275 NAUTICAL BLVD - GAS PIPING i , , CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
5 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: 16-MCHG-639
Job Type: MECHANICAL GAS PIPING
Description: 1 outlet
Estimated Value:
Issue Date: 3/16/2016
Expiration Date: 9/12/2016
PROPERTY ADDRESS:
Address: 275 S NAUTICAL BLVD
RE Number: 170703-0373
PROPERTY OWNER:
Name: BRUGGEMAN OLIVE H & TOM, *
Address: 275 S NAUTICAL BLVD
GENERAL CONTRACTOR INFORMATION:
Name: Hall's Gas Services, Inc.
Address: 11428 Princessa Lane Jacksonville, FL 32218-4054
Phone: - -
FEES:
Trade Permit Base Fee $55.00
State Mech DCA Surcharge $2.00
State Mech DBPR Surcharge $2.00
Gas Pipe Outlets $10.00
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
JOB ADDRESS: o7 7 5 .44( a/ al PERMIT#
PROJECT VALUE $ G cr. 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_
Duct Systems: Total CFM REQUIRED
REPLACEMENT 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
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 f (e.;-. Pumps
#Vented Wall Furnaces Refrigerator Condenser BTU's
# Water Heaters Solar Collection Systems
Tanks (gallons)
Wells
OTHER:
'ermit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.I hereby certify that I have read
his 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
tot. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction.
koperty Owners Name 6/105-c,49,\ Phone Number ,2'l9.301-Z
90
✓Iechanical Company )44//:s 6fs ..cr1-'u5 c Office Phone 70/6 Fax
:o. Address: I(tid` PO4 uss,-, City Jai x State Fc Zip /?
License Holder(Print): ZFysh, / ys/' State Certification/Registration# 3 711
Jotarized Signature of License Holder A .i
Before me this /6 .- of AM/ 20 J(0
Signature of Notary Public •
Y"e Notary Public State of Florida •
d� Shirley L Graham