130 Poinsettia St HVAC permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
U
MECHANICAL HVAC PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-MECH-2277
Job Type: MECHANICAL HVAC ONLY
Description: replace one (1) 2.0-ton AHU
Estimated Value: $3,680.00
Issue Date: 10/12/2016
Expiration Date: 4/10/2017
PROPERTY ADDRESS:
Address: 130 POINSETTIA ST
RE Number: 170636-0050
PROPERTY OWNER:
Name: NARKI EWICZ, BRENT J
Address: 130 POINSETTIA ST
GENERAL CONTRACTOR INFORMATION:
Name: AIR SOURCE AMERICA INC
Jason M. Buehler,CAC1816716
Address: 2615 CRYSTAL COVE CT RICHARD E EPPERSON JR
Phone: 904-233-8831
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:
Furnaces and Heating $20.00
AC and Refrigeration $16.00
State Mech DBPR Surcharge $2.00
State Mach DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $95.00
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 1Lr M EC+1 — a49'}
JOBADDRESS• 13a0 PERMIT#
PROJECT VALUE S 3le'l O ARI# REQUIRED
_Air Handling Equipment Only _LAir 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 ?--
Heat: Unit Quantity BTU's Per Unit 2h,mow Seer Rating 11-1
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)
IT" PLACES MISCELLANEOUS:
Prefabricated Fireplace QtyAutomobile Lifts
Gras 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 ifwork does m commence within a six month period or work is suspended or abandoned for six months.I hereby certify dim I have read
this application and know the same to be hue and cone s, All provisions oflaws and ordinances governing this work will be complied with whether specified or
not. The permit does not give authority to violate the provisions ofany other slate or local law regulation construction or the perfommnce ofconshuction.
Property Owners Nam �e+.�S•.,o-ar.e` Z Phone Nwnber .2.24'a+-314
�
9
Mechanical Company ^ �,c�.�..� ... �.+��t c Office onene
29S•�531Fax
Co.Address: o r state Ft,zi
Liven"se Holder(Print): State Certification/Registration#Gf-N c-%%V-Alto
Notarize ' " afV -y' c Holder ..-0 yam.
ayr
TAM of FIARItY1 Befo a this��day of D _20 \\ —
Gaarrl FF12a496
Expires 61412018 Signature of NotaryPu to
CITY OF ATLANTIC BEACH
DCO SEMINOLE RD
ATLANTIC BEAC,FL 37233
10'12,2016 1025:73
CREDIT CARD
MC SALE
Card a )DO 3115
SEQ p'. 4
Balch u: 213
INVOICE 4
Approval Code: 0313BG
Entry MW: mmlw
Mak: Orth
Tar Ar": 50.00
Card Code: M
SALE AMOUNT $95
CUSTOMER COW
CITY OF ATLANTIC BEACH
900 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
POE (9D4) 247-5655
Cashier Id: atlhcld\atlbbja
Receipt Date: 10/12/2016 10:26:25 AM
Receipt Number: OS-71455
Job ID: 16-MECH-2277 - replace one (1) 2.0-
ton AND M18 - Furnaces and Heating $20.00
Joh ID: 16-WCH-2277 - replace one (1) 2.0-
ton AHU M2 - AC and Refrigeration $16.00
Jab ID: 16-MECH-2277 - replace one (I) 2.0-
ton AHU MDBPR - State Mach DEPR Surcharge
$2.00
Job ID: 16-MECH-2277 - replace one (1) 2,0-
ton AND MOCfl - State Mech OCA Surcharge S
2.00
Job ID: 16-MECH-2277 - replace one (I) 2.0-
ton AND TP - Trade Permit Base Fee $55.00
Amount Due: $95.00
Tender Information: Cash 595.00
Tender Type: CC
Tender Amount: $95.00
Change Due: 80,00