1612 Atlantic Beach Dr GSRS19-0019 gas-piping permit MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
GSRS19-0019
PERMIT
ISSUED: 3/5/2019
EXPIRES: 9/1/2019
CITY OF ATLANTIC BEACH
L
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:
1612 ATLANTIC BEACH DR MECHANICAL RESIDENTIAL GAS 4 GAS-PIPING OUTLETS FOR $1135.00
NEW SINGLE-FAMILY HOME
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169505 1130 ATLANTIC BEACH
COUNTRY CLUB UNIT 01
COMPANY: ADDRESS: CITY: STATE: ZIP:
CONSTRUCTION 5225 EDGEWOOD CT JACKSONVILLE FL 32254
SOLUTIONS & SUPPLY, LLC
OWNER: ADDRESS: CITY: STATE: ZIP:
ATLANTIC BEACH 414 OLD HARD RD FLEMING ISLAND FL 32003
PARTNERS LLC
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 4 $10.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
Issued Date: 3/5/2019 1 of 2
MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
GSRS19-0019
PERMIT
ISSUED: 3/5/2019
CITY OF ATLANTIC BEACH EXPIRES: 9/l/2019
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$69.00
Issued Date:3/5/2019 2 of 2
MECHANICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904)247-5845
JOB ADDRESS: CX C C-1i U\ PERMIT#
PROJECT VALUE$ 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 Ratin
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
ALL OTHER GAS PIPING Heat Exchanger
Quantity of Outlets D, Pumps
#Vented Wall Furnaces Refrigerator Condenser BTU's
# Water Heaters Solar Collection Systems
Tanks (gallons)
Wells
OTHER:-To�,l � b-opL
J I
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 NameTc-, I-C1.��A, i-,�) Phone Number
96 9
< i&,L(
Mechanical CompanyL�-204- i--�.,."c 1� Office Phone Fax
Co. Address: 5�0�� State r-�-zip
CJ� City
License Holder(Print): State Certification/Registration# ZX
N Ider
qff%- Notary Public S te of Florida
"I David joseph Klotz B�roremethis Zy of 20
My Commission GG 239595
Expires 07/1 W022
11'J
Signature of Notary Publi
Cash Register Receipt Receipt Number
?EW,q,
City of Atlantic Beach R8323
DESCRIPTION ACCOUNT CITY PAID
PermitTRAK $69.00
GSRS19-0019 Address: 1612 ATLANTIC BEACH DR APN: 169505 1130 $69.00
MECHANICAL $65.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
GAS PIPING OUTLETS 455-0000-322-1000 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
TOTAL FEES PAID BY RECEIPT: R8323 $69.00
Date Paid: Tuesday, March 05, 2019
Paid By: CONSTRUCTION SOLUTIONS &SUPPLY, LLC
Cashier: CB
Pay Method: CREDIT CARD 98036
Printed:Tuesday, March 05, 2019 9:56 AM 1 of 1