314 12th Street GSRS23-0056 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
HENDERSON ROBERT
WAYNE 2102 BEACH AVE ATLANTIC BEACH FL 32233-5514
COMPANY:ADDRESS:CITY:STATE:ZIP:
Ideal Gas LLC 3200 Parker Dr St. Augustine Fl 332084
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171924 0000 SELVA MARINA UNIT 01
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
314 12TH ST MECHANICAL RESIDENTIAL GAS
GAS PIPING - 200 GAL
UNDERGROUND TANK & 2
OUTLETS
$1200.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
GAS PIPING OUTLETS 455-0000-322-1000 1 $10.00
MECHANICAL 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
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: 8/18/2023
PERMIT NUMBER
GSRS23-0056
ISSUED: 8/18/2023
EXPIRES: 2/14/2024
MECHANICAL RESIDENTIAL GAS
PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
TANKS GAS OR LIQUEFIED PETROLEUM 455-0000-322-1000 200 $20.00
VENTED WALL FURNACE WATER HEATER UNIT 455-0000-322-1000 1 $5.00
TOTAL: $94.00
2 of 2Issued Date: 8/18/2023
PERMIT NUMBER
GSRS23-0056
ISSUED: 8/18/2023
EXPIRES: 2/14/2024
MECHANICAL RESIDENTIAL GAS
PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $94.00
GSRS23-0056 Address: 314 12TH ST APN: 171924 0000 $94.00
MECHANICAL $90.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
GAS PIPING OUTLETS 455-0000-322-1000 1 $10.00
TANKS GAS OR LIQUEFIED PETROLEUM 455-0000-322-1000 200 $20.00
VENTED WALL FURNACE WATER HEATER
UNIT 455-0000-322-1000 1 $5.00
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: R24358 $94.00
Printed: Friday, August 18, 2023 4:51 PM
Date Paid: Friday, August 18, 2023
Paid By: Ideal Gas LLC
Pay Method: CREDIT CARD 1141684404
1 of 1
Cashier: TG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R24358
GSRS23-0056