200 5TH ST MECH GAS PIPING CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
' -" ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
r
MECHANICAL GAS PIPE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-MCHG-502
Job Type: MECHANICAL GAS PIPING
Description: fireplace -wood
Estimated Value:
Issue Date: 3/9/2015
Expiration Date: 9/5/2015
PROPERTY ADDRESS:
Address: 200 5TH ST
RE Number: 170174-0000
PROPERTY OWNER:
Name: RIPLEY TRUST, MARGARET J
Address: 200 5TH ST
GENERAL CONTRACTOR INFORMATION:
Name: SETZERS & COMPANY
Address: 7660 PHILLIPS HWY QA WILLIAM D. SNEAD
Phone: -
FEES:
Gas Piping Units $0.00
State Mach DBPR Surcharge $2.00
State Mach DCA Surcharge $2.00
Trade Permit Base Fee $62.00
Total Payments: $66.00
PERMIT IS APPROVED ONLY N' ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
MECHANICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904)247-5845
B ADDRESS: aff) -S 4_ ,O�,4 PERMTT#
PROJECT VALUE$ J°19 l,81r
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
ARI#
Air Conditioning: Unit Quantity Tons Per Unit REQUIRED
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)
rtRE PLACESMISCELLANEOUS:
Prefabricated Fireplace Qty _ t 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 dues 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 cannot. 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 kov
.-. 7l. 1, C�fMPhone Number �3 F,- q ft,
MechanicalCompany Buzzy-5 Office Phone751-4rpt) Fax 21LL 3S
Co. Address: &D 0 Ph, 11p5� ,u City32
State-I(,—Zip 3 �aG
License Holder(Print): 4tT(212-_LtS State Certification/Registration# ?JU$(oi)
"tarized Signature of License Holder
Sworn and subscribed before me this day of 20_
Signature of Notary Public