1132 Beach Ave GSRS19-0046 Install Tank for New HomeMECHANICAL RESIDENTIAL GAS
PERMIT
L
CITY OF ATLANTIC BEACH
PERMIT NUMBER
GSRS19.0046
ISSUED: 5/21/2019
EXPIRES: 11/17/2019
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
e.nn.nnrol enriHes such as water management districts, state agencies, or federal agencies.
•. err•
install 2 water heaters,
1132 BEACH AVE MECHANICAL RESIDENTIAL GAS range, & 250 -gal. tank for $1500.00
new home
170279 0000 ATLANTIC BEACH
COMPANY:ADDRESS:
FLORIDA PROPANE -Griffis 461 TRESCA RD JACKSONVILLE FL 32225
Gas
OWNER:ADDRESS:
BRUSSELS BELGIUM
MOMS BEACH HOUSE LLC C/O SUSAN WEED MEMBER 1200
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.
7- LIST OF CONDITIONS
(Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION
FEES
ACCOUNT
QUANTITY PAID AMOUNT
GAS PIPING OUTLETS
ass-oaaoazz-loco
3
$Lo oo
MECHANICAL BASE FEE
655-0()00322-1000
1 0
$5500
STATE ()RPP SU0.CHARGE
E55-0000-208-0]00
0 1
$240
Issued Date: 5/21/2019 1 of 2
Yy>`� MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
N PERMIT GSRS19-0046
CITY OF ATLANTIC BEACH ISSUED: 5/21/2019
un » EXPIRES: 11/17/2019
STATE OCA SURCHARGE 455-0000.208-0500 D
TANKS GAS OR LIQUEFIED PETROLEUM 455-0000.322-1000 1 250 $20.00
VENTED WALL FURNACE WATER HEATER UNIT 4550000.322-1000 1 2 ttnm
Issued Date: 5/21/2019 2 of 2
Mechanical Permit Application
City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept(@coab.us
**ALL INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED.
PERMIT#: CIS f S( I-00lf"
JOB ADDRESS: 1i eo.lf-\ D�.)C PROJECr VALUE$ J,js�
❑ NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI #(REQUIRED)
❑ Air Handling Equipment Only
❑ Condenser Only
❑ Air Handling Unit & Condenser
Air Conditioning: Unit Quantity
Tons per Unit
Value
Heat: Unit Quantity
BTUs per Unit
Seer Rating (REQUIRED)
Duct Systems: Total CFM
Fire Suppression Systems
Quantity
❑ REPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION
ARI # (REQUIRED) _
o Air Handling Equipment Only
❑Condenser Only
o 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
❑FIRE PREVENTION
Fire Sprinkler System
Quantity
Fire Standpipe
Quantity
Underground Fire Main
Value
Fire Hose Cabinets
Quantity
Commercial Hoods
Quantity
Fire Suppression Systems
Quantity
❑FIRE PLACES
Prefabricated Fireplace (Qty)_
Gas P' ing Outlets _
LL OTHER GAS PIPING
Quantity of Outlets
# Vented Wall Furnaces
# Water Heaters
I
(Requires 3 sets of plans)
(Requires 3 sets of plans)
(Requires 3 sets of plans)
(Requires 3 sets of plans)
(Requires 3 sets of plans)
(Requires 3 sets of plans)
❑ MISCELLANEOUS:
Automobile Lifts
Boilers
Elevators/Escalators
Heat Exchanger
Pumps
Refrigerator Condenser
Solar Collection Systems
Tanks (gallons)
Wells
BTUs
BTUs
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I here)
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: 1 v rt S r LAA c LL—'
Mechanical CompanyCL6 fat�C' afnC�S
Co. Address:
License Holder: I,,1Orc 1L —
Notarized Signature of License Holder
The foregoin instrment was acknowledged before meS* his I
County of u _
Signature of Notary Public
rRw.•y:f:,=J0NSTou [ I personally Known OR [
A oxi Od2BBa T e of Identification:r21, 2020VPdi!blb nnEarnfAen
Phone Number:
Office Phone: 8'�f '7r}Y `13'3 Fax%7 J7-\ 2J l3
City: I k State: IL Zip: 7
State Certificat io n/Regist ration If
204 in the State of Florida,
UpdandIO19/18