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1760 Selva Marina Dr (vault) 4313 DEPARTMENT OF BUILDING CITY OF ATLANTIC BEACH PERMIT INFORMATION - LOCATION INFORMATION Permit Number: 4313 %ddress: 1760 SELVA MARINA DRIVE Permit Type: ELECTRICAL ATLANTIC BEACH, FLORIDA 32233 Class of Work : ADDITION ---- LEGAL DESCRIPTION Constr. Type: WOOD FRAME Lot : Block: Section : Proposed Use: SINGLE FAMILY Township: RNG: 0 Dwellings: 1 Code: 0 Subdivision: SELVA MARINA Estimated Value: $0. 00 Improv. Cost : $0. 00 Total Fees: $16. 20 Amount Paid : $16. 20 Date Paid : 9/10/91 Work Desc. : INSTALL OUTLETS, RECEPTACLES AND SWITCHES - - - - - OWNER INFORMATION —-- APPLICATION FEES --- Name: HESSION PERMIT $16. 20 Address : 1760 SELVA MARINA DRIVE WATER IMPACT FEE $0. 00 ATLANTIC BEACH, FLORIDA 32233 SEWER IMPACT FEE $0. 00 Phone: (904)399- :-,050 WATER METER $0. 00 RADON GAS-H. R. S. $0. 00 CONTRACTOR INFORMATION RADON GAS - 57. $0. 00 Name: ALL SERVICE ELECTRIC OF JAX WATER TAP $0. 00 Address: P. O. BOX 16694 SEWER TAP $0. 00 JACKSONVILLE, FL 32245-6694 HYDRAULIC SHARE $0. 00 License: Type: 0 RE-INSPECT FEE $0. 00 SEC. H IMPACT FEE $0. 00 OTHER $0. NOTES: NOTICE —ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER "FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS." ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. ATLANTIC BEACH BUILDING DEPARTMENT By: fr 4300 DEPARTMENT OF BUILDING CITY OF ATLANTIC BEACH PERMIT INFORMATION -- — - LOCATION INFORMATION Permit Number: 4300 Address: 1760 SELVA MARINA DRIVE Permit Type: BUILDING ATLANTIC BEACH, FLORIDA Class of Work: ALTERATION LEGAL DESCRIPTION Constr. Type: WOOD FRAME Lot : 9 Block: 9 Section: Proposed Use: SINGLE FAMILY Township: RNG: 0 Dwellings: 1 Code: 0 Subdivision: SELVA MARINA UNIT 5 Estimated Value: $10586. 00 Improv. Cost : $0. 00 Total Fees: $97. 50 Amount Paid : $97. 50 Date Paid : 9/ 4/91 Work Desc. : CONSTRUCT IMPROVEMENTS F PLANS - - -- OWNER INFORMATION --- APPLICATION FEES Name: LAURA HESSION PERMIT $97. 50 Address: 1760 SELVA MARINA DRIVE WATER IMPACT FEE $0. 00 ATLANTIC BEACH, FLORIDA 37 SEWER IMPACT FEE $0. 00 Phone: ) - WATER METER $0. 00 RADON GAS-H. R. S. $0. 00 - —-— CONTRACTOR INFORMATION -- RADON GAS - 5% $0. 00 Name: LUCKIN CONSTRUCTION WATER TAP $0. 00 Address: 241 ATLANTIC BLVD. SEWER TAP $0. 00 ATLANTIC BRACH, FLORIDA 32233 HYDRAULIC SHARE $0. 00 License: CRC044823 Type: 7 RE-INSPECT FEE $0. 00 SEC. H IMPACT FEE $0. 00 OTHER $0. 00 NOTES: NOTICE –ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER "FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS." ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. ATLANTIC BEACH BUILDING DEPARTMENT By: Address / '7 +°. r` S E cc/ I(� /� 1\ IL(( tfrt N� � (FIvccose SFr"ti: /orzcf/ ) Heated Square Footage a ?C( @ $ 53.00 per sq ft = $ / .�, S 8 2- Garage/Shed @ $ per sq ft = $ Carpor orch <oZ 9 y) @ $ / 760 Y `1 � Deck per sq ft = $ ) Patio @ $ per sq ft = $ @ $ per sgft = $ • TOTAL VALUATION: $ /O f 5(fa .00 Tot 1 Val t on� ,� ,0 " $ S. o c� 1st $ ,00c 9 , .57). 0 Remainder Valuation $ . per thousand or $ a portion thereof ADDITIONAL PERMITS and/or FEES REQUIRED Total Building Fee $ �- 6 + Filing Fee $ 3 Z_ 0 Mechanical Fireplaces @ 15.00 $ Plumbing BUILDING PERMIT FEE $ q ? j Z) Electric/New Electric/Temp Septic Tank BUILDING PERMIT $ 9 7, s Well WATER METER CHARGE $ Swimming Pool SEWER IMPACT FEE $ Sign WATER IMPACT FEE $ Water Connection MISCELLANEOUS $ Sewer Connection $ Water Meter Elevation Certificate GRAND TOTAL DUE $ 27, ')-7-) CALCULATIONS and/or NOTES 0 ',OFTZ-Tsv,7):4 ic.:1 ; iq AUG 281991 G..� CITY OF ATLANTIC BEACH Bufr!in and Zoning PERMIT APPLICATION REMODEL, ADDITIONS OR ALTERATIONS Ownerts) : L66-ir4 PeSS I GO .Address: I060 (lgtnQ Y q Phone: Lot it Block or Unit 4P 1 Sub 5,division: xt 6(4vlylc, V,nd S Contractor: L u h CY1S+ • Describe work to be donee AV c( L k Present use of building: -E-C1 `A do-L r y� Valuation:_[C 6,_ c& c (L) Proposed use: Is this an addition? 1/ /4-- If yes, what are the dimensions of the added space: ft. X ft. Will the added area j��tt �as be heated and cooled? New electrical (or increase) ? P t° e . New plumbing fixtures?r°_ New fireplace?____New Heat/AC? ' lu SUBMIT TWO COMPLETE SETS OF PLANS, INCLUDING SITE PLAN, SURVEY, ENERGY CODE FORMS, NOTICE OF COMMENCEMENT, AND OWNER/CONTRACTOR AFFIDAVIT, IF OWNER IS CONTRACTOR. Signature OWNER: Date: Signature CONTRACTOR:_,__ Cc 7Y Date: f a� J1 APPROVED CITY OF ATLANTIC BEACH PLANNING & ZONING OFFICE AUG 2 9 1991 By LUCKIN CONSTRUCTION 241 ATLANTIC BOULEVARD SUITE 2 • NEPTUNE BEACH, FL. 32233 • (904) 241-1639 City of Atlantic Beach Building Department Attn: Don Ford RE: Permit for remodeling 1760 Selva Marina Drive . Don: The attached permit application is for removing screening off existing porch and replacing with Anderson double hung windows . There is an existing roof structure and footer , slab, 3 ' knee wall with exterior brick finish. We will also be closing up one door opening into the existing porch and replacing a set of existing french doors leading into house . Electric will be run to code in remodeled area and one a/c duct will be run off existing unit into this area . If any further information is needed please contact our office. Thank Y u, iRod Luckin A,"OVEO CITY OF ATLANTIC BEACH BUILDING OFFICE Si.? ° ' 1 }�1 :fyyyi ti: • AUG 281991 Bu k ing and Zoning IMAP SHOWING SURVEY 0 LOT 9, BLOCK 9, SELVA MARINA UNIT NO 5, AS RECORDED IN PLAT BOOK 30, PAGES 29 AND 29A OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. FOR.' -/UCK -/ARhv1,�1- 1 1 0�1 Y P re .SEL V,,4 MQR/NA OP/1/E \�j a� �,�u� �,o .d 6�> e ^� BOO'Q/µ/ • 0' . .12' / f ;� S./- 4'57-E. . /sa.00' ,eZ P/ I' / en / uFr ,ressx<r�wv .+�. { 8 , /' ,� 0 8 �i Vi • 0 ;', �.r', as,• %9s , t 0 o '.'.0 ri' n O /-sTasz /CK C • I K Y1 /O ;,:;,:e..," ' j are..-inn. 3 ' 7 04141 O f7PP '!•La'AT/GIN sir • v 4 ks.nv a Ccs. rooms 'jn o cj _.. K n/ • i pP��PA��pNS1C BFCICt • S /S2�• !✓�S NNtNf R so f; o7,- .7 4vP IW "I 2° .9 91 - �� 7� A./:? A /J, 81 . Pri (erIglitir . . • / • r.+/5 /S ••1 S�xogQY ru.PVfY. •77•.'•'A.' 0.��-,-Y DES F.�o _� AUG G•, %1•' ./N/CN (S 7NE ..R!.. of rf+! •W-yeAe/k+D piE .v0,a/4K et,,t, •S�'Yi..L i£OCO. � J 281091 IV Building and Zoning I hereby•nrify that this survey meets the minimum technical standards as set forth by the Florida Board of Land Surveyors,pursuant D. A. DUDE ti to Section 472.07 Florida Statutes. & ASSOCIATESINC. / �. ._ ,,,�_ LAND .urrw.o wevno• ,T.//`77r�w iii\___ . SURVEYORS Fo.1Onk.Box 50870 SIGNED ? -!�'f /8 Ip 6S 830 Beach Boulevard / •� p' J.ck.onvMl.S..cR Florida 32250 SCALE:_ : THIS SURVEY NOT VALID UNLESS THIS PRINT IS EMBOSSED WITH THE SEAL OF THE ABOVE SIGNED. /Sags `� -� V 1 4 1k.)SvLpfT01-) • Zrd RA4'-T PS .• CEaa2 ►'\I YIN N . I °n°o°o ' 3/p Sorri i w( CO>,r1, s c rza �n _ et CI 01 CI . -Cc Oui UC �� AN VC 12-So Pi' I/1 Be_o1.)2 E w ►, ! 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EX._ISTD■14' ScR N__ ._ 12- MO1> �t-e-� PO RCA w LL DV-r"M-1r �.�r��� . _. _.._ J i I r - - . t_ i i ! ! i.r ' i k i t { I. - - !- t_I . r_. __.1._.„i___-1 1 ._i_4_1 •1, .1 ,1 : ! t ' r 1 .1 I 1 1 ; 1 , • I ZIq 1k)SvLA-TiON ZKd RiirlCr?: 1b2 . . 0 a 0�4 eEiL �c VI VI Vi axio .� .� � W W W ,I ' _-~ `.` YI N N ._ 1� d, I +I 1 1 .0. +� 3Ip Solid w( Cox-n, 5crtci-i ` as°a C C C OF .rcQe. fl?-)G. HIV bt Rso►-1 VI 8R_oNZE W II-) ow.s • ?x4 t - - I $R1c1✓ vet tec2 12-11 ins , ax4 p.-+•. EX_1 ST!til G SCRpEN _� ; I PO RCN I LC. fl �' 1N A��. F i. 0 E.TPc-1 l.- , 1 f __ 1 i I ! _.F - � 4..._ Li t• f t i- t i ! f 4 , -} 1 -r } i } - �- --- ._ I - 1 ; r I t � f � r-- 4.-. i . _ _.r_._w._.�., I • • . CITY OF f4I`awstec Beach-4laticla i7.7-- Office of Building Official REQUEST FOR INSPECTION `��J Date 9'— O Permit No. �3 `••� d Time , A.M. Received P.M. District No. Job •ddr�s Locality Owner's A � Name ` or �,_ _ / •• DING 1 - • CRETE - MBING MECHANICAL IN Footing ❑ ... •. ■ Rough ❑ Air.Cond.& ❑ Re Roofing ■ Slab ❑ Temp Pole ❑ Top Out ❑ Heating Lintel ❑ Fire Place ❑ Pre Fab READY FOR INSPECTION A.M. Mon. Tues. Wed. Thurs. Friday P.M. • action Made '. ."" Inspector an. l l Inspection❑eil Certificate of Occupancy Date ,,,,,i Li_ r) CITY OF ATLANTIC BEACH, FLORIDA • Approwdby APPLICATION FOR ELECTRICAL PERMIT CA L LE-6 .r iu 7-C1 11,9-t � TO THE CHIEF ELECTRICAL INSPECTOR: DATE: j!_ CI / 19_ IMPORTANT NOTICE: IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WORK AS DESCRIBED IN THE FOLLOWING, WE HEREBY AGREE TO PERFORM SAID WORK IN ACCORDANCE WITH THE ATTACHED PLANS AND SPECIFICATIONS, WHICH ARE A PART HEREOF, AND IN ACCORDANCE WITH THE ELECTRICAL REGULATIONS, CODES AND CITY OF ATLANTIC BEACH ORDINANCES. At S"Ui[6 '6C T70 c_ `� / ' J AmS fuLC, [//P/U ELECTRICAL FIRM: MAS EL CTRICIAN SIGNATURE JOURNEYMAN NAME HES'S/ °fU /766 SE2- VA- vvil- _ JA Die ADDRESS:_.,, _ ,RFD BOX BLDG.SIZE BETWEEN: $4 T U Q l/Si4 d L•/vE U* RES. ( al APT. ( ) COMM.( ) PUBLIC ( ) INDUS. ( ) NEW ( ) OLD ( ► REW.( ) ADDITION ()1) TRAILER ( ► TEMP.( 1 SIGNS ( ) SQ. FT. a' d U SERVICE: NEW 1 ) INCREASE ( ) REPAIR ( ) FEE CONDUCTOR SIZE AMPS COPPER ( ) ALUM. ( ► SWITCH OR BREAKER AMPS PH W VOLT RACEWAY EXIST.SERV.SIZE AMPS PH W VOLT RACEWAY FEEDERS NO. SIZE NO. SIZE NO. SIZE LIGHTING OUTLETS I _ CONCEALED OPEN — TOTAL 3 d RECEPTACLES P., CONCEALED OPEN TOTAL e, O 0-30 AMPS. 31•100 AMPS. SWITCHES J 7 J INCANDESCENT FLUORESCENT&M.V. FIXED t 0.100 AMPS. OVER — -- APPLIANCES _ BELL TRANSF. AIR H.P. RATING H.P. RATING CONDITIONING COMP.MOTOR OTHER MOTORS AMPS CEIL HEAT: KW-HEAT 0-1 I I OVER MOTORS H.P. VOLTAGE PHS NO. 1 H.P. VOLTAGE PHS MISCELLANEOUS I— TRANSFORMERS: UNDER 600 V. OVER 600 V. NO. KVA NO. KVA ' NO.NEON TRANSF. NO. VA. MA. MOTOR SIZE SWITCH FLASHER ' EACH SIGN • FORWARDED $ TOTAL FEES / , 2-C 0'12 19 7 CITY OF NTIC BEACH,, FLORIDA Approved by APPLICATION FOR ELECTRICAL PERMIT TO THE CHIEF ELECTRICAL INSPECTOR: DATE: - • 19 IMPORTANT NOTICE: IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WORK AS DESCRIBED IN THE FOLLOWING, WE HEREBY AGREE TO PERFORM SAID WORK IN ACCORDANCE WITH THE ATTACHED PLANS AND SPECIFICATIONS, WHICH ARE A PART HEREOF, AND IN ACCORDANCE WITH THE ELECTRICAL REGULATIONS, CODES AND CITY OF ATLANTIC BEACH ORDINANCES. ' 41 .445144j#, Lvz-4-6(5LE TRICAL FIRM: M ELECTRICIAN SIGNATURE JOURNEYMAN NAME C 1j j l IL NV V &0 ADDRESS: C ! IIL' :..i C!FD BOX BLDG.SIZE_ BETWEEN: RES. ( APT. ( ) COMM. ( ) PUBLIC ( ) INDUS. ( ) NEW ) LD ( ► REW. ( ) ADDITION ( ) TRAILER( ) SIGNS ( ) SO. FT. SERVICE: NEW((.�,/Y INCREASE ( ) REPAIR ( ) FEE CONDUCTOR SIZE (� AMPS ..100 COPPER ( ) ALUM.(- SWITCH OR BREAKER o1 Oa AMPS / PH 3 W )VOLT RACEWAY EXIST.SERV.SIZE AMPS PH W VOLT RACEWAY FEEDERS NO. SIZE NO. SIZE NO. SIZE LIGHTING OUTLETS CONCEALED OPEN TOTAL RECEPTACLES CONCEALED OPEN TOTAL 0.30 AMPS. 31-100 AMPS._ SWITCHES INCANDESCENT FLUORESCENT&M.V. FIXED 0.100 AMPS. 1 OVER l APPLIANCES BELL TRANSF. AIR H.P. RATING H.P. RATING CONDITIONING COMP.MOTOR OTHER MOTORS AMPS CEIL HEAT: KW-HEAT 0-1 OVER MOTORS H.P. VOLTAGE PHS NO. 1 H.P. VOLTAGE PHS MISCELLANEOUS / lrr aMrA jILkYr 4 uss te, TRANSFORMERS: UNDER 600 V. OVER 600 V. NO. KVA NO. KVA NO. NEON TRANSF. NO. VA. MA. MOTOR SIZE SWITCH FLASHER EACH SIGN FORWARDED TOTAL FEES CITY OF ATLANTIC BEACH, FLORIDA % 3 Approved by APPLICATION FOR ELECTRICAL PERMIT TO THE CHIEF ELECTRICAL INSPECTOR: DATE: IMPORTANT NOTICE: IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WORK AS DESCRIBED IN THE FOLLOWING, WE HEREBY AGREE TO PERFORM SAID WORK IN ACCORDANCE WITH THE ATTACHED PLANS AND SPECIFICATIONS, WHICH ARE A PART HEREOF, AND IN ACCORDANCE WITH THE ELECTRICAL REGULATIONS, CODES AND CITY OF ATLANTIC BEACH ORDINANCES. ./ f !/kf V 4iw),r/ C`1EfC L CT'ICAL FIRM: MAS 'ER LECTRICIAN SIGNATURE �� ; k „ • k NAME Lkka. ADDRESS: /r : �' �� lfFD BOX BLDG.SIZE BETWEEN: RES APT. ( ) COMM. ( ) PUBLIC ( ) INDUS. ( ) NEW OLD ( ) REW. ( ) ADDITION ( ) TRAILER ( ) TEMP. ) GNS ( ) SQ. FT. SERVICE: NEW( ) INCREASE ( ) REPAIR ( ) FEE CONDUCTOR SIZE AMPS 6 COPPER ( ) SWITCH OR BREAKER 6 fi AMPS / PH a W �30/OLT RACEWAY EXIST.SERV.SIZE AMPS PH W VOLT RACEWAY FEEDERS NO. SIZE NO. SIZE NO. SIZE - 1 LIGHTING OUTLETS CONCEALED OPEN TOTAL RECEPTACLES _ CONCEALED OPEN TOTAL 0.30 AMPS. 31-100 AMPS. SWITCHES INCANDESCENT FLUORESCENT&M.V. FIXED 0.100 AMPS. OVER APPLIANCES BELL TRANSF. AIR H.P. RATING H.P. RATING CONDITIONING COMP.MOTOR OTHER MOTORS AMPS CEIL HEAT: KW-HEAT 0.1 1 OVER MOTORS H.P. VOLTAGE PHS NO. 1 H.P. VOLTAGE PHS MISCELLANEOUS TRANSFORMERS: UNDER 600 V. OVER 600 V. NO. KVA NO. KVA NO. NEON TRANSF. NO. VA. MA. MOTOR SIZE SWITCH ( FLASHER EACH SIGN FORWARDED TOTAL FEES II 1:::/ . O r INN" n O Orot• -� `17 0 'Vh O Q 1-3 C > 0 � NIZ _n, t 0 nxr ° ' "I ' _` °N.75 25I0 E.250.0" 200.0 o < z. x =K . o' k Ln n. o - 1?J G f . 1 �' N r rte' R'• Ac L 41<-. NJ os °S ,c/ LA _ �' zC 51 rr Z. a C r z E , p /i © ti` 0 CO C O I 7J 77 r4 0 cn z , x _ _ --.. _ - - .� .& ` 222.0' / . 575°2570" W 275.0' o , ti�l _=I r-, 0 Co Ti :A © *r. r■ zm .. F m It= C. 2 0 i... N �n 0 r , s,,.0114, Tii aaac) DL. is F < tll Z R1 , mg c , x OD D D x �t / o I ' f?( o , N. - C M 'f( —I J'8. 0_-► m o H f t' Iti 0r x D if z t -+ n .3 3 C > ,-, ,--, 3 r, H > C Z 171 'T; Z Crl yyt� :r] dC bz r � 0 ti -� :ny �„3 < h � r tn O � � M ztl � C � c � `� � x ° � y / M � aG� C C W 1-1 Cn C K y .� O. a3 m NUJ' � C z .T. N rn D ~ > = .3 ‹ n On j� 1 n I in 3 r K t'7 n CZi7 T� / / = p 1 xtiZKU} Cr-) �, �If M 3 ~ ■- r � � 3aU. K c ' C �7 r O ci %e!, O 3 > y O Z '9 D Cn O b w N o Z "" > > .' z yv7 > I I = fir' CD' Z C +-3 1`) D 0 D n:' O C y C � Z 2 E i 97 D ti° O Z 2 � / ' co -i q � O C C >� co -11 (:),•'' o b p z ,-, cn < z ntr7 K Z es w ( _ 5) F-, I--I X x � _4 , 0x � H > • '1 J1 m i> r j d > tl] � 2ZK r0K ;% 18. . rn rn 1_4'2' `' z ° ,_g O °XI � C i!/� CJ) L 'v • Z tT1 TJ �' > N r fil I Z Z - > 2ACO03 • > 2 -1 m o ( � cn0 �yOC o - +N� Cj ,0 w civat� r1n -- Iv > 70 y Z z a � h CD Cn < CnLTip Cr] � 7 OZ co LT7 ■� y' C CnKZZC ,-3 = Cn DEPARTMENT OF BUILDING �` Q c CITY OF ATLANTIC BEACH,FLORIDA PERMIT NO. V .J 9 U PERMIT TO BUILD 41eo0 T. THIS PERMIT MUST BE POSTED ON JOB 418.5OCKT a 7748 IA 8/26/35 Date August 16, 19 85 6996 .flQCACo 3.20 Fee 418.50 7748 I A C/26/O5 Valuation$ 125,39 _ 111170 This permit not valid until above fee has been paid to City Treasurer,and is subject to revocation for violation of applicable provisions of law. This is to certify that HARD MAN BUILDLRS MSC. 1644 Park Terrace Wes+ has permission to build Sing]P Farfri 1 y 1—inns PRepPr p1 ars gt thmi tted Classification residential Zone PLID RS1 Owned by James file Lot Block 9 S/D #5 House No. 1760 SELVA MARINA DRIVE According to approved plans which are part of this permit NOTICE—ALL CONCRETE FORMS AND FOOTINGS MUST BE IN- SPECTED BEFORE POURING. PERMIT VOID SIX MONTHS -n AFTER DATE OF ISSUE O Building material, rubbish and debris Zi from this work must not be placed in public space, and must be cleared u s and hauled away by either con- rac •r- owner. A • /0e a-D NGTG.LJ Building Official. FOR OFFICE PERMIT USE ONLY NUMBER DATE CONTRACTOR PLUMBING ELECTRICAL SEWER WATER PLUMBING PERMIT f "', BUILDING PERMIT WORKSHEET ELECTRIC PERMIT S-a TEMPORARY ELECT. ► eated Square Footage p79o2 @ $ c per sq ft = $ ///, 7727 d° dzd arage/Shed ,57 @ $ 6d per sgft = $ /u/ .P9tr• arport @ $ per sq ft = $ orches .Q @ $ &If' per sq ft = $ /1 ,17D3• a . eck 23 0 @ $ L ` -7e) per sq ft = $ fts' Kc), Q. 6 atio @ $ per sq ft = $ TOTAL VALUATION $NS` 59 a /,73/. 3.7,3 - c3 6 . S $ cats() otal Valuation Data 1st $ /QO,DOv."O • ,2,5; 34(5.-. "o- 3a (3-2) 3a, 622 $ ?mainder Valuation @ $ / . a' per thousand or portion thereof TOTAL BUILDING FEE $ 0Z( 9. 00 + 1 FILING FEE $ / 43(74 J FIREPLACE @15 . 00 $ l ,- - -v U TOTAL BUILDING PERMIT $ 4// cs'- S—d UMBING PERMIT FEE$ MECHANICAL PERMIT FEE$ ECT. TEMPORARY $ ELECTRICAL PERMIT $ TER METER SIZE $ ACCOUNT NUMBER WER IMPACT FEE $ TER CONNECTION $ (@10. 00 per fixture unit) 'ROVED BY: TOTAL BUILDING/PLAN FILING FEE $ 9/8q v TOTAL WATER METER CHARGE $ ?LC- d 8 TOTAL SEWER IMPACT FEES $ lO 33.. CO -' 7 0VEp TOTAL WATER CONNECTION CHARGE $ c_3, C. a � F O BEACH MISCELLANEOUS CHARGES ' 3 OFFiC� $ pi1 , 1985 / GRAND TOTAL DUE: $ 4 d ii 8,5- - PLUMBING WQ KSHEET SINKS SHOWERS / DISHWASHERS CLOSETS 2- BATH TUBS FLOOR DRAINS l WASHING MACHINE ° WATER HEATERS / DISPOSALS LAVATORY URINALS OTHER TOTAL FIXTURE COUNT l0 @ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *..* FIXTURE UNIT BREAKDOWN FIXTURE UNITS ARE ESTABLISHED AS THE MEASUREMENT OF WATER DEMAND FOR EACH WATER FIXTURE UNIT INSTALLED AND CONNECTED TO THE CITY WATER SYSTEM. THE WATER SUPPLY CHARGE IS HEREBY FIXED AT $10.00 PER FIXTURE UNIT CONNECTED TO THE CITY WATER SYSTEM. id BATHROOM GROUP CONSISTING OF I LAVATORY (1 UNIT) WATER CLOSET, LAVATORY, AND BATH TUB OR SHOWER STALL SERVICE SINK TRAP STAND (6 UNITS) (3 UNITS) DRINKING FOUNTAIN (.1 UNIT) URINAL, WALL LIP FLOOR DRAIN (1 UNIT) zz (4 UNITS) URINALS PEDESTALS SYPHON `J WASHING MACHINE RES. JET BLOWOUT (8 UNITS) (3 UNITS) WATER CLOSETS, VALVE OPERATED WATER CLOSETS, TANK-OPERATED (8 UNITS) (4UNITS) SHOWER STALL, DOMESTIC BATHTUB (W/OR W/0 OVERHEAD (2 UNITS) SHOWER) (2UNITS) BIDGET (3 UNITS) LAUNDRY TRAY (2 UNITS) 2 DISHWASHER (2 UNITS) KITCHEN SINK (2 UNITS) v KITCHEN SINK/WASTE GRINDER (3 UNITS) TOTAL FIXTURE UNITS @ $10.,00 EACH-.3J ]Vigo 3/6 • . Date 18 .._.. CITY OF ATLANTIC BEACH Permit # F«:..._.-_......�_.. Valuation $ FLORIDA House # APPLICATION FOR BUILDING PERMt' Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure described. This application is made in compliance and conformity with the Building Ordinance of the City of Atlantic Beach, Florida, and all provisions of the Laws of the State of Florida, all ordinances of the City of Atlantic Beach and all rules and regulations of the Building Department of the City of Atlantic Beach, shall be complied with, whether herein specified or not. The Contractor or Owner-Builder who has been issued a Building Permit is automatically responsible to ascertain that all sub- contractors engaged by him are duly licensed in the City of Atlantic Beach, Florida. To prevent delay or embarrasment regard- ing intermediate or final inspections it is suggested that a list of sub-contractors be submitted to this office so that licenses can be verified. �Q Date i..;) • ' 6 5- , 18 Owner \Lows J.1 iQ !o' bh Address )� Z9 . - Telephone No •2-ii 8 Architect Address. Telephone No. Contractor Builder_11 F�.(i.461.• 4 j NC, Address 1644 P A•O.Telephone No.244-11 45 Lot No. 9 Block No ,1 Sub Division5AVA....,IMe414.1.1SIA L.)it!7" 5 Zone_3Z233 5V-VA MAK i&IA D4. Street < \,J Side Between LIVE and.---..9!i4_1*A —. St.. Valuation $.1.20 Q For what purpose will building be used P-€SIQ.e,Jc. is �a Type of construction��tA�'.$!� � ��� Dimensions of Building ---,?.(t5o Dimensions of Lot.--.l c0.--x...2..r.o Size of Footings 1.52•. 5, ' Size of Piers N..,4,- Size of Sills AL.-A. Greatest Sill Span in ft. •A� Type xoaf.lAl.0aAa.f.t.l:'k..._ How will Building be Heated? r*t.A ttl.47• PPS (y). Will Building be on Solid or Filled Ground? i.i,{.i.._..•_.._._._... Size of Ceiling Joists fiki,?b5 , Distance on Centers 2-4~ , Greatest Span. 240 1 Size of Floor Joists 5 1-.441.4• , Distance on Centers , Greatest Span - N Size of Rafters ill EGA' 1-124),, , Distance on Centers L4" , Greatest Span Zlo` M This rectangle is to represent the lot. APPROVED right the building or buildings in the GITY r:; r,T1.ANTIC REACH all to desoamndGiexistlis buildings. in feet from PUrL'317,IG OFFICE REAR LOT LINE Two copies of plans and specifications shall CC be submitted with application. ? J Inspections required. 1. When steel is In place and ready to pour footing. - _ c.2.4111W 2. When steel is in place and ready to pour columns and/. lintel. 3. When steel is in place and ready to pour beam. 54.8 Ptak) 4. When framing is completed. 5. When rough plumbing is completed,and ready to cover up. c -c+"J° �O 6. When septic tank drain field or sewer is laid but before it is covered. �iQy1.4, t=1 Po7. Electrical inspection by City of Jacksonville. en 8. Final inspection. Note: In case of any rejection,re-inspection MUST be called for after corrections are made. FRONT OF LOT In consideration ., • - ven for doing the work as described in the above stateme we hereby agree to perform said work in acco . .:!with at .-. -d plans and specifications, which are a part heree ; and accordance with e b regulations .fe Ci : of Atlantic B- •.. Signature_ -_.__.. _.. ..__. Address ,es.-s.- cuK, , y . _. Signature of Owner......_..si,ea.cc.,.....- Address /� r-� • 0-"4, FLORIDA ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION aw� SECTION 9—RESIDENTIAL POINT SYSTEM METHOD CLIMATE ZONES FORM 900-A-84 DEPARTMENT OF COMMUNITY AFFAIRS NORTH 1 2 3 This form may be used to demonstrate compliance with the Energy Code for new single-family detached or multifamily attached dwellings under Section 9 of the Energy Code. An alternative to this method for single-family detached dwellings, and multifamily attached dwellings of three stories or less, is provided in Section 10 of this Code.Only dwellings which are above ground frame(wood siding, brick veneer,etc.)or concrete wall type construction may be calculated using Sections 9 and 10.Other types of construction must comply under Section 4 or Section 5 of this Code.Additions to existing residential buildings shall comply with the requirements of Section 10 of this Code.Detailed information on how to complete this form may be obtained from your local building department or the Department of Community Affairs, Energy Code Program,2571 Executive Center Circle East,Tallahassee, Florida 32301. PROJECT NAME 14//6[i DeNc6 PERMITTING OFFICE: AND ADDRESS: 4O7.- S ,/jLC 9 S- N4 ti (IA/ITS CIRCLE CLIMATE ZONE: 1 2 3 BUILDER: C ayA,,q _ de4Q,ezzon _H t! ZepRi /�c.,, PERMIT NO.: OWNER: C__1/4%-1 G fPC4-e JURISDICTION NO.: DETACHED IF MULTIFAMILY NO OF UNITS GLASS AREA AND TYPE COVERED BY THIS CALCULATION: CLEAR TINT,FILM,SOLAR SCREEN SEPARATE CALCULATIONS ARE REQUIRED I SGL SGL FOR EACH WORST CASE UNIT TYPE.CHECK IF ATTACHED THIS CALCULATION REPRESENTS A WORST CASE CONDITION. DBL DBL NET WALL AREA AND INSULATION CONDITIONED CEILING INSULATION CBS R= 1 FRAME R= FLOOR AREA UNDER ATTIC SGL.ASSEMBLY (.,' 6P / / t�{�l 2- 710 R= ,- .0 R= • COOLING SYSTEM PRIMARY HEATING SYSTEM PRIMARY HOT WATER SYSTEM K.CENTRAL NONE ELECTRIC STRIP GAS NONE ELECTRIC RESISTANCE SOLAR - ROOM OIL L 1 SOLAR I HEAT RECOVERY GAS 1 I PACKAGE TERMINAL AC X HEAT PUMP:COP = Z g DED. HEAT PUMP:COP = EER/SEER = e .S' OTHER: OTHER: CALCULATED E.P.I.: g 0 5 1 CALCULATED E.P.I.MUST NOT EXCEED 100 POINTS In accordance with Section 553.907 FS., I hereby certify that the plans Review of the plans and specifications covered by this calculation indi- and specifications covered . this calculation are in compliance with the cates compliance with the Florida Energy Code. Before construction is Florida Energy Code completed, this building will be inspected for compliance in accordance with Section 553.908, F.S. OWNER/AGEp:'ii owl BUILDING OFFICIAL: DATE: / "�lP`O.f DATE: 9A PRESCRIPTIVE MEASURES(Must be met or exceeded by all residences.) MINIMUM REQUIREMENTS CHECK TO INDICATE COMPONENTS REQUIREMENTS COMPLIANCE WINDOWS(903.1) MAXIMUM OF 0.5 CFM per LINEAR FOOT OF OPERABLE SASH CRACK. DOORS(903.1) MAXIMUM OF 0.5 CFM PER SQUARE FOOT OF DOOR AREA.INCLUDES SLIDING GLASS DOORS. EXT.JOINTS&CRACKS(903.1) TO BE CAULKED,GASKETED,WEATHER-STRIPPED OR OTHERWISE SEALED. CEILING INSULATION(903.9) MINIMUM OF R-19. WATER HEATERS(903.2) MUST BEAR ASHRAE STANDARD 90-80 LABEL OR A MAX.4 WATT/SO.FT.STAND-BY LOSS.SWITCH OR CLEARLY MARKED CIRCUIT BREAKER(ELECTRIC)OR CUT-OFF VALVE(GAS)MUST BE PROVIDED. SWIMMING POOLS(903.3) IF HEATED BY OTHER THAN SOLAR,MUST HAVE POOL COVER DESIGNED TO MINIMIZE HEAT LOSS. ALL NON-COMMERCIAL POOLS MUST BE EQUIPPED WITH A POOL PUMP TIMER. HOT WATER PIPES(903.4) INSULATION IS REQUIRED ONLY FOR RECIRCULATING SYSTEMS. IN SUCH CASES,PIPING HEAT LOSS SHALL BE LIMITED TO A MAX.OF 17.5 BTU /H PER LINEAR FOOT OF PIPE(SEE 504.4). SHOWER HEADS(903.5) WATER FLOW MUST BE RESTRICTED TO NO MORE THAN 3 GALLONS PER MINUTE. HVAC DUCT CONSTRUCTION CONSTRUCTED IN ACCORDANCE WITH INDUSTRY STANDARDS AND LOCAL MECHANICAL CODE. (903.6) DUCTS IN UNCONDITIONED SPACE MUST BE INSULATED TO A MINIMUM R-4.2. I HVAC CONTROLS(903.7) A SEPARATE,READILY ACCESSIBLE MANUAL OR AUTOMATIC THERMOSTAT FOR EACH SYSTEM. 1 I FORM 900-A-84 CLIMATE ZONES 1 2 3 1 9C I DESIGN CREDIT POINTS(CP) 9D HEATING SYSTEM CREDIT POINTS CEILING FAN IN COND.SPACE(max 5 CP) 1 NATURAL GAS/PROPANE HEATING 16.0 MULTIZONE A/C SEPARATED BY DOOR 5 OIL HEATING 12.8 CROSS VENTILATION(1 CP per room) 1 WHOLE HOUSE FAN(min.1.5 cfm/s.f.) 5 WOOD STOVE 7 9E DESIGN PENALTY POINTS FIREPLACE WITH OUTSIDE COMBUSTION AIR 2 WASHER AND DRYER IN COND SPACE 3 TOTAL GLASS OPENS LESS THAN 40% 5 9C TOTAL(not to exceed 12 points) FIREPLACE WITH INSIDE COMBUSTION AIR 5 9F I WINTER OVERHANG FACTOR(WOF) _ 9F SUMMER OVERHANG FACTOR(SOF) 1 FEET N NE E _ SE S SW W NW FEET N NE E SE S SW W NW 0-0.9 1.00 0.98 0.99 0.74 0.71 0.82 0.93 1.00 0-0.9 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1-1.9 1.00 0.98 0.99 0.75 0.73 0.83 0.93 1.00 1-1.9 1.00 1.00 0.99 0.98 0.97 0.98 0.99 1.00 2-2.9 1.00 0.98 0.99 0.77 0.76 0.84 0.94 1.00 2-2.9 1.00 0.98 0.94 0.92 0.91 0.92 0.94 0.98 3-3.9 1.00 0.98 0.99 0.81 0.79 0.87 0.94 1.00 3-3.9 1.00 0.95 0.89 0.86 0.85 0.86 0.89 0.95 4-4.9 1.00 0.98 0.99 0.84 0.83 0.89 0.94 1.00 4-4.9 1.00 0.91 0.84 0.80 0.82 0.80 0.84 0.91 5-5.9 1.00 0.99 1.00 0.87 0.87 0.92 0.95 1.00 5-5.9 0.99 0.88 0.79 0.76 0.79 0.76 0.79 0.88 6-6.9 1.00 0.99 1.00 0.90 0.90 0.93 0.96 1.00 6-6 9 0.99 0.85 0.75 0.73 0.78 0.73 0.75 0.85 7-7.9 1.00 0.99 1.00 0.93 0.94 0.96 0.97 1.00 7-7.9 0.99 0.83 0.72 0.70 0.77 0.70 0.72 0.83 8-8.9 1.00 0.99 1.00 0.95 0.96 0.97 0.98 1.00 8-8.9 0.99 0.81 0.70 0.68 0.77 0.68 0.70 0.81 9-9.9 1.00 1.00 1.00 0.97 0.98 0.98 0.98 1.00 9-9.9 0.98 0.79 0.68 0.67 0.76 0.67 0.68 0.79 10-10.9 1.00 1.00 1.00 0.99 0.99 0.99 0.99 1.00 10-10.9 0.98 0.77 0.66 0.66 0.76 0.66 0.66 0.77 11-11.9 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 11-11.9 0.97 0.76 0.64 0.64 0.76 0.64 0.64 0.76 12 UP 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 12 UP 0.97 0.75 0.63 0.64 0.76 0.64 0.63 0.75 9G _ HEATING SYSTEM MULTIPLIER(HSM) HEAT PUMP COP 2.5-2.6 2.7-2.8 2.9-3.0 3.1-3.2 3.3-3.4 3.5&UP HSM .40 .37 .34 .32 .30 .29 SOLAR HEATING SYSTEM _ (BACKUP SYSTEM FRACTION) x (BACKUP SYSTEM HSM) ELECTRIC STRIP HEAT 1.0 NATURAL GAS/PROPANE/OIL 1.0(SEE TABLE 9D FOR CREDITS) PTAC&ROOM HEAT PUMPS MINIMUM COP 2.2.HSM FOR COP 2.2- 2.4= .45. SEE TABLE ABOVE FOR COP> 2.4 9H COOLING SYSTEM MULTIPLIER(CSM) ELECTRIC EER/SEER 7.8-7.9 8.0-8.4 8.5-8.9 9.0-9.4 9.5-9.9 10.0-10.4 10.5-10.9 11.0-11.9 12.0-UP CSM .83 .81 0.76 0.72 0.68 0.65 0.62 0.59 0.54 GAS COP 0.40-0.44 0.45-0.49 - 0.50-0.54 _ 0.55-0.59 0.60-0.64 1 0.65-0.69 0.70&UP CSM 1.50 1.25 1.20 1.09 1.00 I 0.92 0.89 MINIMUM SEER/EER LEVEL 7.8 FOR STRAIGHT COOL OR HEAT PUMPS; MINIMUM OF 7.5 EER FOR ROOM UNITS AND PTAC. FOR ROOM UNITS AND PTAC,CSM FOR EER 7.5 - 7.7= .87.SEE TABLE ABOVE FOR EER>7.7. 91 HOT WATER CREDIT POINTS(HWCP) ELECTRIC RESISTANCE WATER HEATER 0 GAS WATER HEATER 10 INSTANTANEOUS WATER ELECTRIC 4.5 HEATER GAS 12.6 ELECTRIC BACKUP 6.7 HRU(A/C)WATER HEATER GAS BACKUP 13.9 ELECTRIC BACKUP 9.7 HRU(HP)WATER HEATER GAS BACKUP 14.5 HEAT PUMP WATER HEATER COP 1.60-1.89 1.90-2.19 2.20-2.49 2.50-2.79 2.80-3.00 (DEDICATED HEAT PUMP) CREDIT POINTS 9.0 11.4 13.1 14.4 15.4 OVERALL SOLAR FRACTION* 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 SOLAR o= ELECTRIC BACKUP 2.4 4.8 7.2 9.6 12.0 14.4 16.8 19.2 21.6 24.0 HOT WATER $d GAS BACKUP 11.4 12.8 14.2 15.6 17.0 18.8 19.8 21.2 22.6 24.0 *PERCENT OF ANNUAL HOT WATER PROVIDED BY SOLAR SYSTEM_100=OVERALL SOLAR FRACTION 4 I DEPARTMENT OF BUILDING CITY OF ATLANTIC BEACH,FLORIDA C� PERMIT NO. " PERMIT TO BUILD THIS PERMIT MUST BE POSTED ON JOB Date AL RL-T IL 19_Ed 7 76.50 3u4 1 4 7 > ' Valuation$ ��� ' Fee$ 6997 *VICKG paid to City Treasurer,and is L_345 1 Q J/2 3/0■ This permit not valid until above fee has been p Y ' subject to revocation for violation of applicable provisions of law. This is to certify that AMA MI •14 • V , t•1. I ■ has permission to Vild (INSTALL PLUMING ING RESIDENTIAL Zone Classification Owned by HARDMAN BLURS Block_—______ /D Lot 1760 SELVA 'MARINA DRIVE: House No. According to approved plans which are part of this permit OTICE—ALL CONCRETE FORMS = AND FOOTINGS MUST BE IN- SPECTED BEFORE POURING. E PERMIT VOID SIX MONTHS 1 -n AFTER DATE OF ISSUE —� O Building material, rubbish and debris /--� from this work must not be placed in public space, and must be cleared .• hauled away by either con- * tract, `owner. .!/ Building Official. Or FOR OFFICE - DATE Or CONTRACTOR USE ONLY PLUMBING millimilill ELECTRICAL SEWER -R . CITY OF ATLANTIC BEACH APPLICATION FOR PLUMBING PERMIT JOB LOCATION /`7 a £J o, I1401-V;x'14 �r PLUMBING CONTRACTOR k1 L pfi c C�s'f' �°` ' •'`'� Cc.vr. LICENSE NUMBERS C Inc' 2152.9 OWNER BUILDING CONTRACTOR RIWA N- A4-, TYPE OF BUILDING S Z i nA../4 "10 a SINKS / SHOWERS 14 LAVATORY 2 WATER HEATERS a BATH TUBS / DISHWASHERS URINALS / DISPOSALS 3 CLOSETS I WASHING MACHINE / FLOOR DRAINS / OTHER Z 04 a°`f TOTAL FIXTURE COUNT INSTALLATION OF PLUMBING AND FIXTURES MUST BE IN ACCORDANCE WITH THE MOST RECENT EDITION OF THE SOUTHERN STANDARD PLUMBING CODE . DEPARTMENT OF BUILDING w CITY OF ATLANTIC BEACH,FLORIDA PERMIT NO. b CJ•) PERMIT TO BUILD THIS PERMIT MUST BE POSTED ON JOB Date AUGUST 16, 19 85 Valuation$ MECHANICAL 76.00 Fee$ 76.00 TL This permit not valid until above fee has been paid to City Treasurer,and is 76.00M subject to revocation for violation of applicable provisions of law. I IA 10/21/60 r This is to certify that TAYLOR'S HE4TIr& & AIR •• to l'11nr, r ; 0000 has permission to btu T[ISTAT T, HEAT SIR Classification RES O IAL• Zone Owned by HABI11AN BUILDERS Lot Block S/D House No. 1760 S LVA MARIiVA DRIVE According to approved plans which are part of this permit NOTICE—ALL CONCRETE FORMS AND FOOTINGS MUST BE IN- SPECTED BEFORE POURING. PERMIT VOID SIX MONTHS -n AFTER DATE OF ISSUE o Building material, rubbish and debris from this work must not be placed in public space, and must be cleared = up an! hauled away by either con- �r f owner. Building Official. FOR OFFICE PERMIT USE ONLY NUMBER DATE CONTRACTOR PLUMBING MIN ELECTRICAL SEWER WATER BUILDING AND ZONING INSPECTION DIVISION CITY OF ATLANTIC BEACH ATLANTIC BEACH, FLORIDA 32233 APPLICATION FOR MECHANICAL PERMIT CALL-IN NUMBER IMPORTANT — Applicant to complete all items in sections I, II, Ill, and IV. I. LOCATION Street Address: / 7 lv Q S I U 4 /1"4,emia ' D'- OF Intersecting Streets: Between And BUILDING Sub-division 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 part hereof and in accordance with the City of Jacksonville ordinances and standards of good practice listed therein. Name of Mechanical Contractors / Contractor (Print) / �,C-/ (mac" C•.- ` A/ ,� Master i — L)5" Name of 1) , , f ` Property Owner W I (-it Signature of Owner Signature of or Authorized Agent Architect or Engineer III. GENERAL INFORMATION A' Type of Mating fuel: B. IS OTHER CONSTRUCTION BEING DONE ON ❑ Electric THIS BUILDING OR SITE? `i `� ❑ Gas—0 LP ❑ Natural ❑ Central Utility IF YES, GIVE NUMBER OF CONS Cr; ❑ Oil PERMIT /�/_ Q�fher — Specify /4-7`--c-/g. 'S a 46 IV. MECHANICAL EQUIPMENT TO RE INSTALLED NA OF WORK (Provide complete list of components on back of this ford "Residential or ❑ Commercial ❑ Heat ❑ Space ❑ Recessed ❑ Central 0 Floor New Building ❑ Air Conditioning: ❑ Room ❑ C�rel ❑ Existing Building - rt *3.).❑ Duct System: Material . 15'.9 Thickness ( ❑ Replacement of existing system Maximum capacity c.f.m. ( w installation(No system previously installed) ❑ Refrigerefion ❑ Extension or add-on to existing system C3 Cooling tower: Capacity g.p.m. ❑ Other — Specify ❑ Fire sprinklers: Number of heads ❑ Elevator ❑ Manlift ❑ Escalator (number) ❑ Gasoline pumps THIS SPACE FOR OFFICE USE ONLY pu pe (number) (Received) D] ,ankt (number) Remarks ❑ LPG containers (number) ❑ Unfired pressure vessel 1:7 oilers Permit Approved by Date ❑ Other — Specify Permit Fee LIST ALL EQUIPMENT AIR CONDITIONING AND REFRIGERATION EQUIPMENT Number Unite Description Model Number Manufacturer jy A rno i 3m C( '61)(,(7) , k / / / # Ib, HEATING - FURNACES, BOILERS, FIREPLACES Number Units Description Model Number Manufacturer (BTU)y ��► TANKS How Many Nominal and Dimensions Capacity Type Liquid Name of Serial Approving Contained Manufacturer No. Agency