0 Seminole Rd TEMP19-0018 ELECTRICAL TEMP POLE PERMIT PERMITNUMBER
CITY OF ATLANTIC BEACH TEMP19-0018
800 SEMINOLE ROAD ISSUED: 5/23/2019
ATLANTIC BEACH.FL 32233 EXPIRES: 11/19/2019
MUST CALL INSPECTION PHONE LINE (904)
14
PM FOR NEXT DAY INSPECTION.
ALL • • • • • • • . .• I r OF • • • •
CODE, BUILDING
AND CITY OF • • OF ORDINANCES .
ALL CONDITIONS OF
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: DESCRIPTION:
354 Seminole Rd-60
0 SEMINOLE RD ELECTRICAL TEMP POLE amps/240 volts/first phase- $800.00
temp pole
TYPE OF BUILDING
r • ZONING: SUBDIVISION:
170428 0020 SALTAIR SEC 02
COMPANY: rr .
EXCEED ELECTRIC, INC. 5290 FLORAL BLUFF COURT JACKSONVILLE FL 32211
• ADDRESS: CITY: STATE: ZIP:
MICROBIAL NATURAL
PRODUCTS INC 1207 SEMINOLE RD ATLANTIC BEACH FL 32233
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-MM-322-1000 0 $35.00
ELECTRICALWEFEE 455-0006322-1000 0 $55.00
STATE D•PR SURCHARGE 455400-20"00 0 $2.00
STATE DCA SURCHARGE 455-0000-2Wr 600 a $200
Issued Date:5/23/2019 1 of 2
ELECTRICAL TEMP POLE PERMIT PERMIT NUMBER
TEMP19-0018
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 5/23/2019
++" y ATLANTIC BEACH, FL 32233 EXPIRES: 11/19/2019
TOTAL:$94.00
Issued Date:5/23/2019 2 of 2
Electrical Permit Application ""ALL INFORMATION t
Application HIGHLIGHTED IN -
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 A �y
Phone: (904) 247-5826 Email: Building-Dept@ccab.us PERMIT#; T6MPIq—w/g
JOB ADDRESS: n Ie /rnRd PROJECTVALUE$ ?00
aD
JFORMA�OREQUIRED QUIIRRE ON AL
EA INPERMITS: AMPS, �VOLTS If PHASE
El NEW SERVICE: ❑Overhead oUnderground ❑Underground up Pole
❑Residential(Main)Service:
oO-100amps ❑101-150amps :151-200amps ❑ amps #of Meters
oCommercial(Main)Service:
00-100amps 0101-150amps o1S1-200amps . damps ❑CTService amps
Conductor Type Size
oMultl-Family(Main)Service:
00-100amps ❑101-150amps :151-200amps ❑ amps #of Unit Meters
TEMPORARY POLE: Lamps
❑ SERVICE UPGRADE: ❑ amps oCT Service amps
❑ NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.):
❑SOOamps ❑150amps ❑200amps Camps ❑CTService_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:
oSwimming Pool ❑Sign oSmoke Detectors (Qty) ❑Transformers KVA oMOlorsHP
❑ FIRE ALARM SYSTEM(Requires 3 sets of plans):
Qty volts/amps
❑ REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can 05afety Inspection DPanel Change 00H to UG
upooreo10/sz/ia
❑Other:
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: lc'ey;i YI/J d Phone Number:
Electrical Company: Exil t1)
//� Office Phone: IOL/ &1n fCq-5 Fax
Co.Address: 5740 F/n�.a�l R rd City: IG.c.1: 5Ar1 yJfl[ state: R—Zip:
License Holder: / J! State Certification/Registration#: EC/M4l
Notarized Signature of License Holder.
The foregoing instrument was acknowledged before me this _day of(� 20 k4lIn the State of Florida,County of V�
•;�:,..',"•, JIENNIrER JONNSTON Signature of Notary Public VT
' MY COMMISSION#aG 012956 ",w
:~ E%PIRES:October 21.W20 ( ] Personally Known OR(q rioducedldentific�tion
autlmurea, iren Type of Identification: F �..�(�y1