410 GARDEN LN -GSRS18-0065 i ��
�, CITY OF ATLANTIC BEACH
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<, Y 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
05319%-' INSPECTION PHONE LINE 247-5814
MECHANICAL RESIDENTIAL GAS -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: GSRS18-0065
Description: GAS PIPING -WATER HEATER
Estimated Value: 1600
Issue Date: 6/5/2018
Expiration Date: 12/2/2018
PROPERTY ADDRESS:
Address: 410 GARDEN LN
RE Number: 172020 5208
PROPERTY OWNER:
Name: TOOMER CURTIS W
Address: 410 GARDEN LN
ATLANTIC BEACH, FL 32233-4528
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
,
Phone:
Name: WESTERN NATURAL GAS COMPANY
Address: 2960 STRICKLAND ST
JACKSONVILLE, FL 32205
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.
06/05/2018 13:43 9043876034 WESTERN NATURAL PAGE 01/01
MECHANICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax (904) 247-5845Gs Rs s �6S
JOB ADDRESS: 41 0 C O.rd Ck. a/14.e_ r 41-16.A_AL de-A-a-- PERMIT#
PROJECT VALUE $ I4 d) . AR!# 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 _i_ Solar Collection Systems
Tanks (gallons)
,r .A lli
t02.Wells (� }� C�y
OTHER: . -.♦t ,_ �
A.' . I . 1 ►J iL/�y!'! IYb 1l) -,(,JJ71 r YIJ
ii.„ Aimiummeni
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 01 ICil&I k �U1ny)^n..c.v- Phone Number ,. (/ -FV-7a.
Mechanical Company liti - f--(3-A i 1 G U.rC-1 6t t (.0 Office Phone-WI-357i Fax
k i°8
Co. Address: o2%o v . Yi C G:1v.C� S City 4 '01.e_i_5o1,1t/i/!e.. State ;E.. Zip 36;1ys
License Holder(Print): 5. le-e ev\-4-` 60-1--- 1,-- Stat Certification/Registration 1# 6D 511.
No i r u e License Holder
�. WILLIAM of� / 8
r, � a NotaryPub ie St a of Florida fore e this day 20
�'' Gtr.
;; �, Comnilsoion•FF 985603tnature
of Notary Public
� ; My Comm,-Expires Aug?,2020
,� kAP_C1sal VCs C vJFu LP : cc et\
-s=A, •r
,s
, ' ,_i, Receipt Cash Register Receipt Number
s)
"r -0 City of Atlantic Beach R5260
v r;i s).
DESCRIPTION ACCOUNT I QTY I PAID
PermitTRAK $69.00
GSRS18-0065 Address: 410 GARDEN LN APN: 172020 5208 $69.00
MECHANICAL $65.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
GAS PIPING OUTLETS 455-0000-322-1000 1 $10.00
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: R5260 $69.00
CITY OF ATLANTIC BEACH
800 SEMINOLE RD
ATLANTIC BEAC,FL 32233
06/05/2018 15:13:19
CREDIT CARD
VISA SALE
::ARD# ;0000(XXXXX8147
INVOICE 0012
SEQ#: 0010
Bad#: 000812
approval Code: 09565C
ntry Method: Manual
,lode: Online
::ard Code: M
:TALE ACUNT S69,00
CUSTOMER COPY (�
" J
Date Paid:Tuesday, June 05, 2018
Paid By:TOOMER CURTIS W
Cashier: CB
Pay Method: CREDIT CARD 09565C
Printed:Tuesday,June 05,2018 3:14 PM 1 of 1 1r
1M101