1165 Ocean Blvd HVAC permitCITY OF ATLANTIC BEACH
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:
170276-0010
Job ID:
17-MECH-3024
Job Type:
MECHANICAL HVAC ONLY
Description:
install 125 CFM & range vent & hood
Estimated Value:
$720.00
Issue Date:
1/18/2017
Expiration Date:
7/17/2017
PROPERTY ADDRESS:
120 Cumberland Park Or ST
Address:
1165 OCEAN BLVD
RE Number:
170276-0010
PROPERTY OWNER:
Name:
JASKIEWICZ, ADAM
Address:
913 SORRENTO RD 913 SORRENTO RD
GENERAL CONTRACTOR
INFORMATION:
Name:
CREEKS AIR CONDITIONING & HEATING
Ben Wesley Smith, Jr., CMC1249868
Address:
120 Cumberland Park Or ST
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:
Air Duct System
$20.00
State Mach DBPR Surcharge $2.00
State Mech 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 CODE&
1Ctmg ptw0MECHANICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845
11 Oetotn Pplvd ��-rJt�Ctt-3oaN
Jos AnvRess: 7 ��,�PERMIT #
PROJECT VALUE 11�-{� 1(70 �# 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
Hear: Unit Duct Systems: Total CFM
BTU's Per Unit Seer Rating
REQUIRED
FIRE PREVENTION
Fire Sprinkler System Quantity
Fire Quantity
(Requires 3 sets of plans)
Underground
UndergroundFire Main Value
(Requires 3 sets of plans)
(Requires 3 sets of plans)
Fire Hose Cabinets Quantity
Commercial Hoods Quantity
(Requires 3 sets of plans)
Fire Suppression Systems Quantity
(Requires 3 sets of plans)
(Requires 3 sets of plans)
FIRE PLACES
Prefabricated Fireplace Qty
Gas Piping Outlets
ALL OTHER GAS PIPING
Quantity of Outlets
# Vented Wall Furnaces —
# Water Heaters
OTHER: i ws- kt l 0
mnn oecomes vo,a n won: aces not commence within a six
this application and know the same to be nue and carted. All
not. 71c penult does not give authority to violate
'tthee/poucvlsio
Property Owners Name Q m s�
Mechanical Company _
Co. Address:
License Holder (Print): _
MISCELLANEOUS:
Automobile Lifts
Boilers BTU's
Elevators/Escalators
Heat Exchanger
Pumps
Refrigerator Condenser BTU's
Solar Collection Systems
Tanks (gallons)
Wells , , ,
ad or work is suspended or abandoned for six ml
oflaws and ordinanees governing this work will
her stale or local law regulation conmuction or
Notarized Signature of License Holder /� /( –.11(d
AMYL KNIGHT 1 �'T
tk' tore me this IJ day of
My CpxquSS� N FF9,6wST
` EXPIRES Saptemeor 09, 201% nature of Notary Public
City 10 State L zip
20 ��
ATLANTIC BEACH
PERMIT RECEIPT
PERMIT DESCRIPTION: install 125 CFM & range vent & hood
PERMIT NUMBER: 17-MECH-3024
ADDRESS: 1165 OCEAN BLVD
OWNER:
Air Duct System
$20.00
State Mech DBPR Surcharge
$2.00
State Mech DCA Surcharge
$2.00
Trade Permit Base Fee
$55.00
INVOICE
0003
Totals:
$79.00
6
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o%00 I,c��cw
January 18, 2017
CRY OF ATLAMIC BEACH
800 SEABNOLE RD
ATIAAMC BEAC, R 32233
0118,2017
12:51:42
CREDIT CARO
VISA SALE
CARD
XXXUXKKXXXX8530
INVOICE
0003
SEQ n:
0003
Batch h:
000479
Approval Code:
024666
Entry IkM:
Mewl
Mode:
OhBx
Tar Arm t
$0.00
Cad Code:
M
SAVE AMOUNT 01
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