300 5th st 2015 GAS CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
MECHANICAL GAS PIPE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-MCHG-674
Job Type: MECHANICAL GAS PIPING
Description: GAS OUTLET
Estimated Value:
Issue Date: 3/20/2015
Expiration Date: 9/16/2015
PROPERTY ADDRESS:
Address: 300 5TH ST
RE Number: 169827-0500
PROPERTY OWNER:
Name: JERNAGAN 111, LOUIS R & HOPE V,
Address: 300 5TH ST
GENERAL CONTRACTOR INFORMATION:
Name: GAS APPLIANCE SPECIALISTS
Address: 4007 SAN BERNADO DR DANIEL M SMITH
Phone:
FEES:
Gas Pipe Outlets $10.00
State Mech DBPR Surcharge $2.00
State Mech DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $69.00
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 j lq,4,4 C - 6
JOB ADDRESS: ?>ero S-tt 4- -%� Ar,wv?, 0 TWO PERMIT#
PROJECT VALUE $ 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 (Requires 3 sets of plans)
Fire Sprinkler System Quantity
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 Hoo Quantity (Requires 3 sets of plans)
(Requires 3 sets of plans)
Fire Suppression Systems Quantity
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 BTU's
#Vented Wall Furnaces Refrigerator Condenser
#Water Heaters Solar Collection Systems
Tanks(gallons)
Wells
OTHER: ble'-6f 4r,� ie !t
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.I iiereby 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 V. —PhoneNumber
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Co. Address:
License Holder(Print): /Vi. State Certification/Registration#
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Notarized Signature of License Holder D
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