745 Amberjack Ln GSRS19-0005 gas permit MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
PERMIT GSRS19-0005
ISSUED: 1/16/2019
CITY OF ATLANTIC BEACH
EXPIRES: 7/15/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT EDITION • OF •
CODE, ' OF BEACH CODEOF • '
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: IEMUM�
bury tank & run
745 AMBERJACK LN MECHANICAL RESIDENTIAL GAS underground line to water $545.54
heater
TYPE OF
ZONING: :D •
• • GROUP:
171197 0000 ROYAL PALMS UNIT 01
• • . ADDRESS:
AEI INTERNATIONAL CORP. 7709 ALTON AVE JACKSONVILLE FL 32211
• ADDRESS:
CLAY REALTY INVESTORS 745 AMBERJACK LN ATLANTIC BEACH FL 32233
INC
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.
CONDITIONSLIST OF
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 45S-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 4S5-0000-208-0600 0 $2.00
TANKS GAS OR LIQUEFIED PETROLEUM 455-0000-322-1000 120 $20.00
Issued Date: 1/16/2019 1 of 2
� y'flf MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
x' PERMIT GSRS19-0005
ISSUED: 1/16/2019
rs>' CITY OF ATLANTIC BEACH EXPIRES: 7/15/2019
VENTED WALL FURNACE WATER HEATER UNIT 455-0000-322-1000 1 $5.00
TOTAL:$84.00
Issued Date:1/16/2019 2 of 2
Mechanical Permit Applicationplication **ALL INFORMATION
Mechanical
AL
IGHLIGHTED IN
City of Atlantic Beach Building Department X=.
800 Semino!e Rd, Atlantic Beach, FL 32233 S —b cx y
Phone: 904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 1, 11 Ci -CC,C0
4 L�-
JOB ADDRESS:I = PROJECT VALUE $ -IIi� _
❑NEW AIR CONDITIONING& HEATING SYSTEM INSTALLATION Af:I#(REQUIRED)
❑Air Handling Equipment Only 0 Condenser Only E3 Air Handling Unit& Condenser
Air Conditioning: Unit Quantity Tons per Unit
Heat: Unit Quantity BTUs per Unit Seer Rating (REQUIRED)
Duct Systems: Total CFM
❑REPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI#(REQUIRED)
❑Air Handling Equipment Only ❑ Condenser Only p Air Handling Unit& Condenser
Air Conditioning: Unit Quantity Tons per Unit
Heat: Unit Quantity BTU's Per Unit Seer Rating(REQUIRED)
Duct Systems: Total CFM
❑FIRE PREVENTION
Fire Sprinkler System Quantity (Requires 3 sets of plans)
Fire Standpipe Quantity (Requires 3 sets of plans)
Underground Fire Main Value (Requires 3 sets of plans)
Fire Hose Cabinets Quantity (Requires 3 sets of plans)
Commercial Hoods Quantity (Requires 3 sets of plans)
Fire Suppression Systems Quantity (Requires 3 sets of plans)
FIRE PLACES r7 MISCELLANEOUS:
Prefabricated Fireplace (Qty) Automobile Lifts
Gas Piping Outlets Boilers BTUs
Elevators/Escalators
❑ALL OTHER GAS PIPING Heat Exchanger
Quantity of Outlets Pumps
#Vented Wall Furnaces Refrigerator Condenser BTUs
#Water Heaters Solar Collection Systems
Tanks (gallons) l 20 aj
Wells
MOTHER: k- 4- ttr,� cx{tr.o� wait Permit becomes 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: '_ 'd-,r—" tx��V � _ _ :��cy.�,��.�� 2 Phone Number
Mechanical Company: i _^ _ -h,.-: Office Phone .'` Fax
Co.Address: ") r%% City: + 1 'State: -fRr,Zip: .' l
License Holder. t`�� JGx•; �t9Yc�-CY)ts ,.a._,,,.. State Certification/Registration#
Notarized Signature of License Holder R-mli
The foregoi instrume it was acknowledged before me thisL�da of C(1ULllZ4 ,20in the State of Florida,
County of \ ),k -
Signature of Notary Public
NolarY State of Ronda
Stephanie
E Carter Personally Known OR [ J Produced Identification
Step
p My Commimon GG 238425 Type of Identification:
ExPaes 0711 e12022
Updated 10/9/18
r
Register
• • � • Receipt b•
y
City
J
of Beach • •
DESCRIPTION
• CITY PAID
PermitTRAK $163.00
GSRS19-0004 Address: 526 ATLANTIC BEACH CT APN: 169505 1410 $79.00
MECHANICAL $75.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
GAS PIPING OUTLETS 455-0000-322-1000 4 $10.00
VENTED WALL FURNACE WATER HEATER 455-0000-322-1000 2 $10.00
UNIT
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 1 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
GSRS19-0005 Address: 745 AMBERJACK LN APN: 171197 0000 $84.00
MECHANICAL $80.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
TANKS GAS OR LIQUEFIED PETROLEUM 455-0000-322-1000 120 $20.00
VENTED WALL FURNACE WATER HEATER 455-0000-322-1000 1 $5.00
UNIT
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
,TOTAL11
CITY OF ATLANTIC BEACH
800 SENINOLE RD
ATLANTIC B=AC,FL 32233
01,16 2019 13:19:11
CREDIT CARD
VISI,SALE
Card XXXXXXXXXXXX2786
SEQ;: 5
Batch ; 772
INVOICE 7
Approval Code: 016034
Entry Method: Maui
Mode: Onlhe
Tax Amount: $0.00
Card Code: M
Date Paid: Wednesday,January 16, 2019 L
Paid By: AEI INTERNATIONAL CORP. SALE AMOUNT $163,
Cashier: BA
Pay Method: CREDIT CARD 7
CUSTOMER COPY
Printed:Wednesday,January 16,2019 1:20 PM 1 of 1
frim
3 rS�`IrIJ
Cash Register
City of Atlantic Beach • • • •
DESCRIPTION • QTY PAID
PermitTRAK $55.00
GSRS19-0005 Address: 745 AMBERJACK LN APN: 171197 0000 $55.00
MECHANICAL GAS FINAL"02/12/2019 RBE $55.00
MECHANICAL GAS FINAL"02/12/2019 RBE 45500003221002 0 $55.00
TOTAL • . $55.00
Date Paid: Tuesday, April 02, 2019
Paid By: AEI INTERNATIONAL CORP.
Cashier: CB
Pay Method: CREDIT CARD 10
Printed:Tuesday,April 02, 2019 3:12 PM 1 of 1
I