1804 SELVA GRANDE DR HVAC CITY OF ATLANTIC BEACH
f-7; 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 -979
Job Type: MECHANICAL HVAC ONLY
Description: 1 CU 1 AHU 2 TONS
Estimated Value:
Issue Date: 4/27/2016
Expiration Date: 10/24/2016
PROPERTY ADDRESS:
Address: 1804 SELVA GRANDE DR
RE Number: 169542 -5002
PROPERTY OWNER:
Name: LIVERMORE, LAURA M
Address: 1804 SELVA GRANDE DR
GENERAL CONTRACTOR INFORMATION:
Name: DAVID GRAY HEATING AND AIR INC
Address: 6491 S POWERS AVE RYAN C ZABINSKY
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.
MECHANICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247 -5826 Fax (904) 247 -5845
C
TOB ADDRESS: I goo E LV14 G/ /-1 Ni ) - 7?j -?N % ie- — 6&- - i PERMIT #
3 ; a33
PROJECT VALUE $ 1 4C - 59 l . (08 ARI # e31'753- REQUIRED
_Air Handling Equipment Only Air Handling Unit & Condenser Condenser Only
vEW 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 a--
Heat: Unit Quantity I BTU's Per Unit Aa, ovc.) 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
riot. 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 LOW /Z 4 �tq k- /t'/ Phone Number 90q- - q -�14O
goy e3vy
-
Mechanical Company 1,q i> » i) a 2fJ )--k )--k � Al /f5 ' v « 2 Office Phone 7 , `+ - /an Fax //ail- 59a"
Co. Address: (2 ( -f 9 / � L) t,c.) &P S Av C- City \.JA ckunu; / / &State 1 Zip L3 / 7
License Holder (Print): y AN X R b ,Sk£( State Certification/Registration # d4£? hg 788(0
Notarized Signature of License Holder - �k. /,,1 /1z.
' ri f A PA,'L 20 /Z0
OZOZ15120 sai!dx3 � "'° ,., ', Befor me this day
£ygo96 dd uo!ss!wwOO' b' a. saleJoW W I! ON '44 � Si nature of Notary Public `l) . `�) io4a J 2
ePiqu 1 ale1S 0!IQnd keloN nd utO
o g Y '_I