1165 Ocean Blvd mchg permitCITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
MECHANICAL GAS PIPE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID:
17-MCHG-3043
Job Type:
MECHANICAL GAS PIPING
Description:
install one (1) gas piping outlet for cooktop
Estimated Value:
$700.00
Issue Date:
1/19/2017
Expiration Date:
7/18/2017
PROPERTY ADDRESS:
Address:
1165 OCEAN BLVD
RE Number:
170276-0010
PROPERTY OWNER:
Name:
JASKIEWICZ , ADAM
Address:
913 SORRENTO RD 913 SORRENTO RD
FEES:
Gas Pipe Outlets $10.00
State Mach DBPR Surcharge $2.00
State Mech DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $69.00
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
JOB ADDRESS: 1, ( b S Lf_ st AwL - PERMIT #
PROJECT VALUE $ %oD.— 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
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 l
Pumps
# Vented Wall Furnaces
Refrigerator Condenser BTU's
# Water Heaters
Solar Collection Systems
Tanks (gallons) T...o .'k4 G�Ilontr�KS.
Wells
OTHER: Opp �_r. tic tip.
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 goveming this work will be complied with whether specified or
not. The permit does not give amboritylto violate the provisions of any other state or local law regulation construction or the performance ofconstruction.
Property Owners Name M a . 4, S(4 t r 1 f r z. Phone Number GAJ'
Mechanical Company Iter; Qr g//ac 4, ianrcs QA fi fir d{, L OfficePhone y3yjFax 9w �2f a�'t3 -
Co. Address: City '.Ike State�ff.Zip -n2_7
License Holder (Print): �c St Cc ification/Re istration# 3(-oG
NOEi-,
7�-COMMISSCNOGG04298A
%n1VAJ6t$e1�ief 1yn pp'' ��'�"""''] cfore me this �day of v n vt20r Nw, rwu um. r p\�`y^�� �U� UU p 1
ignature of Notary Public � 4tX&