871 Ocean Blvd mechanical gas permit b1i-
CITY OF ATLANTIC BEACH
SO
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
MECHANICAL RESIDENTIAL GAS -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: GSRS18-0057
Description: install 2 gas-piping outlets &water heater
Estimated Value: 2700
Issue Date: 5/23/2018
Expiration Date: 11/19/2018
PROPERTY ADDRESS:
Address: 871 OCEAN BLVD
RE Number: 1702360020
PROPERTY OWNER:
Name: POLANEC CONNIE ET AL
Address: 871 OCEAN BLVD
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: SUBURBAN PROPANE L.P.
Address: 45 S DIXIE HVVY
ST AUGUSTINE, FIL 32084
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.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions
applicable to this property that may be found in the public records of this county, and there may
be additional permits required from other governmental entities such as water management
districts, state agencies, or federal agencies.
* 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 13EACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904)247-5845 S 00S-�L
JOBADDRIESS: 6-71 0(:rAr\J bklf) A17-AN-1- &-Vi 3A23-3 PERMff#
PROJECT VALUE S Q-700 . Q0 ARI# __.REQU1RED
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
4 Water Heaters Solar Collection Systems
Tanks(gallons) /-70 j4ef—a2
tD
Wells
fi'e-om 6;�si5-r1tA;r -rAtvK, V-L,..o APerO-Z P15- -�, I/z" j)15 UNIN6w- f6\jc,(5- -3 SiPewA
OTHER: w",e-,z kwAT-6w- 3 9-L-1 Aamy- .26' mIL 14" 70 Vie" -Am 6,da&X a 4-0 2-n-1 C&o y-Tzho
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 &1aff 4:ms Phone Number ;2o/- 3 2-o- 0 1'17-
Mechanical Company SQ OfficePhone!!?�
Co. Address; 05 5 - Q I Y 16 City 6FIA (,USTWJ6-State r(- Zip 84
License Holder(Print): U0(> "V,16 - State CeTtification/Registration# f)15C7.3
Notarized Signature of License Holder
aNolary Public SWe of Flonda efore me this cg,-3 day of 02,40 20
Glada R Swank
my co—L-i-GG 194r-13 ignature of Notary Public A�oA
OFF., Eviays 03131t2022
M01 4 K
OEM
Av.lvs0nC,FL32094
45 S. Dixie Hi-u-I-ay - ';uburbq"ProP3"0-`I
(()04) 829-5623 Fax:(904)829-1 www
NAME:
ADDRESS:
DtzAWNG NOT TO SCALE
----------
j-L)
Iry
DATE:
STATE LICENSE 9 BY:,
Cash Register Receipt Receipt Number
City of Atlantic Beach R5156
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $74.00
GSRS18-0057 Address: 871 OCEAN BLVD APN: 170236 0020 $74.00
MECHANICAL $70.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
GAS PIPING OUTLETS 455-0000-322-1000 2 $10.00
VENTED WALL FURNACE WATER HEATER 455-0000-322-1000 1 $5.00
UNIT
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0600 0 $2.00
STATE DCA SURCHARGE 45500002080700 0 $2.00
TOTAL FEES PAID BY RECEIPT: R5156 $74.00
CITY OF ATLANTIC BEACH
800 SEMINOLE RD
ATLANTIC BEAC,FL 32233
05/23/2018 13:51:23
CREDIT CARD
MC SALE
Card XXM=2862
SEQ 4
Bath#: 612
INVOICE 4
Approval Code: 023679
Entry Method: Manual
Mode: Online
Tax Amount: $0.00
Cust Code:
Card Code: M
SAIE AMOUNT $741
CUSTOMER COPY
Date Paid: Wednesday, May 23, 2018
Paid By: SUBURBAN PROPANE L.P.
Cashier: BA
Pay Method: CREDIT CARD 4
Printed:Wednesday, May 23, 2018 1:52 PM 1 of 1 to