1723 SEMINOLE RD - GAS (----
SJ CITY OF ATLANTIC BEACH
iiit
si 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
"2•01119 INSPECTION PHONE LINE 247-5814
MECHANICAL RESIDENTIAL GAS -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: GSRS18-0089
Description: Gas Outlets &Tank
Estimated Value: 0
Issue Date:
Expiration Date:
PROPERTY ADDRESS:
Address: 1723 SEMINOLE RD
RE Number: 169643 0010
PROPERTY OWNER:
Name: Ed & Meredith Hines
Address: 1723 SEMINOLE RD
ATLANTIC BEACH, FL 32233-5832
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.
08/20/2018 09:28 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) 247-5845
JOB ADDRESS: /�2 c .3 �^ hra(c .... _PERMIT# -44
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 CONZ)ITIONING & 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 ___1_22.6.41 t-- Pumps
#Vented Wall Furnaces Refrigerator Condenser BTU's -
#Water Heaters / Solar Collection Systems
,Solar
(gallons) _4-2-0
Wells
)THER: ,,i, to. 0 L... i 4641- tk riduu /r,u Far •0 6.46r 'r g, ✓' -e_,
ermit 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
tis 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
ot. The permit does not give authority to violate the provisions ofanyother state or local law regulation construction or the performance of construction.
'roperty Owners Name ere4f c l4 °E Int�rt.e,p Phone Number 9.2'/-3fl 1'8'
4echanical Company #'-,frvn nasi-we-4 tdr&/ a_S Office Phorzt t7-35.-/(F axfOct-38'7.Ivo /
;o. Address:c2R(o0 Iak S _ CityT&C . yv vV at- State Zip 3c7-?5V
,ieense Holder(Print): i i_ n d-1-- f.-1- ,-- State ertification/Registration# OD iS 1
0' ;,,�= WILLIAM I TATE der 4 y
1 r . --,'t '; Notary Public•State of Florida Before i e thOr is, Ci `day of ' vim_20 /P
4 ‘,v411,, , Commission. FF 985603 1
4 4,?-7:, 6-kMy Comm.:Explrea Aug 7,2020 signature of Notary Public —"-`
0 "P',
'tCash Register Receipt Receipt Number
4•.._.
City of Atlantic Beach R6089
''.JRI)'
DESCRIPTION ACCOUNT QTY I PAID
PermitTRAK $89.00
GSRS18-0089 Address: 1723 SEMINOLE RD APN: 169643 0010 $89.00
MECHANICAL $85.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
GAS PIPING OUTLETS 455-0000-322-1000 2 $10.00
TANKS GAS OR LIQUEFIED PETROLEUM 455-0000-322-1000 120 $20.00
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: R6089 $89.00
CITY OF ATLANTIC BEACH
800 SENINOLE RD
ATLANTIC BEAC,FL 32233
08;20 2018 14:34:36
CREDIT CARD
VISA,SALE
Card; XXXXXXXXXXXX8147
SEQ#: 4
Batch#: 673
INVOICE 4
Approval Code: 03080C
Entry Method: Manual
Mode: Online
Card Code: M
SALE AMOUNT $89,30
CUSTOMER COPY
Date Paid: Monday, August 20, 2018
Paid By: COBLE GERTRUDE C ET AL
Cashier: BA
Pay Method: CREDIT CARD 4
Printed: Monday,August 20,2018 2:35 PM 1 of 1 1F
MOOT