353 355 2nd St temporary pole permit CITY OF ATLANTIC BEACH
s> 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ELECTRICAL TEMP POLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: TEMP17-0036
Description: 100 amps/240 volts/single-phase temp pole
Estimated Value: 0
Issue Date: 12/28/2017
Expiration Date: 6/26/2018
PROPERTY ADDRESS:
Address: 353 355 2ND ST
RE Number: 169786 0000
PROPERTY OWNER:
Name: JOHNSON JOANN
Address: 181 PROCTORS PURCHASE RD
HARTLY, DE 19953
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: AMERICAN ELECTRICAL CONTRACTOR
Address: 5065 ST AUGUSTINE RD APT 13 5065 ST. AUGUSTINE RD#13
JACKSONVILLE, FL 32207
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU 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.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
ELECTRICAL PERMIT APPLICATION
CITY OP A-F'i,.A.NTlr'GFA(-"
800 Seminole Rd, Atlantic Beach, FL 32233 -Tb NIP I '+ — oD�
. �C G-� l I,P,h (904) 247-58+26 Fax (904)247-5845 � S
JOB ADDRESS. _ J d S ! PERMIT# -�Z
JEA INFORMATION REQUIRED ON ALL PERMITS /00 AMPS 240VOLTS PHASE
VALUE OF WORKS
NEW SERVICE `6 Overhead ❑ Underground ❑T Underground up Pole
L.Residential(Main) Service
10-100 amps r 101-150amps 1151-200amps I amps #of Meters
I_:Commercial(Main)Service
L'0-100 amps 1. 101-150amps 1. 151-200amps [ ._amps L I CT Service amps
Conductor Type Size
PMulti-Family(Main)Service
,1i1-110 amps F 101-150amps 151-200amps :I amps #of Unit Meters
Temporary Pole amps
SERVICE UPGRADE C amps L- CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
L 100 amps 2150amps L'200amps l amps CCT Service 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 �iDkw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
L Swimming Pool Sign ;Smoke Detectors_Qty -Transformers KVA U Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK S
REPAIRS/MISCELLANEOUS
I IReplace Burnt/Damaged Meter Can Safety Inspection LPanel Change JOH to UG
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.
Property Owners Name o ���S ( C Phone Number
Electrical Company AMLY( CG( n 'G l 6C,-�—k C-Ck- Office Phone-T3 - 77 ^Fax- -
Co.Address:�� - 1/1 G( . City States t_ Zip 327C �
License Holder (Print): Cl 1 ertification/Registration#ecl 3001 I-)(I
Notarized Signature of License Holder
S orn and subscribed before me this ed�?'—`'' da of �FCl MF-e— 20 1r7
PAUL R BAGGY � y
MYCOMMISSION#FFt7038
a gnat-Lire of Notary Public
EXPIRES January 23.2019 �
(407)3%-0t5a FlorltleNota tiennce.com
s
> Cash Register ' Receipt Num • -
City r�
of Beach R37•
DESCRIPTION • QTY PAID
PermitTRAK $94.00
TEMP17-0036 Address: 353 S5: =._- = APN: 169786 0000 $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 455-0000-208-0600 0 $2.00
STATE DCA SURCHARGE 45500002080700 0 $2.00
'TOTAL FEES PAID BY RECEIPT: . , $94.00
Date Paid:Thursday, December 28, 2017
Paid By: AMERICAN ELECTRICAL CONTRACTOR
Cashier: BA
Pay Method: CREDIT CARD 3
Printed:Thursday,December 28,2017 10:24 AM 1 of 1 T
TPAW