149 S Oceanwalk Dr 2013 bath remodel CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002614 Date 5/06/13
Property Address . . . . . . 149 S OCEANWALK DR
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 10000
----------------------------------------------------------------------------
Application desc
BATH REMODEL
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
SWAIM STEVEN A & TORI S BOSCO BUILDING CONTRACTORS
149 OCEANWALK DRIVE SOUTH 2158 MAYPORT RD.
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 241-0320
--- Structure Information 000 000 BATH REMODEL
Occupancy Type . . . . . . RESIDENTIAL
----------------------------------------------------------------------------
Permit . . . . . . RESIDENTIAL ALT/OTHER
Additional desc . .
Permit Fee . . . . 100 . 00 Plan Check Fee 50 . 00
Issue Date . . . . Valuation . . . . 10000
Expiration Date . . 11/02/13
----------------------------------------------------------------------------
Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 NATIONAl ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 100 . 00 100 . 00 . 00 . 00
Plan Check Total 50 . 00 50 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 154 . 00 154 . 00 . 00 . 00
PERMIT IS APPROVED ONLV IN ACCORDANCE WITH ALL CITV OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
JobAddress: dc*WALV- tv- �. Permit Number: 1-3—c�
Legal Description 12-601 DR-,)5- 14E, Parcel #
Floor Area of Sq.Ft. --Sq.Ft
Valuation of Work$-/10 Propose( : heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial eznM��
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval #
For multiple products use product app—row—al I-orni
Describe in detail the type of work to be performed: r-)a4&roc�
Property Owner Info rination:
Name:f2itken� -T-or q i 5wCL4'rf1\ Address: 199 CtQjoux,0aAt Dr- ':_�i
City ""CLDIC r�QacLl StateF.0 Zip Phone
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: I A 11 1 r Qualif
W&M y Agent:
Addressa- 1.5k M�,� KkrI Of - city jj�C_ &a CA, State F-L_ Zip 3"Y�)
Office Phone90_-1/_ 2v( (33;0 Jo 31tul ax#
State Certification/Registration# J' REIM M- -D FOR CODE eOM - __11
Architect Name&Phone# UEAW"Vw __ —
CMA A�OF ATLMqTj
Engineer's Name& Phone 4 C BEACH
Fee Simple Title Holder Name and Addres PERMITS PUR-AUD-17rIONAL rn
I s AM CONDI-flONS.
Bonding Company Name and Addres ILM L
7( 11,
Mortgage Lender Name and Address REVMWED BY: El ATE
a n a ca imenced prior to the
'Is �os'I la w
' " 'i s �
ards a
0 k is s
O�r
A * at here made I la''n a ermit to do the work and i a f
"c e io s by d h 0 0' 'k ill be e or ed to Z I the s a'
f
in I ;or, c s or
(6 n f
ipp'nc ' a permit an I at all 0 p Z I I c.Ire'd or Eject'.1ca
and "d,'7'ok'_s not co""C'd"_thpi,six 0 on r'
k is f "cd I"d 'd th t s p r I pr isimit be sec
coin �j e'sta a e a ae e
'As andA"Cn i ine's,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING9 CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
]here certify that I have read and examined this application and know the same to be true and correct. All provisions oflaws and ordinances governing this
1�work will be com iedwithwhether ecift'iedherei n or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions ofany otherfe e 1,slate, or loc lating construction or the peifo�mance ofconstruction.
Signature of Owne Signature of Contracto&
Print Name 4.
Print Name
......................................................................................................................................
Sworn to and subscribed before me Sworn to and subscribed before me WILLIAM L.POP�Q
this Day of W-1111AM1209!& this Day of
NoWry Public,StateoT rJorlua 6 wmry FuNic,Do Oct 19,;015
Comm. pires Oct.19,721
Expires
P rommissionNO-Cr-
Notary ublic commission No.FT IBM:) Notary Public
Revised 0 1.26.10
Doc#2013110458, OR BK 16353 Page 1 102,
NOTUT Number Pages 1
011" CONINIFNICEMIFNIT Recorded 05/02/2013 at 03:57 PM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
Permit No. RECORDING$10-00
TaN Folio
I t�NDF'RSI('N[:[) herchN 9j,t'N lwficc that improvenicllj�, %%ill be Milde to certain real pfoperty,wid ill a(Lordance\-.ith Section
713 13 4411it:Holitla's'latillet"the follm"ifue infornialion i�,Pro \ided in thk NOTICE
I I)Cscf illtion ol'pioperIN (Irgal d,-.%(-rj[)1ion): -d �-a cir
_Y,),-6 0/ 0 cle 0 C,-
a) Street(joh) Address: 0 Cj2CL11 LK,)6L t K
2
�A;cneral description of improvements: eP977F 10-e---k
.I.Owner Information
a)Name and address:
b)Name andaddress of fee simple fi- q1 0c12a-NwcL(f- 6(- S A6 3,U33
111cholder(if other thail owner)
c) Interest in proPt,r(N
4.Contractor InIlbrination
a)Name and address: OOSO DU l(0.4ejl 601`4 11-4MWVZ_� Ipc r_v;6 nivq�,vaeGrw A-rL+r,7(-
h)Telephone No.: cic�'i 2,�q t -0 3 2-0- - Fax No. (Opt.) _ 19o4 24 1- 032-(,
V�5
urety Information
a)Name and address:
h)Amount ot'llorld:
c)'I'clephonc No.:. Fax No. (Opt.)
6.1.endcr
a)Name and address:
Phone No.
7. Identity of person within the Stateof Florida designated hy owner upon whom notices or other
a)Name and address:
b)l*c'l hone No.: —--------- Fax No.(Opt.)
8.1naddiflont, imself,owner designates the following person Ill receive a copy of the I.ienor's Notior.a_S provided in Section
713.13(l)(b),Florida Statutes:
a)Name and address:
b)Telephone No.: Fa.x No. 1 0'pt.)
9.Fxpiration date of Notice one year from the date of recording unless P different dale
isspecifted):
WARNJNGTOOWNER. ANY PA VM ENTS M A DE BY Til E' OWNE'R Al,"I'll-1-11 TH E' EX Ill RATION Of-'THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS I)NDER CHAI-I-ER 713,PART I.SEC"I'llON 713.13.
FL,ORIDA STATI)TES,AND CAN RESUUr IN VOtIR PAI'INGTWICE FOR IMpROVEMENTSTO N'()IIR PROPIERT'll'.
A NOTICE OF(-'()MNlFN(.'VMFN'lr MI)ST BE RFCORDED AN17) POSTFD ONTFIF JOB SITE PFFORP.Tim PiRST
-R Oil AN Al-[',ORNVV BEIFORE
1NSP1,.',CT1ON. Ill'V011 IN'I*FNI)'I*O OBTAIN FINAN( ING,CONSIA"ll.Volll� IANDE
('0MMF,N('1NC WORK Oil REC'01401INC V01IR NOTICE "ONIME.N('11
OF
NIA'10:01,FLORMA
MUNI I 01cl-INI-LIAN 10.
'9n rc ill 1 01 0 1 sAts hi . lee RX njulel/managel
1k)a 1r -N
Print Nanw
The foregoing instriviient was acknowlOdgeA bellbre'Ile this 'Z— .(lay of 4� 20 /,7,by
,is
1 1 (type of sitilhorily,e.g.officer,frusite,
allornes. in fact)for
(na file or Im rty Oil liwIl 0 If of W Isom i fis I l-u Ille"t "34S C X C c U I ed).
OR Produced Identil'i"tion Nolary Signsfurr
Type of'Identification Pti.x1loced
Name(print)
OR WILLIAM L.POPE
Vcrificafion pursmint to S(cli011 92 �2�, 1 lorlda ','tHluics. Lhidvi penalties of pc Wr), I (IcL hit(- Illal I
the facis ill il ,,tl( ITLI(.1,(1, ll)eq of ilry lind beliuf'� My Comm,Expires Oct.19,2015
Commission No.EE 128745
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COMMERCIAL AND RESIDENTIAL
904-241-0320
ERE PREPARED FOR ONE SPECIFIC PROJECT FOR THE CLIENT LISTED IN THE TITLEBLOCK AND ANY OTHER USE IS PROHIBITED AND VIOLATES COMMON COPYRIGHT LAWS
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THM PL"
City of Atlantic Beach 181
Building Department "assig_ N L-Alal
800 Seminole Road
Atlantic Beach, Florida 32233-5445,
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us
Cityweb-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: .9tPgOnent review r'
Oquired Y No
Applicant: Planning&Zoning
Tree Administrator
Project: Public Works
Public Utilities
Public Safety
Fire Services
Other Agency Review or Permit Required Review or Rec'elpt Date
of Permit Verified_By
Florida Dept.of Environmental Protection
Florida Dept of Transportation
St Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacoo
Other 7
APPLICATION STATUS
Reviewing Department First Review: EApproved. FIDenied.
(Circle one.) Comments:
PLANNING&ZONING Reviewed by: Date:
TREE ADMIN. Second Review: E]Approved as revised. F�DenieW
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SER\ACES Third Review: nApproved as revised. FIDenied.
Comments:
Reviewed by: Date:
Revised 07127/10
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002614 Date 5/29/13
Property Address . . . . . . 149 S OCEANWALK DR
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 10000
----------------------------------------------------------------------------
Application desc
BATH REMODEL
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
SWAIM STEVEN A & TORI S BOSCO BUILDING CONTRACTORS
149 OCEANWALK DRIVE SOUTH 2158 MAYPORT RD.
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 24 1-0 3 2 0
--- Structure Information 000 000 BATH REMODEL
Occupancy Type . . . . . . RESIDENTIAL
----------------------------------------------------------------------------
Permit . . . . . . ELECTRICAL PERMIT
Additional desc . .
Sub Contractor . . ERICKSON ELECTRICAL CONTRACTOR
Permit Fee . . . . 63 .40 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 11/25/13
----------------------------------------------------------------------------
Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 NATIONAl ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE ELEC DCA SURCHARGE 2 . 00
STATE ELEC DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 63 .40 63 . 40 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 67 . 40 67 .40 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, Fl, 32233
Ph(904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: Wk 0 Cf Wig Wa VL 9 PERMIT# 13 ,2� 14_
klOtkl\o_ VV-_�LA , jr-1— SZZ'7-53 WA4# I-U INT �5p)
JEA INFORMATION REQUIRED ON ALL PERMITS Z�Q'0 AMPS \LVIZ,4 VOLTS PHASE
VALUEOFWORKS �-Z_cv
NEW SERVICE El Overhead nderground Underground up Pole
'Residential(Main)Service
LA-100 amps �_1101-150amps -200amps amps #of Meters
E Commercial(Main)Service
F-1 0-100 amps 7--101-150amps �t !151-200amps Ll amps E CT Service amps
Conductor Type Size
y(Main)Service
'Multi-Famil
#of Unit Meters
1-10-100 amps �'101-150amps 11 151-200amps I amps
�Kj
Nop
"Temporary Pole amps
SERVICE UPGRADE I CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
[1100amps 0150amps 0200amps 11 amps [�CT Service amps
ADDITIONS,REMODELS,YXPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: __jeo��0-30amps 3 1-1 00amps 101-200amps
Appliances: 0-30amps 3 1-1 00amps 101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
-1 1 Swimming Pool Ll Sign 1-1 Smoke Detectors_Qty ri Transformers KVA []Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty_volts/amps VALUE OF WORK S
REPAIRS/MISCELLANEOUS
I I Replace Burnt/Damaged Meter Can I I Safety Inspection I I Panel Change I IOH to UG
-1 Other: ?a44404V1_% P4 44 0 r110 �Ocotb
0
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 'Me permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of
construction.
Property Owners Name Phone Number
Electrical Company U�qaa0f&Office Phone ��A\-C(()0(0 Fax
Co. Address: C)4 — V ID� City L�RCV00VA V�UW State F L Zip 7�Z ZA
License Holder(Print): —State Certification/Registration# 0001;�Z_0
Notarized Signature of License Holder
s Of
d subsc bed bef is d of 2(43
0
KA'�G
i-�A` ()mMlSS*N#0*%?
�-MRES-February 1 2014
blic e fNo Pub=ic
nded Thru NotarY Public e of No
t st CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
- 19
Application Number . . . . . 13-00002614 Date 5/24/13
Property Address . . . . . . 149 S OCEANWALK DR
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 10000
----------------------------------------------------------------------------
Application desc
BATH REMODEL
----------------------------------------------------------------------------
Owner Contractor
------------------------
------------------------
SWAIM STEVEN A & TORI S BOSCO BUILDING CONTRACTORS
149 OCEANWALK DRIVE SOUTH 21S8 MAYPORT RD.
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(9 04) 24 1-03 2 0
--- Structure Information 000 000 BATH REMODEL
Occupancy Type . . . . . . RESIDENTIAL
----------------------------------------------------------------------------
Permit . . . . . . PLUMBING PERMIT
Additional desc 6 FIXTURES
Sub Contractor COGBURN AND WAKEFIELD PLBG
Permit Fee . . . . 97 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 11/20/13
----------------------------------------------------------------------------
Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 NATIONAl ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 97 . 00 97 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 101 . 00 101 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: 4 S 0(� L_)k I �_ PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FixTURE QTY TYPE OF FixTuRE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
RE-PIPE:
TYPE OF FixTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
[:i Sewer Replacement F-i Back Flow Preventer Ei Grease Interceptor (Trap) gallons(Requires 3 sets of plans)
F-i Lawn Sprinkler System-Number of Heads Ei Well
** SJR WD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.
1-1 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.
Property Owners Name C>_5 Cc) Z LA 11 d f-M �A Phone Number 016 1- 2,q 1'C)3
Plumbing Company 1� WAIISILU OUlt-n. OfficePhone
���Cl'ity State
Co. Address: (0 01 +.&,,,�' L-) s;- - �Zip 3-22 (0
License Holder(Print): aA,% 0"C. �)L J PI-) State Certification/Registration FL 114 2-8t Lf 6
Notarized Signature
OWISSON#EE0573413e re m/his day of 20
MY C 2 ,2015 .
EXPIRM M . Underw
nded Thru NOWY
ure of N!tic
C, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
arl I
Application Number . . . . . 13-00002740 Date 5/28/13
Property Address . . . . . . 149 S OCEANWALK DR
Application type description MECHANICAL HVAC ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
----------------------------------------------------------------------------
Application desc
DUCT MODIFICATION ONLY
----------------------------------------------------------------------------
Owner Contractor
------------------------
------------------------
SWAIM STEVEN A & TORI S HAMMOND AIR CONDITIONING INC
149 OCEANWALK DRIVE SOUTH 3412 GALILEE ROAD FL 32207
ATLANTIC BEACH FL 32233 JACKSONVILLE
(904) 626-6867
----------------------------------------------------------------------------
Permit MECHANICAL HVAC PERMIT
Additional desc . -
Permit Fee . . . . 75 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 11/24/13
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE MECH DCA SURCHARGE 2 . 00
STATE MECH DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 75 . 00 75 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 79 . 00 79 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
MECHANICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,Fl, 32233
Ph(904)247-5826 Fax(904) 247-5845
JoBAiDDRESS: hq L)�- - 5 , PERmrr#
PROJECT VALUE $ GO0 .00— ARI# REQUIRED
Air Handling Equipment Only Air Handling Unit & Condenser Condenser Only
NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION
Air Conditioning: Unit Quantity_ Tons Per Unit
Heat: Unit Quantity BTU's Per Unit Seer Rating REQUIRED
Duct Systems: Total CFM
REPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION
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 MISCELLANEOUS:
Prefabricated Fireplace Qty_ Automobile Lifts
Gas Piping Outlets Boilers BTU's
Elevators scalators
ALL OTHER GAS PIPING Heat Exchanger
Quantity of Outlets Pumps
9 Vented Wall Furnaces Refrigerator Condenser BTU's
9 Water Heaters Solar Collection Systems
Tanks (gallons)
Wells
OTHER: T�QcA-
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.
Property Owners Name Phone Number C104- '2�1 I-0 32-Q
Mechanical Company Office Phone Fax
city 11 Statet—L. Zip-3 -7
Co. Address: 11 GIL 2aQ—
License Holder(Print): S teCertification/Registration# Q-K,�3'�lG�\'�-,C>
FL--D W-A 55 3-0'15-1 H
Notarized Signature of License Holder
Before me this of 20
Signature of Notary Publi AL
MYC SSION#FF011480
EX S-Aphl24,2017
Bonded Thru Notary Public