700 SAILFISH DR HVAC PERMIT rjy1,`lr
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CITY OF ATLANTIC BEACH
j 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-1384
Job Type: MECHANICAL HVAC ONLY
Description: MECH - DUCT REMODIFICATION
Estimated Value: $500.00
Issue Date: 6/15/2016
Expiration Date: 12/12/2016
PROPERTY ADDRESS:
Address: 700 SAILFISH DR
RE Number: 171210-000
PROPERTY OWNER:
Name: DAWSON ET AL, STACY ANN
Address: 700 E SAILFISH DR
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:
Air Duct System $20.00
State Mach DBPR Surcharge $2.00
State Mach DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $79.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
MECHANICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904)247-5845 -rv�eC 3O
Jog ADDREss: /rr 92 <4 it P,5[L( � _PERMff# `t
PROJECT VALUE$ SOU Apj# REQUIRED
_Air Handling Equipment Only _Air Handling Unit & Condenser _ Condenser Only
NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION
Air Conditioning: Unit QuantityTons 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 QtyAutomobile Lifts
Gas Piping Outlets Boilers BTU's
Elevators/Escalators
ALL OTHER GAS PIPING Heat Exchanger
Quantity of Outlets Pimps
#Vented Wall Furnaces Refrigerator Condenser BTU's
#Water Heaters Solar Collection Systems
Tanks(gallons)
Wells
DTHER: lgct4CtCA7ton
'emit 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
rot. The permit does not give auth_o�nJty to violate the provisions of my other state or local law regulation construction or the perfo ce con`Mcmm*
amperty Owners Name ler - Lam/..- I Phone Numbe
dechanical �j Office Phone Fax
'o.Address: City State_Zip
.icense Holder(Print): to Certification/Registration#
iotariyed Signature ofLicens r
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s sa,e.emNrar Pubr[uN tureofNotary Public
CITY OF ATLANTIC BEACH
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'OWNER/ BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART i 'CONSTRUCTION
CONTRACTING'REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAVH.
FSELLOR
URE STATEMENT FOR SECTION 489.103('1),FLORIDA STATUTES:
TATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
E EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS
N CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE ON TRU NYO YOURSELF, YOU MAY BUILD OR IMPROVE A ONE—OR
MILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THR B I DING
BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
ELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION, YOU MAY NOT
HIM AN UNLICENSED PE ON AS YOURCONTRACTOR, YOUR CONSTRUCTION MUST'
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICES REQLMD BY STATE LAW AND BY COIM OR ! BC 4L CEN ING
ORDINANCES
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN-OCCUPATIONAL LICENSE'IS NOT ADEQUATE THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY 'CERTIFICATE OF COMPETENCY' OR THE FLORIDA "CONTRACTORS
CERTIFICATE' TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR, TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT;I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT. (] .1 �+ �j
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