1965 Brista De Mar Cir GSRS18-0112 gas permit MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
PERMIT GSRS18-0112
ISSUED: 11/7/2018
CITY OF AT LANTIC BEACH EXPIRES: 5/6/2019
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:
1965 BRISTA DE MAR CIR MECHANICAL RESIDENTIAL GAS PreFab Gas Fireplace $1200.00
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1695061668 SELVA NORTE UNIT 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
WESTERN NATURAL GAS 2960 STRICKLAND ST JACKSONVILLE FL 32205
COMPANY
OWNER: ADDRESS: CITY: STATE: ZIP:
Valerie Steece 1965 BRISTA DE MAR CIR ATLANTIC BEACH FL 32233-4525
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.
0-
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
GAS PIPING OUTLETS 455-0000-322-1000 2 $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 52.00
455-0000-322-1000 60 $20.00
TANKS GAS OR LIQUEFIED PETROLEUM
TOTAL: $89.001
Issued Date:11/7/2018 1 of 2
MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
PERMIT GSRS18-0112
ISSUED: 11/7/2018
CITY OF ATLANTIC BEACH EXPIRES: 5/6/2019
Issued Date: 11/7/2018 2 of 2
11/06/2018 14:02 9043876034 WESTERN NATURAL PAGE 01/01
IWECHANICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845
JOB ADDRESS:j
#
PROJECT VALUE $---13LL0- ARj REQUIRED
Air Handling Equipment Only Air Handling Unit & Condenser Condenser Only
NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION
Air Conditioning: Unit Quantity Tons Per Unit
Heat: Unit Quantity 13TU's Per Unit Seer Rating
Duct Systems: Total CFM
REPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION
Air Conditioning: unit Quantity Tons Per Unit
Heat: Unit Quantity BTU's Per Unit Seer Rating
Duct Systems: Total CFM YE-Q—UIRED
FIRE PREVENTION
Fire Sprinkler System ' Quantity (Requires 3 sets of plans)
Fire Standpipe Quantity
Underground Fire Main value (Requires 3 sets of plans)
(Requires 3 sets of plans)
Fire Hose Cabinets Quantity (Requires 3 sets of plans)
Commercial Hoods Quantity (Requires 3 sets of plans)
Fire Suppression Systems Quantity (Requires 3 sets of plans)
FIRE PLACES MISCELLANEOUS:
Prefabricated Fireplace Qty Automobile Lifts
Gas Piping Outlets
Boilers BTU s
ElevatorZs—calators
ALL OTHER GAS PIPING Heat EXchanger
Quanfity of Outlets Pumps
# Vented Wall Fumaces Refrigerator Condenser BTU's
# Water Heaters Solar Collection System s
Tanks (gallons)
Wells
OTHER: LjjkB
ennit becomes void if work does not commence within a six—month period or work is suspended or abandoned for six months.I hereby certify that I have rftd
his application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be c w th
iot. The permit does not give autho I omplied with he er specified or
T!!Z to violate the provisions of any other state or local law regulation construction or the Porformance ofconstruction,
-Iroperty Owners Name
Phone Number(
vlechanical Company LIT'd GLS CO Office Phon& e�- �
V,3S7 'j?7--60-3q
JFaX,
'o. Address: CityL�a�dy�lv- �/ tate6— Zip,3.�,l
,iceose Holder(Print):
State Certification/Registration#OD 5Y-3
�qla I
NLLIAM T Wk for6l"is 7W day of
N8t1ry.PL4)ji0-$Wto of Flolide 20 / 8
M d6ifififtslon 0 FF 905063 gnature of Notary Public 06, ,.a ea i7z:
Receipt Number
Cash Register Receipt
City of Atlantic Beach R7281
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $89.00
GSRS18-0112 Address: 1965 BRISTA DE MAR CIR APN: 169506 1668 $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 60 $20.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R7281 $89.00
Date Paid: Wednesday, November 07, 2018
Paid By: WESTERN NATURAL GAS COMPANY
Cashier: CB
Pay Method: CREDIT CARD 962c
Printed:Wednesday, November 07, 2018 10:20 AM 1 of 1