765 Bonitas Rd TEMP21-0018 Temp Pole 1 ELECTRICAL TEMP POLE PERMIT PERMIT NUMBER
q " so TEMP21-0018
4. CITY OF ATLANTIC BEACH
'19- 800 SEMINOLE ROAD ISSUED: 6/15/2021
"40;:»" ATLANTIC BEACH. FL 32233 EXPIRES: 12/12/2021
MUST CALL INSPECTIO 'PHON LINE(904 47-S$1,—;`,'-,'F'M'FOR NEXT D.Y INSPECTION; t.
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: 1 VALUE OF WORK:
100 Amp Temp Pole:
765 BONITA RD ELECTRICAL TEMP POLE INTERIOR REMODEL AND $600.00
ROOF
TYPE OF REAL ESTATE •ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171134 0000 ROYAL PALMS UNIT 01
COMPANY: ADDRESS: CITY: STATE: ZIP:
MCCLURE ELECTRICAL 1521 Inverness Rd Fernandina Beach FL 32034
CONTRACTORS
OWNER: ADDRESS: CITY: STATE: ZIP:
SIENKIEWICZ ROBERT J JR 765 BONITA RD ATLANTIC BEACH FL 32233-4206
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT Ii\
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.
I
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1
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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
Issued Date:6/15/2021 1 of 2
Electrical Permit Application **ALL INFORMATION
�� HIGHLIGHTED IN
-- City of Atlantic Beach Building Department GRAY IS REQUIRED.
i'
j 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:1 YA/T? (-VDI
j L3 '
JOB ADDRESS: —T L ori (� RD PROJECT VALUE $ 6b0 0 0
JEA INFORMATION REQUIRED ON ALL PERMITS: f e 0 AMPS / VOLTS ( PHASE
Er-NEW SERVICE: 74verhead ❑Underground ❑Underground up Pole
uResidential (Main) Service:
❑0-100 amps -101-150amps o151-200amps ❑ amps #of Meters
oCommercial (Main) Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps CT Service amps
Conductor Type Size
❑Multi-Family(Main)Service:
❑0-100 amps o101-150amps o151-200amps ❑ amps It of Unit Meters
1 ./T `
EMPORARY POLE: t 0 c) amps
SERVICE UPGRADE: amps ❑CT Service amps
NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.):
❑100 amps ❑150amps ❑200amps amps CT Service amps
ADDITIONS, REMODELS, REPAIRS, BUILD-OUTS, ACCESSORY STRUCTURES, ETC:
Outlets/Switches: 0-30amps 31-100amps 101-200am ps
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
7 FIRE ALARM SYSTEM (Requires 3 sets of plans):
Qty volts/amps
REPAIRS/MISCELLANEOUS:
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change EON to UG
❑Other: Updated 10/17/18
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. nn
Owner Name: V. c C-& t S r e nJ k', e '►-/ L-7 Phone Number:
Electrical Company: P^`C.L•, >2 e 4-k<cin t b-' Office Phone: (a`{ —Z 3.1 —4-7 0 I Fax:
Co.Address: I SZ 1 Z Nuc.--rt r S S '12D• City: FL-r2NP.-.-0'0-1 A State: ICL Zip: 32.:') a
License Holder: `CL- art St ertification/Registration#: E-ie-soov $8
Notarized Signature of License Holder --
The foregoing instrument was acknowl-•:e• before me this /5 day of J V(V ,20 2 i in the State of Florida,County of
"" ignature of Notary Public 6h-tri �/�
.... ''• CHRISTIAN GILES
ip MY COMMISSION#HH 117153 [ ] Personally Known OR[ roduced Identification
L
u' J/ EXPIRN tarp Pu13,2025 Type of Identification: FL D (,°i(`q" Bonded T1xu Notary Public Underwriters