286 POINSETTIA ST 2015 HVAC \j
I' ll SS CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
dji 1
MECHANICAL HVAC PERMIT
MUST CALL BY 4PM FOR NE)(T DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-MECH-431 ONLY
Job Type: MECHANICAL HVAC
Description: 2.5 TONS 30K BTUS
Estimated Value:
Issue Date: 2/27/2015
Expiration Date: 8/26/2015
PROPERTY ADDRESS:
Address: 286 POINSETTIA ST
RE Number: 170568-0010
PROPERTY OWNER:
Name: ARWEN, BUNRINGO
Address: 286 POINSETTIA ST
GENERAL CONTRACTOR INFORMATION:
Name: AIR SOURCE AMERICA INC
Address: 2615 CRYSTAL COVE CT RICHARD E EPPERSON JR
Phone: 904-233-8831
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 $20.00
State Mech DBPR Surcharge $2.00
State Mech DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $99.00
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
- PERmrr#
JOB ADDRESS: -2- %14'--�- "" " k-
PROJECT VALUE $ F55 XD-2 ARI# REQUIRED
Air Handling Equipment Only 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 �Z-'S Seer Rating \ '-A
Heat: Unit Quantity BTU's Per Unit��O—.c—<> 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/Escalators
ALL OTHER GAS PIPING Heat Exchanger
Quantity of Outlets Pumps
#Vented Wall Furnaces Refrigerator Condenser BTUs
#Water Heaters Solar Collection Systems
Tanks(gallons)
Wells
OTHER:
d or pended or abandoned for six months.I hereby certify that I have read
Permit becomes void if work does not commence wi in a six month perio work is sus
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.
Phone Number -N
Property Owners Name
Office PhoneZ�b -1Z
�1 Faxn-7---':�V
Mechanical Company
City-_\A. State-'E�—.- Zip
Co. Address:
State Certification/Registration#
License Holder(Prin
Notarizei&* atmV-fff bib;amse Holde
NOTARYPLSW B 20 1 P-i
n
STATE OF FLOWA Be e this d o
Comm$FF129M Signature of No u lic
E)OM9 6/412018