158 16th St GSRS18-0081 gas permit CITY OF ATLANTIC BEACH
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: GSRS18-0081
Description: install 2 gas-piping outlets &water heater
Estimated Value: 870
Issue Date: 7/19/2018
Expiration Date: 1/15/2019
PROPERTY ADDRESS:
Address: 158 16TH ST
RE Number: 1718790000
PROPERTY OWNER:
Name: POLYTINSKY GABRIELE MARSHA KLING
Address: 158 16TH ST
ATLANTIC BEACH, FL 32233-5804
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: AEI INTERNATIONAL CORP.
Address: 7709 ALTON AVE QA LEWIS SPRADLIN
JACKSONVILLE, FL 32211
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.
11/04/2011 05:24 9047213350 AEIGAS PAGE 01/01
MECHANICAL PERMIT APPLICATION
CITY OF ATLANTic BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax(904) 247-5845 S S `6' 00 6
bll ADDRESS: Lo�k I PiERmrr
'-n C) �00
PROJECT VALUE $ ARI#
Air Handling Equipment Only Air Handling Unit& Condenser Condenser Only
I
�EW AIR CONDITIONING & HEATING SYSTEM INSTALLATION
Air Conditioning; Unit Quantity Tons Per Unit
Heat. Unit Quantity B.TU's Per Unit Seer Rating-
Duct Systems: Total CFM REQUIRED
MPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION
Air Conditioning: Unit Quantity Tons Per Unit
Heat: Unit Quantity BTUs Per'Unit Seer Rating
Duct Systems: Total CFM REQUIRED
1RE PREVENTION
Fire Sprinlder System Quant1ty (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)
4RE PLACES MISCELLANEOUS:
Prefabricated Fireplace Qty_ Automobile-Lifts
Gas Piping Outlets Boilers BTU's
Elevators/Escalators
LLL OTHER GAS PIPING Heat Exchanger
Ouantity of Outlets . --';; Pw-rips
9 Vented Wall Furnaces Reffigerator Condenser BTU's
Water Heaters Solar Collection Systems
Tanks (gallons)
Wells
)THER: Uj
,rmit becomes void if work docs not commence within a six month period or work is suspended or abandoned for six months:I hereby certify that fhave read
is applicatio�and know the same to bc true and correct. All provisions of laws and ordhiances governing this work will be corrtplied with whether specified or
it. The permit does not give authority to violate the provisions of any other statc or local law jigulAtiOn constniction or the performance of construdion.—
n4
roperty Owners Name_ �61 �tV4�00 tl" Phone Number Lo 16--31 qs
lechanical Company N ba,K-1&-.-5 6' ,1 Lic4mce.Phon—elA'9_7_4a)�];�Ll- �450
o. Address: State I�A Zip33a".
icense Holder(Print): cL State Certification/Registration
�Iafized Signature of License r
N0t*1V;Wr.State of Flonas efore me thi.s 194-6 day of AJ WL4 20
Stephanie Reme McGuire J.
k4y CoMmisajon GIS 123258 AA� ��.
F_xpirba W01/2021 ignaturc of Notary Public
OF
Receipt Number
Cash Register Receipt
City of Atlantic Beach R5762
ii�� DESCRIPTION ACCOUNT CITY PAID
PermitTRAK $74.00
GSRS18-0081 Address: 158 16TH ST APN: 171879 0000 $74.00
MECHANICAL $70.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
GAS PIPING OUTLETS 4SS-0000-322-1000 2 $10.00
VENTED WALL FURNACE WATER HEATER 4SS-0000-322-1000 1 $5.00
UNIT
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R5762 $74.00
Date Paid: Thursday,July 19, 2018
Paid By: AEI INTERNATIONAL CORP.
Cashier:JJ
Pay Method: CREDIT CARD 083024
00"
Printed:Thursday,July 19,2018 12:37 PIVI 1 of I