1695 Selva Marina Dr (vault) FOR OFFI II E ONLY
DEPARTMENT OF BUILDING Date___ �� -- �9
Permit No._ �✓ Fee $_•-----•-
TOWN OF ATLANTIC BEACH, FLORIDA �cx L—--o
• Valuation $___"")(_033:1:3-
_-'-� - -'—"`--
Application for Permit for House No. ___-_-----------------
• Alterations, --- - -id �7 -
Miscellaneous Altera ___
and Repairs
•_-_-- a/ 14, --- - ----, 11
To the Supervisor hereby Building: / y0�' ..2._e1�mm - ,000
The undersigned hereby applies for permit__ �`- -- �-
-----------------------------
_ etc.; install boiler, elevate, , e
(State if to repair, alter,add to or move building: erect a ing, sign, ..0-0.
-----------.Sub. Div.__ --�-----------
____Block No._____ -
Bullding on.9tate fractional part NO.-_—_ ,
1 r___, 1(01 — and------------------Sts.
At_— Side No. �� St. Between..___
Valuation $_17C7 0 0 f,`" ----- — —--' ""—____"-
(State cost of improvement)
BUILDINGS AND OCCUPANCY 4, ,.,
What is present use of building—Residential or Business?------- ---______----------- -
If residential, what type—Dwelling, Garage Apartment, Apartments or Rooming House? ---- --
------------
___. How many when altered?-------------------- �, .,
How many families accommodated now.— __will food be prepared for sale on premises?___-_ -
- - —---
If business, what type?_ _-------------- - ---
----------------------
What plumbing work to be done? _____Size of lot_______-___________
_Size of extension____—___---------
Size of present building__ __after altered ____ __Material of roof___ ---
Number of stories now -------�---"-"
_____Material of extension__
of present building_____:—_-----------_____ --""--
NECESSARY PLANS IN DUPLICATE TO BE SUBMITTED HEREWITH
OIL BURNER OR GASOLINE EQUIPMENT
Type or Model-------"-----------------------
Name of Oil Burner or Gasoline Pump "_------------------------------------------------
- "gallon capacity tank (s)
Name and Address of Manufacturer____—__--___--- _ _ __________-_____
application is ale made to install:-_`(How many) " ground
In connection herewith, pP -___ gr
_ image metal_- - --- -
(Uua or above)
------ er) — — -
out side)- of building. For-__--------------�game of Purchaser)
----------------_------`-- REVERSE SIDE OF THIS BLANK
(inside or outside) E LAYOUT ON REV
FURNISH DRAWING SHOWING EAR'
SIGNS ______—
--------------------------
-----------
e ground, roof,wall, projecting,banner, special, etc.)
SS1fiCation__ ------` (State whether Bra _
Size---------- -------
construction------------•------------------------------ _ ----
_______"_.Materl _ _
Weight—_ - ________---------------
e illumination______ State whether Lamps or Neon)
-- TYp _ __
Illuminated?--------------------------- --- _ -____----------_____Will sign be over public property?____________LIC
TE SHOWING CONSTRUCTION OF SIGN AND METHOD OF HANGIrG
SUBMIT DRAWING IN DUPLICATE INFORMATION BF�OW .�
WRITE ADDITIONAL INF , a sever _-___
(For canvas awnings provide dim ioned draw:
_ the work as described in the above statement, we hereby agree to perform
ILVIPORTANT NOTICE given for doing part hereof, and hereby
accordance with the
In consideration of permit g plans and specifications, which are a p
said work in accordance with the attached p ---- —- Phone No.----------
building regulations of the Town of Atl t• Beach. --
-- �__ Phone No. -----
Signature of Builder ^—____ Address___------•-- ---__
Signature of Owner ------- -
other • ; bridging
• anchors .._ .-•--- --•----•-
Joists: Wood, grade and species _`sI!_.?- � -��•-�'�, mix _------•..... -- - -•---•-. ; thickness ___--._,,;
Concrete slab: ❑ Basement floor; ❑ first floor; ❑ ground supported; ❑ self-supporting;
membrane ... ---•-- - -
rRin(OrCipg ; insulation _
thickness . „•
Fill under slab: Material — •
7. SUI{PLO011ING: (Describe rnderllooriny lot special Moon wader item 21.) ; else •,type
Material: Grade and species ... 1. X 6. at— " j'2
Laid: 0 First floor; 0 second floor; Q attic
eq. ft.; le diagonal; ❑ right angles.
S. FINISH FLOORING: (Woodenly. Desfribe talker finish flowing ender item 21.)__ _ FINISH,
--
LocAnos Rooms�--- (;,ws Srrttu T11aKNf1n r1'mrlt D,DO. PAres
All 30 ,,, Gaik �� 2 li: She-ua. 8c-Ve,i'a-ts ------
First floor. ...
Second floor. `
Attie floor_ U. ft. .. .-
..
1 . )
rsirPISIISTIALI AC LA•real Ale
■
1
1
- 7 ---
RECE/VED
l ,' 2 1 2000
City
Of6‘Al
t(ant(c Beach
Building and Zoning
N,3
..en
I
;
i
1
1,
i
•
MAP SHOWING BOUNDARY SURVEY OF
LOT 11, BLOCK 6, SELVA MARINA UNIT NO. 5, AS RECORDED IN PLAT BOOK 30, PAGES 29 AND 29A,
OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
RICHARD T. MILLER AND LAURA B.MILLER
STEWART TITLE GUARANTY COMPANY
SUNTRUST BANK,NORTH FLORIDA N.A.
RICHARD R. MOREHEAD,P.A.
GOVERNMENT LOT 6
S 11'56'50" E 150.00' (PLAT)
FOUND 1/2" IRON PIPE S 11'45'33" E 149.37' (MEASURED FOUND 1/2' IRON PIPE
0
NO IDENTIFICATION O ,_w .0"�NO IDENTIFl ON
6,6t 44
1 11/
IP 4• Li,* i
LOT 11 GQ3 0 .�
BLOCK 6
o w
w ,
-I CO .. Q�
W .: W
o M �o
O
LU N I \'• M 6
Q M ��, POOL _ — ZONE AE
J y N l` ZONE X
CO
O
0 0 COVCRED
a ,. PATIO
o ; ' LOT 10
o 23.11 68.11' BLOCK 6
_I
Q w w I ONE STORY Jzz.
a. MASONRY 3 }
O— - POSTED // 1695
r- h
17.11' in 13
To• 'I '� COVERED PORCH 4 ") 0 iY)
Z _ i a0 CO
' 725' 7f,>, r N
26.0'
�> I 111
66- 39.4'
mVl 14 tf":b:::' "Ii.f/Q ..
In
I.,r Y-+4
ec
40' BUILDING RESTRICTION UNE ^r ^r +^'
b 10 n �� ` ' LOVO
POINT OF TANGENCY
FOUND 1/2' IRON PIPE
NO IDENTIFICATION A ri+V of Atlantic Beach
N„ .n.,± ^+.r11nO
°o.
' `�,
4. �. 4.
, uj. af. /
•,2c9•q: F,y Pi, SET 1/^.- NCUAR FFOUND 1/2" IRON PIPE
STAMPED 'ACM Lll 6702' N 11'46'15" W 130.00' (MEASURED) NO IDENTIFICATION
" , CO'0` PONT-40 (es of CURVATURE N 11'56'50" W 130.00' (PLAT)
_i 7�' �,J
SELVA MARINA DRIVE
(100.0' RIGHT OF WAY)
NOTES: ACCEPTED BY:
LEGEND:
R = RADIUS —X— = FENCE
L = LENGTH O = CONCRETE
NOTES: REVISIONS
PLAT N 78.(33._1_°" E
I. BEARINGS ARE BASED ON THE BEARING OF __ ___ ALONG THE
NORTHERLY BOUNDARY LINE OF SUBJECT PARCEL. DATE DESCRIPTION
2. BY GRAPHIC PLOTTING ONLY THE CAPTIONED LANDS LIE WITHIN FLOOD ZONE X AND AE— AS SHIM pN THE
NATIONAL FLOOD INSURANCE MAP DATED APRIL 1 7, 1909, COMMUNITY NUMBER 120075, PANEL 8boi D 2.2 -`Zh) (2( r/F/ci-i r/o,L,
3. THIS SURVEY REFLECTS ALL EASEMENTS & RIGHTS OF WAY AS PER RECORDED PLAT &/OR TITLE COMMITMENT
IF SUPPLIED. UNLESS OTHERWISE STATED, NO OTHER TITLE VERIFICATION IIAS BEEN PERFORMED BY THE UNDERSIGNED.
4. THIS SURVEY NOT VALID 1ITHOUT THE EMBOSSED SEAL OF THE CERTIFYING SURVEYOR.
JOB /I 3320 1 DATE OF FIELD SURVEY: 1-4-98 DISK // ZIP 6 T— SCALE 1" = 30'
A, CERTIFICATE
's. 41es*'`� 'y 923 Peninsular Place, Suite 1
♦♦♦ y �, X � I HEREBY CERTIFY THAT THIS SURVEY WAS MADC UN.^CR MY RESPONSIBLE CIIAIiGC
' • l _g r ',v �� ;r Jacksonville, Florida 32204 AND MCCCS THE MINIMUM TECHNICAL STANDARDS .S '.ET FOR ill UY THE FLORIDA
.,,,nj j! < . I' UOAHD OF HROTISSIONPL SC:VEYORS AND MAPPERS r: CIHAP!LR 61GI 1-r,. ILOIiIUA
(Phone) JD'1-35.1-11'I1
, I C )S Y , ADMINIS 11 IVI1NE CODE. i UHSUANT 10 SUCTION 1 72.072 FLORIDA STATUTES.•`!� (Fu ' JOi 3., 1[�5
uRUE'JinU U ;'Y.iA7o*' MIC:IAEL , AIiLLO
LICLNsco IIU',INFSS p G70:' REGISTERED SURVEYOR AND MIPPER i/ 079 SLUE OF FLORIDA
LAND SURVEYS 0 CONSTRUCTION SURVEYS n clIRfll\ilclrmIc
CITY OF
illkadic Bead's.-4
Office of Building Official
REQUEST FOR INSPECTION ��
— '� /} Permit No.
Date v'� A.M. < ����
Time P.M. i�1. '�
Received / 9.S" \ // /` / C�'�
L. ity Jo' Addres
A /���. 1
Owner's /�/ Contractor
Name pLUM61 i M (i
CONCRETE ELECTRICAL Air Cond.MECHANICA BUILDING Rough Wiring Rough Heating
Framing = Footing - Temp Pole E op • C
Slab Fire Place
Re Roofing Final Sewer
Pre Fab
Insulation Lintel
READY FOR INSPECTION A.M.
Tues. Wed
Thurs. Friday_----
Mon. b A.M.
/ � 7 P.M.
Inspection Made Final Inspection❑ I
Inspector__ Certificate of Occupancy C
Date
CITY OF ATLANTIC BEACH
APPLICATION FOR PLUMBING PERMIT
JOB LOCATION: /U/! 5- �l�y /24,,/,141 ))l
OWNER OF PROPERTY: k<t c tl-c' /)/l/.e f
PLUMBING CONTRACTOR: ,, ?/ ' - ,'
CONTRACTOR'S ADDRESS: 4 2 4/4 5 , 6/4(i7 (, . ,1,7/( iL4
STATE LICENSE NUMBER: TELEPHONE: 2,.. V;7- 6 i 7
HOW MAZY OF THE FOLLOWING FIXTURES INSTALLED
SINKS SHOWERS
LAVATORIES WATER HEATERS
BATH TUBS DISHWASHERS
URINALS DISPOSALS
CLOSETS WASHING MACHINES
FLOOR DRAINS SHOWER PANS
OTHER Sr(-✓t f Repicieer44/7,11-
TOTAL FIXTURES: X 3.50 + $15.00
MINIMUM PERMIT FEE = $25.00
SIGNATURE OF OWNER:
SIGNATURE OF CONTRACTOR:
OF PLUMBING AND FIXTURES MUST BE IN ACCORDANCE WITH THE 1994
STANDARD PLUMBING CODE.
CALL A DAY AHEAD TO SCHEDULE INSPECTIONS - (904) 247-5826
SEWER CONNECTIONS MUST BE CALLED IN TO PUBLIC WORKS FOR INSPECTION PRIOR
TO COVERING UP - (904) 247-5834.
PSR-3844 15794
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
..____ PERMIT INFORMATION - - - -- -
_ - LOCATION INFORMATION ---- -
Permit Number: 15794 "address : 1695 SELVA MARINA DRIVE
ATLANTIC BEACH . FLORIDA 3223
Permit Type: PLUMBING
n .--_-- LEGAL DESCRIPTION - -
ass of Work:ALTERATION
Constr . Type:WOOD FRAME Block : Lot : Twp :
Proposed Use : SINGLE FAMILY Section: 0 Subd:
Rna
Dwellings : 0 ,,,bdivision: SELVA MARINA
Est . Value: 0 .00
Improv . Cost
0 . 00
Total Fees : 25 .00
Amount F ai .; 25 . 0 0
ork t ,,c NT -
- - ----- - OWNER INFORMATI'O'N .- -_- APPLICATION FEES -- -
Name: MILLER PERMIT
Addr : L .s5 SELVA MARINA DRIVE
ATLANT I O EEACIL FLORIDA
Phone! 904 )241-S942
- ----- CONTRACTOR INFORMATION ----- _ --
Narm: R i. PLUME IN•^_-
Addr : 400 1ST STREET UNIT
JACKSONVILLE BEACH , FL 32250
�0
Li c : rF°_ 56_99 g Exp: /
NOTES:
NOTICE - INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION
BUILDING AWAY DEBRIS FROM THIS WORK MUST
EITHER CONTRACTOR OR OWNER
BE PLACED IN PUBLIC SPACE,AND MUST BE
CLEAR ED UP AND HAULED
"FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYING TWICE FOR BUILDING
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW. $25.96 14
Date. 1/28/98 91 Receipt: 0026936
CHECKS 527
69166983221886
ATLANTIC CH BUILDING DEPARTMENT
C,-.) ( i
-f
, ito
CITY OF ATLANTIC BEACH
ROOFING PERMIT APPLICATION
JOB LOCATION: / /5 S/fro /21".%L►'+ ,J
OWNER OF PROPERTY: A://t
CONTRACTOR: S! Oit-C- rt.-1
CONTRACTOR'S ADDRESS: 1(-( ii vt 10,#-
efr 3)-L ,fd
STATE LICENSE NUMBER: CCCOS1/11 ! TELEPHONE 5o -24 f 8 f Z-
DESCRIBE WORK TO BE PERFORMED: Re- /200 /'
a
VALUATION OF PROPOSED CONSTRUCTION _3( d
MATERIALS TO BE USED: -SR•'At f41 fr"O4 (b
SIGNATURE OF OWNER:
SIGNATURE OF CONTRACTOR: 742-A
SWORN TO AND SUBSCRIBED BEFORE ME THIS /3 DAY OF( O , 1
NOTARY PUBLIC
Liability Insurance Supplied
".nor'' Patrida Amonette
t• MY COMMISSION N(x553881 EXPIRE`
Workers Compensation insurance Supplied August 27,2000
��° eoeo�nwmorriw ,a�c,
Contractor License Information Supplied •
Occupational License Information Supplied
PSR 15388
• DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
___... PERMIT INFORMATION ----- LOCATION INFORMATION
Permit SELVA MARINA DRIVE
ePermit Number: 153SR Addre�mss� •. ,, .�?
Permit Type:RE-ROOF ATLANTIC BEACH , FLORIDA 322'
:lass of Work:NEW ----------- LEGAL DESCRIPTION
: Lot :Block: Tip
Constr . Type:WOOD FRAME BBlocon: 0 Subd: Twp
proposed Use: SINGLE FAMILY Subdivision: SELVA MARINA
Dwellings : 0
Est . Value: 0 .00
ImproV , Cost : 3 , 600 . 00
Total Fe F ' 25 . 00
Amount F , 25 . 00
1; + p
RtoCr+ • pT.+po1F
"OWNER INFORMATION - --- - -- ------_ .__ APPLICATION FEES _._ _-___.
. .__. _ PERMIT 25 . 00
Name: MILLER
Addr : i;;95 SELVA MARINA DRIVE ^
ATLANTIC BEACH . FLORIDA 32233
Phone: ` 904 ; 241-e.942
------ CONTRACTOR INFORMATION -
Name: SHORE ROOFING
Addr: 914 7TH AVENUE SOUTH
JACKSONVILLE BEACH , FL 32250
Lie : (7(.(7n',4811 Evp • / /
T- '
.
t
NOTES:
NOTICE - INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION
BUILDING MATERIAL, AND DEBRIS FROM THIS WORK RK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE
CLEARED UP AND HAULED AWAY BY EITHER
"FAILURE TO COMPLY WITH THE MECHANICS' LIEN NG LAW CAN RESULT IMPROVEMENTS IN
THE PROPERTY OWNER PAYING TWICE FOR BUILD
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO Date: 10/13/37 61 Receipt: 0862811 REVOCAj�9 G�
FlQR
VIOLATION OF APPLICABLE PROVISIONS OF LAW. CHECKS
66160663221060
ATLANTIC BEACH BUILDING DEPARTMENT
3
- - �� • CITY OF
• . tkieut cc Feat! - �wteda
800 SEMINOLE ROAD
ATLANTIC BEACH,FLORIDA 32233-5445
TELEPHONE(904)247-5800
` � FAX(904)247-5805
r , SUNCOM 852-5800
May 21, 1996
Mr. Bruce R. McElrath
1695 Selva Marina Drive
Atlantic Beach, FL 32233
Dear Mr. McElrath:
Our records indicate that you are the owner of the following property in the City
of Atlantic Beach, Florida:
Re: 1695 Selva Marina Drive
a/k/a Lot 11, Block 6, Selva Marina Unit 5
RE#171999-0000
Investigation of this property discloses that I have found and determined that you
are in violation of City of Atlantic Beach Ordinance Chapter 12, Section 12-1-3, i.e.,
high grass and weeds.
You are hereby notified that unless the conditions above described are remedied
within five (5) days from the date of your receipt hereof this case will be turned over to
the Code Enforcement Board.
Under Florida Statutes 162.09, the Code Enforcement Board may impose fines
of up to $250.00 per day for a first violation and $500.00 per day for a repeat violation.
Sincerely,
Karl W. Grunewald
Code Enforcement Officer
KWG/pah
cc: Public Safety Director
VIA CERTIFIED MAIL
RETURN RECEIPT REQUESTED
y„i:' CITY OF
t v ; Akieuttie 'ead - 96)14.014
800 SEMINOLE ROAD
ATLANTIC BEACH,FLORIDA 32233-5445
TELEPHONE(904)247-5800
\,1
J + FAX(904)247-5805
.j. SUNCOM 852-5800
May 21, 1996
Mr. Bruce R. McElrath
1695 Selva Marina Drive
Atlantic Beach, FL 32233
Dear Mr. McElrath:
Our records indicate that you are the owner of the following property in the City
of Atlantic Beach, Florida:
Re: 1695 Selva Marina Drive
a/k/a Lot 11, Block 6, Selva Marina Unit 5
RE#171999-0000
Investigation of this property discloses that I have found and determined that you
are in violation of City of Atlantic Beach Ordinance Chapter 12, Section 12-1-3, i.e.,
high grass and weeds.
You are hereby notified that unless the conditions above described are remedied
within five (5) days from the date of your receipt hereof this case will be turned over to
the Code Enforcement Board.
Under Florida Statutes 162.09, the Code Enforcement Board may impose fines
of up to $250.00 per day for a first violation and $500.00 per day for a repeat violation.
Sincerely,
Karl W. Grunewald
Code Enforcement Officer
KWG/pah
cc: Public Safety Director
VIA CERTIFIED MAIL
RETURN RECEIPT REQUESTED
PSR-3844 15590
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
----- PERMIT INFORMATION ----- LOCATION INFORMATION -_. �-___
Permit Number : 15590 `,ddress : 1695 SELVA MARINA DRIVE
ATLANTIC BEACH, FLORIDA 32233
Permit Tyre:MECHANICAL -- ---. ..._ LEGAL DESCRIPTION ---- --__.--
'i ris of Work; ALTEF.ATION -Bl Block : Lot : Twp:
Constr . Type:WOOD FRAME Section: 0 Subd: Rng:
Proposed Use: SINGLE FAMILY Subd±visian:BELVA MARINA
Dwellings :
Est . Value: 0 .00
Irnprov .. Cost : 0 .00
Total F},. 45 .00
7,t r 4c 00
OT.4NER INFORMATION ------ - - - -- - . AFpLICATI ON FEES -- __ . -_ ._
Name . MI LLER PERMIT n
n
Addr : 1695 SELVA MARINA DRIVE
ATLANTIC EEACH -
FLORIDA ?2?
Phone: ' 90? 32 1 Qh''
------ ,';'tiNTRACTif% !I Fs triA J J:'a
Name: THIGPFN HEATING ; COOLING INC
Addr: 4229 N . MAIN STREET
JACKSONVILLE . FL 32206
Lic : RA0018 03 Exp: /
Type:, 3
NOTES:
NOTICE - INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION
BUILDING MATERIAL, BD AWAY AND DEBRIS FROM THIS WORK RK MUST NOT BE PLACED IN PUBLIC SPACE,ANrT 'N
CLEARED UP AND HAUL
ME�rS•1 5
"FAILURE TO COMPLY WITH THE MECHANICS' LIEN NG W 4 oR
THE PROPERTY OWNER PAYING TWICE FOR BUILD To REVq�Aq� F
E
c a+,k
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AN,��®19 +t1 _�-
YLOI.ATION OF APPLICABLE PROVISIONS OF LAW. U= n———
/-a II.. 7_ s�o C . irs ,o0
BUILDING AND ZONING INSPECTION DIVISION
` • CITY OF ATLANTIC BEACH
C� ATLANTIC BEACH. FLORIDA 32233
Peel
APPLICATION FOR MECHANICAL PERMIT CALLIN NUMBER
IMPORTANT — Applicant to complete all items in sections I, II, III. and IV.
I Street Address: 16 c( 5 ->C--e.--()A- M A (2 \ I3 :Ac 0� -
LOCATION
OF Intersecting And
Streets: Between �
BUILDING •
Sub-division SS�_r= V� !19/9/Zl A/
• II. IDENTIFICATION -To be completed by all applicants. •
In consideration of permit given for doing.the work as described in the above statement we hereby agree to perform said work in accordance
with the attached plans and specifications which are a pert hereof and in accordance with the City of Jacksonville ordinances and standards
of good-practice listed therein. I.
Contractors 4C /
Come of Mcchanical 1 Master. 1`7
Contractor (Print) t�}I(, P tV ..,i{ea\N(, ,l'� /._
Name of Owner t btAr f (./A i..7(214 On I t� t''2._ �.5.(,Owner At
I Signature of
Signature of U Architect or Engineer
or Authorised Agent t/✓ _
III. GENERAL INFORMATION
e.
A. Type of Mating fuel: IS OTHER CONSTRUCTION BEING DONE ON
I roc THIS BUILDING OR SITE? N7
• Gas—0 LP 0 Neturel 0 Central Utility '
IF YES, GIVE NUMBER OF•CONSTRUCTION
• Oil PERMIT
O Other.— Specify
IV:MECHANICAL EQUIPMENT TO RE INSTALLED NATURE OF WORK
( Residential or ❑ Commercial
,�
(Provide complete list of components on back of this form) c'!
A Control 0 Floor ❑ New Building
`�• Heat 0 Span' 0 Recessed �
Is) Air Conditioning: 0 Room ,g Control ,P51. Existing Building ' `
Replacement of existing system 1
O Duct System: Material - Thickness
❑ New installation(No system previously Installed),::
Meaimwn capacity — c.f.m.
0 Extension or add-on to existing system
O :Refrigeration ❑ Other— Specify
0."Cooling:tower: Capacity g.p.m.
O fin sprinkler: Number of heady
Q Elevator 0 Menlift 0 Escalator-----(number) , THIS SPACE FOR OFFICE USE ONLY
(Received)
0:.;Gasoline pum (number)
P..,'
:aekc (number) '. Remarks
O
;
LPG containers (number) .
o• Unfired pressure vessel Pirmit Aptro`ro a by .:`
•Q F_Oeilers Permit Foe
,:o..Other — Specify
,.1ST ALL EQUIPMENT
' ,AIR CONDITIONING AND REFRIGERATION EQUIPMENT
: ` .
Number Units Description Model Number Manufacturer C(abd) "s '
1 e.o t..)()t
H r 6 0 Lam'.,,v�v v / ? 7S- v4. .v
4.
HEATING - FURNACES, BOILERS, FIREPLACES Csp�lty
Number Units Description Model Number Maas. (B1'IJ)
/ A./f CB ■ /11‘) --6 5 C.f-rviuC) l 5 kw L '
TANKS
Now Many Nominal Capadt;y Type 1414 Serial Ap�'
ate Dlmsnaiooa Contained .
•