1872 HICKORY LN GSRS19-0007 GAS PIPING PERMIT ''J� MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
PERMIT GSRS19-0007
ISSUED: 1/18/2019
19' CITY OF ATLANTIC BEACH EXPIRES: 7/17/2019
MUST CALL INSPECTION • 914 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • '
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE
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.
1872 HICKORY LN MECHANICAL RESIDENTIAL GAS GAS PIPING - COOK TOP $500.00
TYPE OF
• • GROUP:
172020 1458 SELVA MARINA UNIT
12C RIP
COMPANY: ADDRESS:
JOHNSON'S TRACTOR & 86077 MACAW RD YULEE FL 32097
PIPING INC
• ADDRESS:
DANIEL& COREY 1645 Selva Marina Dr ATLANTIC BEACH FL 32233
PIEERSON
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 • •
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 4SS-0000-322-1000 0 $SS.00
STATE DBPR SURCHARGE 4SS-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 4SS-0000-208-0600 0 $2.00
Issued Date: 1/18/2019 1 of 2
MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
PERMIT GSRS19-0007
ISSUED: 1/18/2019
r��;;,;,. CITY OF ATLANTIC BEACH EXPIRES: 7/17/2019
TOTAL: $69.00
Issued Date: 1/18/2019 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 G)S Vn` 1 S f 9 _ O O0
JOB ADDRESS' � �� � PERMIT#
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 Rating
Duct Systems: Total CFM REQUIRED
FIRE PREVENTION
X 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 Pumps
#Vented Wall Furnaces Refrigerator Condenser BTU's
# Water Heaters Solar Collection Systems
Tanks (gallons)
Wells
OTHER: CUot� '
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.
Property Owners Name PC;-,rS a Phone Number
C —
Mechanical Company _0�AS � " (9w)
0ns \r(G�cAw Office Phone Fax
Co. Address: %1)-� M6CGLi e State IF14 Zip 3 Z(D�7
License Holder(Print): 2l t rn to Certification/Registration#
Notarized Signature of Licen older 141
GINDLESPERGER
OOMMISSION#FF 924951 Befor me this day o 0
October 6,2019
:{ a EXPThruWj gPablwunderwr"e' Sign tore No y Public