258 PINE ST MECH GAS PIPING 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-894
Job Type: MECHANICAL GAS PIPING
Description: GAS FOR COOKTOP
Estimated Value:
Issue Date: 4/16/2015
Expiration Date: 10/13/2015
PROPERTY ADDRESS:
Address: 258 PINE ST
RE Number: 170553-0000
PROPERTY OWNER:
Name: DEL GALLOWAY, CHARLES
Address: 912 NW F ST APT 700
GENERAL CONTRACTOR INFORMATION:
Name: AA BOTTLED GAS COMPANY INC
Address: 12601 N MAIN ST EDDIE GENE THIGPEN
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: $69.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
MECHANICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(9/04)247-5826 Fax(904)247-5845
JoB ADDRESS: 11YL & s G, PERMIT#
PROJECT VALUE$ /t 0 O
NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION
Air Conditioning: Unit Quantity Tons Per Unit
Heat: Unit Quantity BTU's Per Unit Seer Rating_
Duct Systems: Total CFM REQUIRED
REPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION
Air Conditioning: Unit Quantity Tons Per Unit ARI#REQU�I1 EDED
Heat: Unit Quantity BTU's Per Unit 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: tit Gt /l`n� /ar L � i-,knd G70�cf
UWIM , pante r ��
Permit becomes void Ifwork does not commence within a six month period or work is suspended or abandoned for s&months.l 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 my other state or local law regulation construction or the performance of construction.
Property Owners Name /�,] ,�, , ��,/_ I /� Phone Number
Mechanical Company, /* ri�rt;r-fC�G L-O Office Phone
S Z'�Fax /— 067
Co.Address: IPWI Al• ,11?&$t <5/keg; ' City <1" tl/I/L State rL'-Zip 3ZZ?la,
License Holder(Print): Fi t State Certification/Registration# D/ 3 3 D
Notarized Signature ofLicense Holder �nz ou. Flp/ �Rly�p'1'111v'7/0%�
Sworn and subscribbefo a this day of 20��
Signature of Notary Puedblic
DONNA MILLER
MY COMMISSION M Pp%1]A
EXPIRFS:Omihcil,3a1]