 171930 0000 $149.18
ELECTRICAL 114� 2
CTRICALBASEFEE 455-0000-322-1000 00
EI�EC NEW SINGLE FAMILY 455-0000-322-1000 300 $90.00
STATE SURCHARGES $4.18
STATE DBPR SURCHARGE 455�0()00-208-0700 0 t!020
� 5 T T C
STATE DCA SURCHARGE 455-0000-208-0600 0
TEMP19-�0017AI:ldress:390 12TH ST APN: 171930 0000 $94.00
ELECTRICAL $90.00
ELEC TEMP SERVICE 455-0000-322-1000 0 $35.00
ELECTRICAL BASE FEE 455�000-322-1000 0 S5S.00
STATE SURCHARGES $4.00
STATE DERR SURCHARGE 455-0000-208-5700:� $2.00
0
STATE DCA SURCHARGE 455-0000-208-CAM $2.00
TOTAL FEES PAID BY RECEIPT: R9977 $243.18
CITY OF ATLANTIC BEACH
800 SEPINOLE RD
ATLILIMC EAC,F.32233
osiokmq 08:28:21
CREDIT CARD
VISIL W
Card; AUMM2402
SEQ 4: 1
Bad#: 848
INVOICE I
Approval Code: 02446G
bm Hedw: Hall
MA: Online
Tax Arrount: $000
Cud Code: m
SALE AMOUNT V43.18
Date Paid:Wednesday, May 08, 2019
Paid By:T&M ELECTRIC INC CUSTOHER COPY
Cashier: CB
Pay Method: CREDIT CARD I
Printed:Wednesday,May 08,2019 8:29 AM 1 of I