1632 W Park Terr GSRS18-0119 mechanical gas permit MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
GSRS18-0119
PERMIT
ISSUED: 11/26/2018
CITY OF ATLANTIC BEACH EXPIRES: 5/25/2019
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:
RUN GAS TO OUTDOOR
1632 W PARK TER MECHANICAL RESIDENTIAL GAS KITCHEN GRILL FROM $500.00
EXISTING LINE
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1720200168 SELVA MARINA UNIT 06
--COMPANY: - ADDRESS: CITY: STATE: ZIP:
CONSTRUCTION 5225 EDGEWOOD CT JACKSONVILLE FL 32254
SOLUTIONS & SUPPLY, LLC
OWNER: ADDRESS: CITY: STATE: ZIP:
RAUSCH FAMILY LIVING 1632 PARK TER W ATLANTIC BEACH FL 32233
TRUST
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 4S5-0000-322-1000 1 510.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 4SS-0000-208-0700 0 $2.00
Issued Date: 11/26/2018 1 of 2
MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
GSRS18-0119
PERMIT ISSUED: 11/26/2018
EXPIRES: S/25/2019
CITY OF ATLANTIC BEACH
-rum 9
STATE DCA SURCHARGE 4SS-0000-208-0600 C) $2.00
TOTAL: $69.00
Issued Date: 11/26/2018 2 of 2
"ALL INFORMATION
Mechanical Permit Application
dr^
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-DeptL-H)coab.us PERMIT#:__ 9
JOB ADDRESS: 1632 Park Terrace West PROJECT VALUE $500-00
Ej NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI#(REQUIRED)
11 Air Hondling Equipment Only Ej Condenser Only 0 Air Hondling Unit& Condenser
Air Conditioning: Unit Quantity_ Tons per Unit
Heat: Unit Quantity BTUs per Unit Seer Rating (REQUIRED)
Duct Systems: Total CFM
D REPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI#(REQUIRED)
[I Air Handling Equipment Only 0 Condenser Only 0 Air Hondling Unit& Condenser
Air Conditioning: Unit Quantity Tons per Unit
Heat: Unit Quantity BTU's Per Unit Seer Rating (REQUIRED)
Duct Systems: Total CFM
EFIRE 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)
7FIRE PLACES 17MISCELLANEOUS:
Prefabricated Fireplace (Qty)_ Autornobile Lifts
Gas Piping Outlets Boilers BTUs
Elevators/Escalators
EALL OTHER GAS PIPING Heat Exchanger
Quantity of Outlets 1 Pumps
#Vented Wall Furnaces Refrigerator Condenser BTUs
4 Water Heaters Solar Collection Systems
Tanks (gallons)
Wells
MOTHER: TIE INTO EXISTING GAS LINE AND RUN GAS TO GRILL@ OUTDOOR KITCHEN
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.
Owner Name:David Rausch Phone Number: (619)665-6513
Mechanical Company: Construction Solutions&Supply LLC Office Phone: (904)389-270C Fax
Co. Address: 5225 Edgew000 Ct City: JaCkSor)ville State: FI Zip: 32254
License Holder: James Romeka State Certification/Registration # 26657
Notarized Signature of License Holders:7—�C-Ir-a.--
The foregoing instrument was acknowledged before me this 3G y o V-�Q\J, , 2-0 1. Z in the State of Florida,
0
County of A �
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Signature of Notary Public
IC
FkW,
.,-ON Notary public State ofo:a
Es Wersonally Known OR Produced Identification
,pp:
Chnistina Cotromano
m M y:
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m TnOGG 23 Type of Identification:
y commission GG 236734
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Expires 07�11IY2022 Updoted 10191'JS
Cash Register Receipt Receipt Number
City of Atlantic Beach R7442
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $69.00
GSRS18-0119 Address: 1632 W PARK TER APN: 172020 0168 $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: R7442 $69.00
CITY OF ATLANTIC BEACH
800 SEPINCLE RD
ATLANTIC BEAC,Fl.32233
11,�261(2018 11:44:30
CREDIT CARD
VISk SALE
Card XMXXXXXX0492
SEQ 8
B&h 738
INVOICE a
Approval Cok 029116
Entr�Method: M&ul
Mode: Onlhe
Tax knount: $0.00
Card Code: M
SAIE AMOUNT $69.1
CUSTOMER COPY
Date Paid: Monday, November 26, 2018
Paid By: CONSTRUCTION SOLUTIONS &SUPPLY, LLC
Cashier: BA
Pay Method: CREDIT CARD 8
Printed: Monday, November 26,2018 11:45 AM 1 of 1