1022 Main Street - Prefab Fireplace i �J jI .
I II CITY OF ATLANTIC BEACH
-
s 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
MECHANICAL HVAC PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814
JOB INFORMATION:
Job ID: 16 -MECH -243
Job Type: MECHANICAL HVAC ONLY
Description: prefab fireplace
Estimated Value:
Issue Date: 2/1/2016
Expiration Date: 7/30/2016
PROPERTY ADDRESS:
Address: 1022 MAIN ST
RE Number: 170996 -0000
PROPERTY OWNER:
Name: MASTERS, RALPH
Address: 1022 MAIN ST
GENERAL CONTRACTOR INFORMATION:
Name: L D PHILLIPS COMPANY
Address: 12544 Sapp RD
Phone: 904 - 387 -5590
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:
Prefabricated Fireplaces $7.00
State Mech DBPR Surcharge $2.00
State Mech DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUIL DING APP ATION h�
CI F TLAN BEACH / — "'
800 Seminole Road, Atlantic Beach, FL 3223 / -
Office (904) 247 -5826 Fax (904) 247 -5845
.-r)--1–ktcai Job Address: /Q a in Q a o 3
Permit Number:
Legal Description Parcel #
Valuation of Work $ .1„ /V) ov PProposed Work he ted /cooled t
non - heated /cooled
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool /spa window /door
Use of existing /proposed structure(s) (circle one): Commercial • - sidentia
If an existing structure, is a fire sprinkler system installed? (Circle one): ' es o N /A
Florida Product Approval #
For multiple products use product approval form
•
Describe in detail the type of work to be performed: 1 ,,,,. * ` 0 •
/
/
Property Owner Information: / �•, i
Name: % {Y) _ , ` ■ ∎ Address: /Q y3.i rJ /J.
City 0 .l1w � - i p Phone /) 7 /..,9 y
- ‘ /f
E -Mail or Fax # (Optional) V , awAru, arn
Contractor Information: CONTRACTOR EMAIL ADDRESS: ph; i1 j p,53 Mr° //� /
n P
�';Dn�C.r St, e:4-- Company Name:L•> PAT A SCfj y Quali A : Dp f j5 rah W P4 S
Address: / A 4.1.S � � � -�in' g en g
Office Phone ' • c/ Cit C kson ✓i /he State rL zp (9� ,p .2 4
�0 - 33 5 5 ,0 Job Site/ Contact Number Fax # %t 3 8 7- 5 5 �fQ
State Certification/Registration #
Architect Name & Phone #
Engineer's Name & Phone #
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not conmenced within six (6) months, or if construction or work is suspended or abandoned for a__pperiod of six (6) months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters,
Tanks and Air Conditioners, etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances g9verning this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate dr cancel the
provisions of any other federal, state, or local law regulating construction or the performance of construction.
Signature of Owner Signature of Contractor r 11 •
?rint Name Print Name h Ea h LAI 11.
3efore me �'"�
his Day of 20 Be • • ne �;
D. of t � /(1
20
"k Notary Public State of Florida
dotary Public „'' I A —
r Y hly Commision FF 086990 = Public ,
EOFf�d` Expir 02/1
Revised 01.26.10