90 S. Forrestal Cir ACRS19-0183 HVAC permit MECHANICAL RESIDENTIAL HVAC PERMIT NUMBER
PERMIT ACRS19-0183
CITY OF ATLANTIC BEACH ISSUED: 5/30/2019
EXPIRES: 11/26/2019
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:
90 S FORRESTAL CIR MECHANICAL RESIDENTIAL replace 2.5-ton 30K-BTU $6140.00
HVAC AHU
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1717510000 ATLANTIC BEACH VILLA
#01
COMPANY: ADDRESS: CITY: STATE: ZIP:
AIR SOLUTIONS HTG & 546 Ellis RD S JACKSONVILLE FL 32254
COOLING
OWNER: ADDRESS: CITY: STATE: zip:
TYSINGER MARK 90 FORRESTAL CIR S ATLANTIC BEACH FL 32233
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
AT-FORNEY 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
AC AND REFRIGERATION 455-0000-322-1000 2.5 $16.00
FURNACES AND HEATING 455-0000-322-1000 30000 $24.00
MECHANICAL BASE FEE 4S5-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
lssued Date: 5/30/2019 1 of 2
MECHANICAL RESIDENTIAL HVAC PERMIT NUMBER
ACRS19-0183
PERMIT
ISSUED: 5/30/2019
CITY OF ATLANTIC BEACH EXPIRES: 11/26/2019
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$99.00
Issued Date:5/30/2019 2 of 2
Mechanical Permit Application "ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FIL 32233 At f—Sict—0 t V-?
0- Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 9-i�F�9 -C)U�
JOB ADDRESS:- c?0 Fo r-re s" (2 iyr.i e S PROJECT VALUE$ U 140, 00
L]NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI#(REQUIRED)
11 Air Handling Equipment Only U Condenser Only El Air Handling Unit& Condenser
Air Conditioning: Unit Quantity Tons per Unit
Heat: Unit Quantity BTUs per Unit Seer Rating(REQUIRED)
Duct Systems: Total CFM
MIREPLACEMENT AIR CONDITIONING& HEATING SYSTEM INSTALLATION ARI#(REQUIRED)
[I Air Handling Equipment Only 0 Condenser Only Air Handling Unit& Condenser
Air Conditioning: Unit Quantity I Tons per Unit 2
Heat: Unit Quantity I BTU's Per U n it 3('-),0 C,C, Seer Rating(REQUIRED) )4
Duct Systems: Total CFM
FIFIRE 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)
F-IFIRE PLACES MMISCELLANEOUS:
Prefabricated Fireplace (Qty)_ Automobile Lifts
Gas Piping Outlets Boilers BTUs
Elevators/Escalators
FJALL OTHER GAS PIPING Heat Exchanger
Quantity of Outlets Pumps
#Vented Wall Furnaces Refrigerator Condenser BTUs
#Water Heaters Solar Collection Systems
Tanks (gallons)
Wells
F-JOTHER:
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: Y-Y'r—t rv-- Tul n(n!2 ew- Phone Number:
Mechanical Company: Riv- Hecd(c)(i 't office Aone: <9c"M-a-7 6 4 Fax
Co.Address: '54tv E11(b Ed 5 City: [TeW e-CWOLC state: FT zip: -522
License Holder: 6 r7 o—ik eofii rr—� State Certification/Registration# oq-e/yj
Notarized Signature of License HolderL��-t-�
The foregojW.instrumgnt was acknowledged before me this�),�) of the State of Florida,
County of. J�LV7--K Signature of Notary Publi�ZAA6-1-141+)fev�\.,--
[Itrersonally Known OR Produced Identification
SUZANNE M PLEMONS
My COMMISSION 0 GG049337 Type of Identification:
EXPIRES February 10,2021
Updated 1019118
Cash Register Receipt Receipt Number
City of Atlantic Beach R9174
DESCRIPTION ACCOUNT CITY PAID
PermitTRAK $99.00
ACRS19-0183 Address: 90 S FORRESTAL CIR APN: 1717510000 $99.00
MECHANICAL $95.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
AC AND REFRIGERATION 455-0000-322-1000 3 $16.00
FURNACES AND HEATING 455-0000-322-1000 30000 $24.00
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: R9174 $99.00
Date Paid:Thursday, May 30, 2019
Paid By: AIR SOLUTIONS HTG & COOLING
Cashier: CT
Pay Method: CREDIT CARD 09317G
Printed:Thursday, May 30,2019 10:48 AM 1 of 1