303 10TH ST - GAS PIPING �' ' ` � CITY OF ATLANTIC BEACH
1 ,� ,� 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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MECHANICAL GAS PIPE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-MCHG-779
Job Type: MECHANICAL GAS PIPING
Description: GAS PIPING -4 OUTLETS & ONE WATER HEATER
Estimated Value: $1,145.00
Issue Date: 4/1/2016
Expiration Date: 9/28/2016
PROPERTY ADDRESS:
Address: 303 10TH ST
RE Number: 170063-0000
PROPERTY OWNER:
Name: BOUY, KIM L
Address: 303 10TH ST
GENERAL CONTRACTOR INFORMATION:
Name: FIRST SOURCE GAS APPLIANCES
Address: P O BOX 1192
Phone: - -
FEES:
Gas Pipe Outlets $10.00
Gas Piping Vented Units $5.00
State Mech DBPR Surcharge $2.00
State Mech DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $74.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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MECHANICAL PERMIT'• PPLICATION
(r) ,... .... ...; CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845
JOB ADDRESS 303 10t"STREET PERMIT#
`J/ PROJECT VALUE S 1145.00 AN REQUIRED
_Air Handling Equipment Only Air Handling Unit&Condenser _Condenser Only
C. ) NEW AIR CONDITIONING&HEATING SYSTEM INSTALLATION
��ll �� Air Conditioning: Unit Quantity Tons Per Unit
n r Heat: Unit Quantity BTU's Per Unit Seer Rating
W Duct Systems: Total CFM REQUIRED
L
REPLACEMENT AIR CONDITIONING&HEATING SYSTEM INSTALLATION
Air Conditioning: Unit Quantity Tons Per Unit
Heat: Unit Quantity BTU's Per Unit Seer Rating
oDuct Systems: Total CFM REQUIRED
V) 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)
c-----r- 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 4 Pumps
#Vented Wall Furnaces Refrigerator Condenser BTU's
#Water Heaters 1 Solar Collection Systems
Tanks(gallons) . -
Wells
•
OTHER:
Permit 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 '
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,:,:
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 E ?ell so • KiM Phone Number
Mechanical Company first source ias appliances Office Phone 904-225-5754 Fax
Co.Address: 463241 SR 200 City Yu .,_ State FL Zip 20' ..
License Holder(Print): William Smith P' ∎■ 'egistration#_31470
Notarized Signature of License Holder X( e .
KELLI SCAHILL �� '�iefore me this ' day of VI 20 'A
+° o's Notary Public-State of Florida ,/
�` • Commission•FF 189863 Itiinature of Notary Public f. Q�� Q nU Q p•`- d,•` My Comm.Expires Jan 14,2019
f0`"¢ Bonded tram*Nation/NdlryAnn
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
PHONE (904) 247-5955
Cashier Id: aspcust\atlblae
Receipt Date: 4/1/2016 3:22:21 PM
Receipt Number: OS-69584
Job ID: 16-MCHG-779 - GAS PIPING - 4 OUTLET
Job ID: 16-MCHG-779 - GAS PIPING - 4 OUTLET
Job ID: 16-MCHG-779 - GAS PIPING - 4 OUTLET
Job ID: 16-MCHG-779 - GAS PIPING - 4 OUTLET
Job ID: 16-MCHG-779 - GAS PIPING - 4 OUTLET
Amount Due: $74.00
Tender Information: Cash $74.00
Tender Type: CC
Tender Amount: $74.00
Change Due: $0.00