2233 SEMINOLE RD # 19 HVAC - jrlly1-
AV' , \s v CITY OF ATLANTIC BEACH
-- ti 800 SEMINOLE ROAD ti " 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 -887
Job Type: MECHANICAL HVAC ONLY
Description: 1 cu 1 ahu 2 tons
Estimated Value: $3,000.00
Issue Date: 4/15/2016
Expiration Date: 10/12/2016
PROPERTY ADDRESS:
Address: 2233 SEMINOLE RD UNIT 019
RE Number: 169519 -0136
PROPERTY OWNER:
Name: SAMARA, BRENDA
Address: 2233 SEMINOLE RD UNIT 19
GENERAL CONTRACTOR INFORMATION:
Name: DONS AIR CONDITIONING INC
Address: 2403 KELLOW CIR QA DONALD ANTHONY CICALE
Phone: - -
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:
Trade Permit Base Fee $55.00
State Mech DCA Surcharge $2.00
State Mech DBPR Surcharge $2.00
Furnaces and Heating $24.00
AC and Refrigeration $16.00
Total Payments: $99.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
7t6' kit
MECHANICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH yy � _ tg 7
800 Seminole Rd Atlantic Beach, FL 32233 f �D " , r `
Ph (904) 247 -5826 Fax (904) 247 -5845
JOB ADDRESS: J � 3 S 1Vt! A/0 h o /.L) OR.` 7 1 / j 3' ?z .� PERMIT #
PROJECT VALUE $ .-_?,e C 0 ARI # t ffl 6-0 ' `-r 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 1 Tons Per Unit -- /1-1
Heat: Unit Quantity 1 BTU's Per Unit ; f C c C 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 Pumps
# Vented Wall Furnaces Refrigerator Condenser BTU's
# Water Heaters 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 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 C L 1VAc k `c' "" A t2 Phone Number i b q" ,S 3 n Y
sic L`
Mechanical Company ho Ns A c, Off7ce v hone 3 1 7 "7-grz t h'ax 3 q , �-1(-5 `?a- -o
Co. Address: )-(4 20 k( k(- Grin City 3eay, State /CL Zip g 2 j '
License Holder (Print): 1 .0 /} tc,4 State Certification/Registration # eilco (er-
Notarized Signature of License Holder -^ nn - .ate l
0 ,� s r w, Notary Public State of Florida Before me this l day 20
D Smallwood
< d' �o< My ExpiCommissio
r es 111 31 2 n 01 FF 8 082925 Signature of Notary Publ'
�.