1671 W. Park Terr GSRS19-0038 gas permit MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
PERMIT GSRS19-0038
ISSUED: 4/24/2019
CITY OF ATLANTIC BEACH EXPIRES: 10/21/2019
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:
1671 W PARK TER MECHANICAL RESIDENTIAL GAS bury 120-gal. propane tank $515.04
& lines
TYPE OF REALESTATE BUILDING USE
ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1720200332 SELVA MARINA UNIT 07
COMPANY: ADDRESS: CITY: STATE: ZIP:
D & D Gas, Inc. 7709 Alton Ave Jacksonville FL 32211
OWNER: ADDRESS: CITY: STATE: ZIP:
JOSEPH & KATHERINE 1671 PARK TER W ATLANTIC BEACH FL 32233-5609
ALBERTI
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
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 $2.00
TANKS GAS OR LIQUEFIED PETROLEUM 455-0000-322-1000 120 $20.00
TOTAL:$79.00
issued Date:4/24/2019 1 of 2
el MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
PERMIT GSRS19-0038
ISSUED: 4/24/2019
CITY OF ATLANTIC BEACH EXPIRES: 10/21/2019
Issued Date:4/24/2019 2 of 2
Mechanical Permit Application "ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
Oft 19 800 Seminole Rd, Atlantic Beach, FL 32233 0�S Vs�Cl - 0 C4
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS:. k! PROJECT VALUE$
NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI#(REQUIRED)
11 Air Handling Equipment Only [I Condenser Only 0 Air Handling Unit& Condenser
Air Conditioning: Unit Quantity Tons per Unit
Heat: Unit Quantity BTUs per Unit Seer Rating(REQUIRED)
Duct Systems: Total CFM
DREPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI#(REQUIRED)
[I Air Handling Equipment Only 0 Condenser Only 0 Air Handling Unit& Condenser
Air Conditioning: Unit Quantity Tons per Unit
Heat: Unit Quantity BTU's Per Unit Seer Rating (REQUIRED)
Duct Systems: Total CFM
F]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)
7 FIRE PLACES F7MISCELLANEOUS:
Prefabricated Fireplace (Qty)_ Automobile Lifts
Gas Piping Outlets Boilers BTUs
Elevators/Escalators
7ALL OTHER GAS PIPING Heat Exchanger
Quantity of Outlets Pumps
#Vented Wall Furnaces Refrigerator Condenser BTUs
#Water Heaters Solar Collection Systems
Tanks (gallons)
Wells
F--]OTHER:&�j -�Ane% rt-o,� lkjej 't (,corkci 7"o Ir)lel. 67q,
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:-J(-(�� '01be"—f Phone Number:-e,.q 7—226-191�7
Mechanical Company: D D �--7o Office Phone: _7 2-5—';' /V C/—Fax-47/
Co.Ad d ress: City: 00 C //C State: FL Zii3:,3�2�2
License Holder: AAA State Ce rtif ica t io n/Regist ration#
Notarized Signature of Lici �sei�,,Her—
The foregoip-&instrument was acknowledged before me this --:d�av of 20 rl, in the State of,Flo ida,
County of
Signature of Notary Public
E/O =Nota4y Put)fic State of Florida
hanie Renee M
Stephanie Renee McGuire
y_,M Cr
Comrnwton GO 123258 [�-YI5`ersonally Known OR Produced Identification
_x
Fxpires 08101/2021
Type of Identification:
UPdated 1019118
Cash Register Receipt Receipt Number
City of Atlantic Beach R8828
DESCRIPTION ACCOUNT CITY PAID
PermitTRAK $79.00
GSRS19-0038 Address: 1671 W PARK TER APN: 172020 0332 $79.00
MECHANICAL $75.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
TANKS GAS OR LIQUEFIED PETROLEUM 455-0000-322-1000 120 $20.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SU RCHARG E 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R8828 $79.00
Date Paid: Wednesday, April 24, 2019
Paid By: D & D Gas, Inc.
Cashier: CT
Pay Method: CREDIT CARD 2449C
Printed:Wednesday,April 24,2019 9:33 AM 1 of 1