1230 Ocean Blvd 2014 HVAC CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
MECHANICAL HVAC PERMINTLANTIC BEACH, FL 32233
CALL BY 4PM FOR NEXT DAY IriRWUO"�17MIkE LINE 247-5814
JOB INVbJ3�-
Job ID: 14-MECH-218
Job Type: MECHANICAL HVAC ONLY
Description: 3.5 TONS, 42K BTUS
Estimated Value:
Issue Date: 10/14/2014
Expiration Date: 4/12/2015
PROPERTY ADDRESS:
Address: 1230 OCEAN BLVD
RE Number: 171821-0000
PROPERTY OWNER:
Name: ETTLINGER, ELLIOTT FARRELL
Address: 1230 OCEAN BLVD 1230 OCEAN BLVD
PERMIT INFORMATION: Sticker for overcurrent protection must be on A/C equipment prior to
inspection. Failure to comply will result in a failed inspection and reinspect fees. No
exceptions.
FEES:
Furnaces and Heating $20.00
AC and Refrigeration $28.00
State Mech DBPR Surcharge $2.00
State Mech DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $107.00
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
JOB ADDRESS: /;, ea/L 9/2,/o/ PERMIT #
PROJECTVALUE $ 3-206, P10 A"# 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 54—
BTU's Per Unit—�7,2�rt
Heat: Unit Quantity I Seer Rating
Duct Systems: Total CFM REQUIRED
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/Escalators
ALL OTHER GAS PIPING - Heat Exchanger
Quantity of Outlets Pumps
#Vented Wall Furnaces Refrigerator Condenser BTU's
# 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 1 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
Mechanical Company ffice one Fax
Co. Address: V city State L r-1 Zip
C n#
LieenseH Ider rint State Certification/Registratio 7/
tarized i at re q s er
Beforeme is of 0 C+ 20
#
M�rommls 17 Signature of Notary
fil 4 6ters PUbli
A
I
Oct. 14. 2014 1 : 55PM No. 0830 _. 1
ACC)ROr CERTIFICATE OF LIABILITY INSURANCE ATE(MM]DD/YYN)
P 10/14/2014
THIS CERTIFICATE IS ISSUE13 AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT- If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVE0,subject to
the terms and Conditions of the policy,certain pwicies may require an endorsement- A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s)
PIZODUCrA 20 NTeCT
NA CertifIcate Desk
Zellner Insurance Agency PHONE (904)356-1492 FA
4114 Sunbeam Road,Wte 101 (Afr Nh F") (Al")�.(904)354-4328
E-MA L
11
JacksonvIlle FL 32257 ADDRESS- carilficates@zellnerinusrance.com
INSURER(S)AFFORDINL�QWRAOE
IN§waEaA_;_NaticI Insurance Company
INSURRO INSURIER t
Sub Tropic Air&Heat LIc
135 Levy Roaci INSURER D,
Atlantic:Beach FL 32233 1NSuRrR 41 1
INSURER F: I
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER.,
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ADDL, POLICY EFF POLICY FXP
TYPE OF INSURANCE S.U" POLICY NUM�91R (Mwbbtywyl LVAIY5
A X COMMERCIAL GENERAL LIABILITY ACPGLD05935380514 11/23/2014 11/23/2015 EACH OCCURRENCE ___- 1�0 00 1 000
DAMA(3E TO RENTED
CLj4jk1S-,MADE 71 OCCUR PRFMIRF.9( A,�eel4err—� $ 100,000
MED EXP Al�zP6 person) $ 5,000
PERSONAIL&ADV INJURY 5 1,()00,0()0
'L AGGREGATE LIM17 APPLIES PER: GENERAL AGGRFGATr S 2,000,000
POLOY:r—J J"ERCOT- 7 LOC PRODUCTS-COMPIOP AGG S 2,000,000
OTHER! $
COIAGINED SINGLE LIMIT
AUTOMOBILE LIABILITY
(EA gccid,ntl
ANYAJTO BODILY INJURY(Per parson)
ALL OWNED SCHEDULED BODILY ZLRY s
AUTOS AUTOS
MON-OWNED PROPERTY DAMAGE
HIR20 AU70S AUTOS (PAr An'lcianl)
$
UMBRELLA LIAS OCCUR EACH OCCURRENCE $
EXCESS LIA B H
CLAIMS-MACE GGREGATE
DEE) � �_RF'rNTION I
WORKERS COMPENSATION �FRT OTH.
ANO eMPLOYERS'LIABILITY Y�N �TA 1ITP EIR
ANY PROPRETORMARTNERIEXECUTNE E,L.EACH ACCIDENT s
OFFICERIMEMBEIR EXCLUDE[ N/A
(Mandatory in NH) El DISEASE-E6�EMPQQYE��
I. ....cr'e un,19,
14"16RIPTICI OF OPFP&71QW�,K.1— El DISEASE-POLtCY LIMIT
DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACOR0 i bl,AddItIonal Romarks SchadU19,mPy ba attechod if mote space is required)
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CERTIFICATE HOLDER CANCELLATION A1001045
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREor, NOTICE WILL BE DELIVERED IN
City Of Atlantic Beach ACCORDANCE WITH TOE POLICY PROVISIONS.
800 Seminole Road r__. 11-7
A NITATIVE
I Atlantic Beach FL �2233 T140 CSE CAL/�
— 8, ACORD ORATION. All rights reserved.
ACORD 25(2014/01) The Ar7ORD name and logo are registered marks of ACIORD