1631 Atlantic Beach Dr GSRS19-0026 gas permit MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
GSRS19-0026
PERMIT
ISSUED: 3/28/2019
CITY OF ATLANTIC BEACH EXPIRES: 9/24/2019
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:
1631 ATLANTIC BEACH DR MECHANICAL RESIDENTIAL GAS install 7 gas-piping outlets & $1695.00
water heater
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169505 1085 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:
ANN T SANTAYANA 1886 BEACH AVE ATLANTIC BEACH FL 32233
REVOCABLE LIVING 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 455-0000-322-1000 7 $16.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
Issued Date:3/28/2019 1 of 2
MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
PERMIT GSRS19-0026
ISSUED: 3/28/2019
CITY OF ATLANTIC BEACH
EXPIRES: 9/24/2019
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
NTED WALL FURNACE WATER HEATER UNIT 455-0000-322-1000 1 $5.00
TOTAL:$80.00
Issued Date:3/28/2019 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 rj — 0 0 2K-+
k PERMIT A RES ISOY/0,
JOB ADDRESS:
PROJECTVALUES 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
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
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 NameTir,�> P)r-A�,f--�5 Phone Number
�0 L-i-3,&.9 1)(-'
Mechanical Company IS r,� "Oeie, OfficePhone -A'?00 Fax O-U'-?
Co. Address: S-R-2-S CA City-,T
c&�<-s t) l)Lg.State rL zip
License Holder(Print): tate Certification/Registration#
0
Not r*Z Ider 1/
=F9lo d
4c� Notary Public State of Florida
David Joseph Klotz B6fo-re�me this day of A4 fv!�tR 20 11
s � 3 595
my commission GG 239595
c e 11 0
ir .0711812022
Expire Signature of Notary Public �-�77�->
Cash Register Receipt Receipt Number
Lv City of Atlantic Beach R8590
DESCRIPTION ACCOUNT CITY PAID
PermitTRAK $154.00
GSRS19-0026 Address: 1631 ATLANTIC BEACH DR APN: 169505 1085 $80.00
MECHANICAL $76.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
GAS PIPING OUTLETS 455-0000-322-1000 7 $16.00
VENTED WALL FURNACE WATER HEATER 455-0000-322-1000 1 $5.00
UNIT
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
GSRS19-0027 Address: 1607 ATLANTIC BEACH DR APN: 169505 1065 $74.00
MECHANICAL $70.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
GAS PIPING OUTLETS 455-0000-322-1000 4 $10.00
VENTED WALL FURNACE WATER HEATER 455-0000-322-1000 1 $5.00
UNIT
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DC.A SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R8590 $154.001
Date Paid:Thursday, March 28, 2019
Paid By: CONSTRUCTION SOLUTIONS &SUPPLY, LLC
Cashier: CB
Pay Method: CREDIT CARD 2
00.1%
Printed:Thursday, March 28, 2019 11:35 AM 1 of 1 1