229 Pine St GSRS18-0110 gas permit MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
A& GSRS18-0110
PERMIT ISSUED: 10/25/2018
CITY OF ATLANTIC BEACH EXPIRES: 4/23/2019
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:
229 PINE ST MECHANICAL RESIDENTIAL GAS install gas fireplace and 1 $395.00
gas-piping outlet
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1705630010 SALTAIR SEC 03
COMPANY: ADDRESS: CITY: STATE: ZIP:
CONSTRUCTION 5225 EDGEWOOD CT JACKSONVILLE FL 32254
SOLUTIONS &SUPPLY, LLC
OWNER: ADDRESS: CITY: STATE: ZIP:
RUBIN DENISE P LIFE 229 PINE ST ATLANTIC BEACH FL 32233-4013
ESTATE
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 4SS-0000-322-1000 1 $10.00
MECHANICAL BASE FEE 4S5-0000-322-1000 0 $55.00
PREFABRICATED FIREPLACES 455-0000-322-1000 1 $30.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 1 $2.001
Issued Date: 10/25/2018 1 of 2
MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
GSRS18-0110
PERMIT
ISSUED: 10/25/2018
CITY OF ATLANTIC BEACH EXPIRES: 4/23/2019
STATE DCA SURCHARGE 455-0000-208-0600 $2.00
0
TOTAL:$99.00
Issued Date: 10/25/2018 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 Is (L 3 1 C6
JOB ADDRESS: 1< -1� �- PERMIT#
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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 CONDITIONING & HEATING SYSTEM INSTALLATION
Air Conditioning: Unit Quantity Tons Per Unit
Heat: Unit Quantity BTU's Per Unit Seer RatinR
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 BTUs
Elevators/Escalators
ALL OTHER GAS PIPING Heat Exchanger
Quantity of Outlets Pumps
# Vented Wall Furnaces Refrigerator Condenser BTU's
# Water Heaters Solar Collection Systems
1�: Tanks (gallons)
Wells
OTHER:
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.
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Property Owners Name ' Nm, S-0- P. 1111�e- Phone Number
Mechanical Company (�DY)�4r I Sj
SAJ)Qt)C UkIPY�5� &AC)�L4 Office Phone-2<c�9 Fax 3il-62-2-2
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Co. Address: Sa�,e-) �X)00� ccn-,-� City
�onulfflj State f5L zip 3�4�s
License Holder(Print): A7 ,,4�te Certification/Registration#
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Notary Public State of Florida
David Joseph K!otz B thi dav ,f 11�06K- 20 (S
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My C mmission GG 239595
iij Expires 07/18/2022
Q0 yF -� .0%^ Signature of Notary Public
Cash Register Receipt Receipt Number
R7167
City of Atlantic Beach
DESCRIPTION ACCOUNT PAID
QTY
PermitTRAK $239.00
GSRS18-0108 Address: 1708 ATLANTIC BEACH DR APN: 169505 1695 $71.00
MECHANICAL $67.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
GAS PIPING OUTLETS 455-0000-322-1000 5 $12.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
GSRS18-0109 Address: 569 TIMBER BRIDGE LN APN: 169505 2055 $69.00
MECHANICAL $65.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
GAS PIPING OUTLETS 455-0000-32 2-1000 4 $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
GSRS18-0110 Address: 229 PINE ST APN: 170563 0010 $99.00
MECHANICAL $95.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
GAS PIPING OUTLETS 455-0000-322-1000 1 $10.00
PREFABRICATED FIREPLACES 455-0000-322-1000 1 $30.00
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: R7167 $239.00
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Date Paid:Thursday, October 25, 2018
Paid By: CONSTRUCTION SOLUTIONS & SUPPLY, LLC
Cashier: CB
Pay Method: CREDIT CARD 29187
Printed:Thursday,October 25, 2018 4:25 PIVI 1 of 1 it