1253 Selva Marina Cir TEMP20-0015ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach,FL 32233
Ph (904)247-5826 Fax (904)247-5845
JOB ADDRESS:I ~53 ~£LVt1 mow •...'111l c,;r PERMIT #/1-'j~3 f
JEA INFORMATION REQUIRED ON ALL PERMITS 68 AMPS '1yo VOLTS ~PHASE
VALUE OF WORK $[o 0
D Underground D Underground up Pole
o 151-200amps 0 amps #of Meters
o 151-200amps 0 amps OCT Service amp
Size
o 151-200amps 0 amps #of Unit Meters
NEW SERVICE D Overhead
OResidential (Main)Service
00-100 amps 0101-150amps
oCommercial (Main)Service
00-100 amps 0101-150amps
Conductor Type:,-::--.,..--:--=-_oMulti-Family (Main)Service
~~Ol:?:15Q3m~
~pole 0 "!!amps..-l
SERVICE UPGRADE 0 amps o CT Service amps---
NEW FEEDER (ADDITIONS,ACCESSORY STRUCTURES,ETC.)
0100 amps o 150amps 0200amps 0 amps OCT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches:0-30amps 31-l00amps 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
o Swimming Pool 0 Sign o Smoke Detectors _Qty o Transformers KVA OMotors __hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty __volts/amps _VALUE OF WORK $,_
REPAIRSIMISCELLANEOUS
O~place BurntlDamaged Meter Can
~ther:I€h-\f PD/e,oPanel Change OOHto UGoSafetyInspection
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.I hereby certify that I have
-ead this application and know the same to be true and correct.All provisions of laws and ordinances governing this work will be complied with whether
rpecified or not.The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of
:onstruction.
>ropertyOwners Name _
~lectrieal conrnl~pain~y~~.s~'~iegV~~~/IT~£~/~~U~~fy~'~rc~=====:;~:~~~;~~~~l.~~o.Address:_S yr-II/ePt Zip 2 2o~
~~#I?c /1JO$~6y.icense Holder (Print):----'---F-~~'-'--~e...-.--""7""~sc____1~.•.•
[otarized Signature of License Holder ~ra~e~~:::=---------
Signature of Notary Public .--'~~~if-r-##""------------
OWNER:ADDRESS:CITY:STATE:ZIP:
DORMESHIAN ANDREW
COMPANY:ADDRESS:CITY:STATE:ZIP:
STEWART ELECTRICAL
CONTRACTORS, INC.545 NORTH PALMETTO AVENUE GREEN COVE
SPRINGS FL 32043
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1253 SELVA MARINA CIRCLE ELECTRICAL TEMP POLE TEMP POLE $100.00
FEES
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
TOTAL: $94.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
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.
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.
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.
1 of 2Issued Date: 6/4/2020
PERMIT NUMBER
TEMP20-0015
ISSUED: 6/4/2020
EXPIRES: 12/1/2020
ELECTRICAL TEMP POLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 6/4/2020
PERMIT NUMBER
TEMP20-0015
ISSUED: 6/4/2020
EXPIRES: 12/1/2020
ELECTRICAL TEMP POLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $94.00
TEMP20-0015 Address: 1253 SELVA MARINA CIRCLE APN: $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: R12067 $94.00
Printed: Thursday, June 04, 2020 10:09 AM
Date Paid: Thursday, June 04, 2020
Paid By: STEWART ELECTRICAL CONTRACTORS, INC.
Pay Method: CREDIT CARD 334865650
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R12067