1417 BEACH AVE GSRS24-0030 ft..t".'',' _ MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
'� GSRS24-0030
PERMIT ISSUED: 3/22/2024
-'--'101319)/ CITY OF ATLANTIC BEACH EXPIRES: 9/18/2024
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.
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: VALUE OF WORK:
1417 BEACH AVE MECHANICAL RESIDENTIAL GAS GAS PIPING - 4 OUTLETS $5000.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170302 0000 ATLANTIC BEACH
COMPANY: ADDRESS: ; CITY: STATE: ZIP:
Hunter Gas 4770 Sandy Run Ln Jacksonville Fl 32224
OWNER: ADDRESS: CITY: STATE: ZIP:
ROSENBLOOM STEVEN 1417 BEACH AVE ATLANTIC BEACH FL 32233-5733
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.
LIST OF CONDITIONS
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
GAS PIPING OUTLETS 455-0000-322-1000 4 $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
TOTAL: $69.00
Issued Date: 3/22/2024 1 of 2
Mechanical Permit Application **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department
Jt GRAY IS REQUIRED.
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: GS(`S a 30
JOB ADDRESS: t (A,. (2)2_GC_11; '"--N119. ' PROJECT VALUE $ So vo .-
NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI#(REQUIRED)
❑ Air Handling Equipment Only ❑ Condenser Only ❑ 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 ❑ 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 1 set of digital plans)
Fire Standpipe Quantity (Requires 1 set of digital plans)
Underground Fire Main Value (Requires 1 set of digital plans)
Fire Hose Cabinets Quantity (Requires 1 set of digital plans)
Commercial Hoods Quantity (Requires 1 set of digital plans)
Fir uppression Systems Quantity (Requires 1 set of digital plans)
FIRE PLACES MISCELLANEOUS:
Prefabricated Fireplace (Qty) Automobile Lifts
G iping Outlets Boilers BTUs
Elevators/Escalators
ALL OTHER GAS PIPING �� Heat Exchanger
r 2
Quantity of Outlets _l____.:- L Pumps
#Vented Wall Furnaces 5\r'-''j c- Refrigerator Condenser BTUs
# Water Heaters Solar Collection Systems
Tanks (gallons)
Wells
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.
Owner Name: �Cszc" iLa;s�V")11b�;•-A Phone Number: u''-01/4A1 TM
Mechanical Company: \ 'At r- (S N Office Phone: et os-k- r4\--0--Fax
Co. Address: LAT1 c.(tr,\ �l L;,.,,e N. City: 00,Lk�dv.UL State: €- Zip: 3Z.Z Z`k
License Holder: t %\ . State Certification/Registration # / 6Z--3 v? c(-� .
Notarized Signature of License Holder . / ___
The foregoing instrument as acknowledged before me this day • I 1 0 - •t'. 'W in the State of Florida,
County ofd ) ; f
Signature of Notary Public � ._Q / / —`
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' : TONIGINDLESPERGER ` }-Personally Known OR [ ] Produced Identification
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,,t- MY COMMISSION#HH 407122 ype of Identification:
....,o+�,t..- EXPIRES:October 6,2027 Updated 10/11/23