1753 Live Oak Ln TEMP19-0030 r51,Q./r%, ELECTRICAL TEMP POLE PERMIT PERMIT NUMBER
xi �f TEMP19-0030
��...,, s, CITY OF ATLANTIC BEACH
�,� 800 SEMINOLE ROAD ISSUED:
.,4_c).219%- ATLANTIC BEACH. FL 32233 EXPIRES:
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:
1753 LIVE OAK LN ELECTRICAL TEMP POLE TEMP POLE $100.00
TYPE OF i REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172020 0186 SELVA MARINA UNIT 06
COMPANY: ADDRESS: CITY: STATE: ZIP:
TRI COUNTY ELECTRICAL 11637 E COLUMBIA PRK DR JACKSONVILLE FL 32258
OWNER: ADDRESS: i CITY: STATE: ZIP:
SCOTT JOSEPH M 1201 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.
i
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
I
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $94.00
Issued Date: 1 of 2
TEP - CoE(
„„,,,,,,s,), Electrical Permit Application **ALL INFORMATION
fs ilk . HIGHLIGHTED IN
jd City of Atlantic Beach Building D apartment GRAY IS REQUIRED.
oli
800 Seminole Rd, Atlantic Beach, FL 32233 c c s
n—r} Phone: 904 247-5826 Email: BuildingDept@coab.us PERMIT#:
t 1 �- I Co i '7S
JOB ADDRESS: 17753 • L_, V.� OAK ,k el a PROJECT VALUE $ /r")( . (C)
JEA INFORMATION REQUIRED ON ALL PERMITS: AMPS r (I VOLTS / PHASE
�-r
..____`1 NEW SERVICE: 0 Overhead OUnderground OUnderground up Pole
DResidential (Main)Service:
00-100 amps 0101-150amps 0151-2C Oamps 0 amps #of Meters
C]Commercial(Main)Service:
00-100 amps 0101-150amps 0151-2C Oamps 0 amps OCT Service amps
Conductor Type Size
• DMuiti-Family(Main)Service:
t"h_1nn^mnc 101-150amp s ❑151-2CDam s
, -:-- ---------,...�.-_._ p El amps #of Unit Meters
TEMPORARY POLE: CO amps
n SERVICE UPGRADE: ❑ amps [XT Service amps
n NEW FEEDER (ADDITIONS, ACCESSORY STRUCTUI:ES, ETC.):
0100 amps 0150amps D200amps 0 < mps al-Service amps
E ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS,P CCESSORY 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❑Sign ❑.Smoke Detectors -(Qty) ❑Transformers KVA ❑Motors HP
FIRE ALARM SYSTEM (Requires 3 sets of plans):
— Qty volts/amps °
n REPAIRS/MISCELLANEOUS:
Replace Burnt/Damaged Meter Can OSafety In:pection Panel Change DOH to UG
❑ether: Updated 10/17/18
Permit becomes void if work does not commence within a six month perio i orwork 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 provisi ans of laws and ordinances governing this work will be complied with whether
specified or not. The permit does not give authority to violate the provisio is of any other state or local law regulation construction or the performance of
construction.
Owner Name: R. vo.6 r ILyer,.(ei[J Phone Number:
Electrical Company: . (.t /' +y r✓/e(. Con4. /iv- .Office Phone:. -(v(? r'/6(9,9 Fax: v) -`/G3'
Co.Address: 1,(,37 C. .C2 Iv..nyi_ pi i)Y". ity: , }-�Y--- State: 2-- Zip: 32.2--s S
License Holder: k V, eN I.- (A) e .te C-rtification/Registration#:CC1,3Q12.54/. 1
Notarized Signature of License Holder i `-• /•
The foregoing instrument was acknowledged before me this A5 clay .' .4 - 2015, In the State of Florida, County of 3>✓v
.. ._ fL_
" f. Signature of Notary Publi: 4 nvv�
�:?/PRY PGB�.� TAMMY PALL
`,= Notary Public-State of Florida personally Known OR[ ] Produced Identification
" » ` Commission#FF 995425
yrF+OV My Comm.Expires Jul 6,2020 ' Type of Identification:
" Bonded through National Notary Assn,
rT `'rJ�,
��� ri, Receipt Number
Cash Register Receipt p
City of Atlantic Beach R10495
»� V
DESCRIPTION ACCOUNT I QTY PAID
PermitTRAK $94.00
TEMP19-0030 Address: 1753 LIVE OAK LN APN: 172020 0186 $94.00
1 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: R10495 $94.00
Date Paid: Thursday, September 26, 2019
Paid By: TRI COUNTY ELECTRICAL
Cashier: CB
Pay Method: CREDIT CARD 6
Printed:Thursday,September 26,2019 1:28 PM 1 of 1