130 CLUB DR - GAS PIPING (2) 6 . CITY OF ATLANTIC BEACH
r. A %' 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: 16-MCHG-609
Job Type: MECHANICAL GAS PIPING
Description: gas piping 2 outlet 1 water heater 1 tank
Estimated Value: $1,195.00
Issue Date: 3/25/2016
Expiration Date: 9/21/2016
PROPERTY ADDRESS:
Address: 130 CLUB DR
RE Number: 170319-0000
PROPERTY OWNER:
Name: Shields, David
Address: 53 Oceanside DR
GENERAL CONTRACTOR INFORMATION:
Name: FLORIDA PROPANE PARTNERS
Address: 461 TRESCA RD TIM CALLAHAN
Phone: - -
FEES:
Trade Permit Base Fee $55.00
State Mech DCA Surcharge $2.00
State Mech DBPR Surcharge $2.00
Gas Piping Vented Units $5.00
Gas Pipe Outlets $10.00
Total Payments: $74.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
MECHANICAL PERMIT APPLICATION
CITY OF ATLANTIC $EACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845
JOB ADDRESS: ,l co ( t Qr. PERMIT#
PROJECT VALUE$_41_11:L.----' — 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 a Pumps
#Vented Wall Furnaces Refrigerator Condenser BTU's
#Water Heaters __1-_ Solar Collection Systems
Tan(gallons) 2 To uA6ervi�,.A. .
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 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 E 1;t-G (—,.0,-+e i _ Phone Number GM LIZ 1g
Office Phone Company Ej lc �f� ar hei M f_642.1231 Fax 9'1 DI 0-77)
Co.Address: t/aTn!Sr c ,Q City d tS So 4 v:i t c State E._Zip 3222,5--
S 2 Z Z 5
License Holder(Print): ., State Certification/Registration# 3 b('
Notarized Sinner ure q'1 irence Milder .---...__
if r. MUSED REVES MORENO ®lr`
•: r MycopmassiON/FP9037Eo Before me this I day of V Ir��. 20_1!--' —
EXPIREa MOM 03.zoto /), ,
Aesis.+� ,,a,,,b,a,,,, signature of Notary Public ��` - .rte )►i 1 el
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