860 SAILFISH DR - GAS OUTLET . Li-V.1-1%1
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�' _ '' CITY OF ATLANTIC BEACH
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800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
JRI� INSPECTION PHONE LINE 247-5814
MECHANICAL RESIDENTIAL GAS -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: GSRS17-0045
Description: ONE SPA OUTLET AND 100 GAL TANK
Estimated Value: 0
Issue Date: 11/30/2017
Expiration Date: 5/29/2018
PROPERTY ADDRESS:
Address: 860 SAILFISH DR
RE Number: 171160 0000
PROPERTY OWNER:
Name: LISA MILHOAN
Address: 860 SAILFISH DR
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name:
Address:
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
MECHANICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845
GS
Rs -t
( 7- ^/l5
JOB ADDRESS: 0 `-' L CIS 6/ b� • 146 32Z 3 3 PERMIT# �
PROJECT VALUE $ 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 Pumps
#Vented Wall Furnaces Refrigerator Condenser BTU's
# Water Heaters S• _ •llection Systems f
Tanks ions) I 0 0 , l
"e s
OTHER: d L c S P A
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 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 LIS A ' / vl 0i 0 Phone Numberg014'70 41-22 1Ii
Mechanical Company SSU V /e a 4-s Office Phone Fax
`� �j� 3 2z.33
Co. Address: t �P D "1 L Ad' /I `� • City G`- r C /� State Zip
License Holder(Print):Y' L-( '..T)'L , tate Certification/Registration#
Notarized Signature of License Holder Ll S Ml, I,(/tocee_n e n u, n. e c
,off,J,'P,;a c,- TONI GINDLESPERGER ;t-fore me this 5 lay of 0 O a i 1,
ez.. MY COMMISSION 4 FF 924951
: ,7. EXPIRES:October 6,2019 .'gnature of Notary Public
u e Bonded Thor Nota Public Underwriters
. _«.-s-.........-d .
ritJLJ r
CITY OF ATLANTIC BEACH
` 4 I�%'WNER / BUILDER AFFIDAVIT'
'``itt9r
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
! DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
1
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE-OR .
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS: THE BUILDING
' MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
HIRE.AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY _YOU HAVE
LICENSES REOUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826) IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
BCDOHi-i. 14 b>'2 A-6 33 qo L) 7D /- � 39 �''
ADDRESS PHONE NUMBER
/ice /L'I / hoetv) .
PRINT N ME
//- 3b — /
SIGNATURE ^ DATE
jr)it
• Before me this 3�%day of '.. 1.J V 2017the county of
Duval,State of Florida,has personally appeared herin by hims 2017
/herself and affirms that
all statements and declarations are trueandaccurate.
Notary Public at Large,State of f( ,County of D ,, v'c/
❑Personally Known , r ` 41 40 - 2 ^� _/ 1, 6 8-7
Produced Identificati• ` J J (� (el
"
NIB IPI ' ;a TONI GINDLESPERGER }
El
IP
*' • MY COMMISSION#FF 924951
Notary Signature: - q, i
1 •tr_
_
- :.:.• ,o; EXPIRES:October 6,2019 i
.,'e•"$P in Notary Public Underwriters
F:BLDG/Owner-Builder Affadavit;REVISED;4/16/20091111
Boned Tdee
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