1641 Park Terr W - HVAC ?tom v.fJ,,
�� e ATLANTIC BEACH
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�� 33 �� January 18, 2017
PERMIT DESCRIPTION: HVAC- 1 AC, 1 AHU, 5 TON
PERMIT NUMBER: 17-MECH-3016
ADDRESS: 1641 W PARK TER A
OWNER:
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State Mech DBPR Surcharge $2.00
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State Mech DCA Surcharge $2.00 \J
Trade Permit Base Fee $55.00 ��
Furnaces and Heating $24.00 u?' i0°b
AC and Refrigeration $40.00
Totals:
$123.00
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01-18-17;09: 14 ;From: To:2475845 ; 9042886619 # 1/ 1
MECHANICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-58457- (\f\ e_ --3 O(
JOB ADDRESS: / G * ' [ . ' PERMIT#
PROJECT VALUE $ ` \ ,c'.7--) ARI>#` 75-1 3 g7 REQUIRED
_Air Handling Equipment Only X. 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 / B1s 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 Pumps
#Vented Wall Furnaces Refrigerator Condenser BTU's
#Water Heaters Solar Collection Systems
Tanks (gallons)
Wells
OTHER:
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Permit becomes void it'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 governing this work will be complied with whether specified or
not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name \I\V \Q.r£ la` Pn Phone Number Zt`}ci-i5-5
Mechanical Company ifr v- t! C- e a Office Phone Dg J-LCI16 Fax_4228—LQLc L I
Co. Address: l)�D(o�—\ ,� 17 __1C>_ . City , ,) 1%k Q... State ITL Zip 3 5
License Holder (Print): _/O,ATillN N e Certification/Registration# G
Not leg .i w6f`Jr nsc. MYFMCE a.$ARRAS rir,_ �l..�...,r , �..�
�,=�" Cam*r FF don Befo•' ni ,t� day •of „r C . . 4 0 �I
Expires 9124/2017 'gnature o 1 otary Public C.c.-t_.\, C.,��
,` *„ Cash Register Receipt Receipt Number
City of Atlantic Beach R2709
DESCRIPTION I ACCOUNT QTY I PAID
PermitTRAK $242.00
17-MECH-3016 Address: 1641 W PARK TER APN: 172020 0322 $242.00
AC AND REFRIDGERATION $40.00
AC AND REFRIDGERATION *NONE* 1 $40.00
BUILDING $119.00
BUILDING PERMIT RENEWAL 455-0000-322-1000 0 $119.00
FURNACES AND HEATING $24.00
FURNACES AND HEATING 455-0000-322-1000 1 $24.00
OS BUILDING FEE $55.00
OS BUILDING FEE 455-0000-322-1000 1 $55.00
STATE DBPR SURCHARGE $2.00
STATE DBPR SURCHARGE 455-0000-208-0600 1 $2.00
STATE DCA SURCHARGE $2.00
STATE DCA SURCHARGE 455-0000-208-0700 1 $2.00
TOTAL FEES PAID BY RECEIPT: R2709 $242.00
CITY OF ATLANTIC BEACH
800 SEMINOLE RD
ATLANTIC BEAC,FL 32233
09,20;2017 16:17:10
CREDIT CARD
MC SALE
Card XXXXXXXXXXX0(5001
SEQ;x: 4
Batch 445
INVOICE 5
Approval Code: 06376C
Entry Method: Manual
Mode: Online
Tax Amount: $0,00
Card Code: M
SALE AMOUNT $242,00
Date Paid: Wednesday, September 20, 2017
Paid By: AIR MCCALL INC CUSTOMER COPY
Cashier: BA
Pay Method: CREDIT CARD 5
Printed:Wednesday,September 20,2017 4:18 PM 1 of 1
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