95 LEVY RD - GAS PIPING f, r
\s\ CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
!3 V =" ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
r'/ c
MECHANICAL GAS PIPE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-MCHG-2139
Job Type: MECHANICAL GAS PIPING
Description: install four 120-gallon above-ground propane tanks
Estimated Value: $500.00
Issue Date: 9/26/2016
Expiration Date: 3/25/2017
PROPERTY ADDRESS:
Address: 95 LEVY RD
RE Number: 172247-0000
PROPERTY OWNER:
Name: 95 LEVY ROAD INC
Address: PO BOX 330108
GENERAL CONTRACTOR INFORMATION:
Name: WESTERN NATURAL GAS COMPANY
J. Kenneth Baker, 13035 - FL Dept. of Agriculture Master
Qualifier
Address: 2960 STRICKLAND ST
Phone: - -
FEES:
Gas Piping Units $18.00
State Mech DBPR Surcharge $2.00
State Mech DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $77.00
I'ERiNIIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
09/23/2016 09:21 9043876034 WESTERN NATURAL PAGE 01/01
MECHANICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845
140- M CW-i- 39
JOB ADDRESS:_____q..5_1_,-L___4_:1/y
t/ I fi'l—' C , FL PERMIT#
PROJECT VALUES 5OD 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
PREVENTION ,G O N S a LUES eFIRE
Fire Sprinkler System Quantity (Requires 3 sets of plans) .W N Clip
Fire Standpipe Quantity (Requires 3 sets of plans)
Underground Fire Main Value (Requires 3 sets of plans) 6 C Ci rn
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 , L Solar Collection Systems
--1-Tanks (gallons) ,a/0
Wells
OTHER: ,. , ' di - . Zd ... • ' .':�r�_ .44.4...:11 ;#— -147,1
'cmtit 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 t 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
iot. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction.
'roperty Owners Name I ., . 1 rd- ", ,.S , - $�v‘' 2-0 Ra Phone Number 953-5/2 '
vlechanical Company_LUL 1—e,rr-, ( (, .../ G Office Phone.i77-3S/( Fax
~o. Address: 210 ��{Y'1 � �- � - City QCksm�V�-/L - State .
Zip a 2ZSf
.,icense Holder(Print): <7
/-�-w'dui e /b' /,r9.r_,› S ate ertifycation/Registration# 6 6 51-71 3
Notarized Signature of License Holder— ,/./ -:_-2,---7--- '; -
,'�'"r"a•4• WILLIAM T TATE f me this Z?- day of -te r r- -_20 ,'/ ,-'r Notify Public•State of Florida
I ,..,, ,; cominI p O •FF 98'5603 lguature of Notary Public •
,s�;,• My Cornet Expires Aug 7,2020 1
ATLANTIC BEACH
J
> PERMIT RECEIPT
\73V
September 23, 2016
PERMIT DESCRIPTION: install four 120-gallon above-ground propane tanks
C
PERMIT NUMBER: 16-MCHG-2139
ADDRESS: 95 LEVY RD
OWNER: 95 LEVY ROAD INC
Gas Piping Units $18.00
State Mech DBPR Surcharge $2.00
State Mech DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Totals: $77.00
CITY OF ATLANTIC BEACH
800 SEMINOLE RD PAID
ATLANTIC BEAC,FL 32233
09/26!2016 15:25:40
CREDIT CARD SEP 26 2016
VISA SALE
Card tt CITY OF ATLANTIC BEACH
XXXXXXXXXXXX8147
SEQ#:
Batch#: 213
INVOICE
Approval Code: 06205D
Entry Method: Manual
Mode: Online
Card Code:
SALE AMOUNT $77,00
CUSTOMER COPY