1601 ATLANTIC BEACH DR - GAS PERMIT r�- ''`�� MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
PERMITA '1i3 GSRS18-0104
o ISSUED: 10/12/2018
4 IF 0 CITY OF ATLANTIC BEACH EXPIRES: 4/10/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
1601 ATLANTIC BEACH DR MECHANICAL RESIDENTIAL GAS ONE GAS OUTLET $675.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169505 1060 ATLANTIC BEACH
COUNTRY CLUB UNIT 01
COMPANY: ADDRESS: CITY: STATE: ZIP:
FARRELL'SMECHANICAL& 3540 OLEANDER STREET JACKSONVILLE FL 32254
PLUMBING INC
OWNER: ADDRESS: CITY: STATE: ZIP:
TOLL FL VI LIMITED 250 GIBRALTAR RD HORSHAM PA 19044
PARTNERSHIP
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR 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.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
GAS PIPING OUTLETS 455-0000-322-1000 1 $10.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
Issued Date: 10/12/2018 1 of 2
MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
PERMIT GSRS18-0104
ISSUED: 10/12/2018
CITY OF ATLANTIC BEACH EXPIRES:4/10/2019
TOTAL: $69.00
Issued Date: 10/12/2018 2 of 2
MECHANICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904)247-5845 C, S RS (8_5 ( O 4-
OB
l ADDRESS: &0( j
�I'ETlC(Vl+ (.° (-'«Q "7 `�if .--7,,?3 3 3 PERMIT#
PROJECT VALUE$ (, 7. T cc 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
tLLL OTHER GAS PIPING Heat Exchanger
Quantity of Outlets / Pumps
#Vented Wall Furnaces Refrigerator Condenser BTU's
# Water Heaters Solar Collection Systems
Tanks(gallons)
Wells
)THER:• r- if, ,
ft,74� Ye7 d (2ei1J e ( r��� a 4t
ermit becomes void if work does not comm4e within a six month period or work is suspended or abandon or six movinths.I hereby certify that I have read
lis 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
t. The permit does not give authori tviolate the provisions of any other state or local law regulation construction or the performance of construction.
roperty Owners Name, A�l� ��� c Z I y%6 Phone Number q/ 9 7'?
q
Techanical Compan e ' 1 /, . - i e _ >' .4 . Ti'C.Office Phon 7�-/ ' Fax 99 Q)7 'gyp-/'/1 a
o. Address: . 1-4,/() /01ei'n/k/c..,3 City jij(°kl(, t State.,t7 Zip,"32,5
icense Holder(Print): al,r t p.5 i, r r e(I 7 (7-1 roc', i State Certification/Registration#t (r p 4/6, /7
`otarized Signature of License Holder 'X'?z`(fr.__,X4.,,, fes/ f
•
Before me this /z �� day of iord.?'
. :.*.v.°, ,, CHRISTOPHER J.NASON
Signature of Notary Public . °.: : :Commission#GG 161369
'. Expires November 16,2021
`FOF f.:, Bonded TTw i�oy Fain Insurance 800-385-7019.
r$.AyYj�
Cash Register Receipt Receipt Number
City of Atlantic Beach R7039
DESCRIPTION I ACCOUNT QTY I PAID
PermitTRAK $69.00
GSRS18-0104 Address: 1601 ATLANTIC BEACH DR APN: 169505 1060 $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 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R7039 $69.00
CIT7 OF Al LAIv IIC BEACH
800 SENINOLE RD
ATLANTIC BEAC,FL 32233
10/122018 16:08:02
CREDIT CARD
VISI,SALE
Card r XXXXXXXXXXXX3549
SEQ#: 7
Batch#: 710
INVOICE 9
Approval Code: 04052C
Entry Method: Manual
Mode: Online
Card Code: M
SALE AMOUNT $69,00
CUSTOMER COPY
Date Paid: Friday, October 12, 2018
Paid By: FARRELL'S MECHANICAL& PLUMBING INC
Cashier: BA
Pay Method: CREDIT CARD 9
Printed: Friday,October 12,2018 4:09 PM 1 of 1
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