720 Triton Rd ACRS19-0214 HVAC permit PERMIT NUMBER
MECHANICAL RESIDENTIAL HVAC
-0214
ACRS19
PERMIT ISSUED: 6/20/2019
CITY OF ATLANTIC BEACH EXPIRES: 12/17/2019
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:
720 TRITON RD MECHANICAL RESIDENTIAL install 4,5-ton 54K-BTU AHU $4000.00
HVAC & 2K-CFM duct system
TYPE OF REALESTATE BUILDING USE
ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP: T
1713380000 ROYAL PALMS UNIT 02A
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
PRODANOFF ZORNITZA 720 TRITON RD ATLANTIC BEACH FL 32233
GENOVA
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
AC AND REFRIGERATION 45S-0000-322-1000 4.5 $32.00
AIR DUCT SYSTEM 45S-0000-322-1000 2000 $20.00
FURNACES AND HEATING 455-0000-322-1000 54000 $28.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00j
45S-0000-208-0700 0 $2.03
STATE DBPR SURCHARGE
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$139.031
Issued Date: 6/20/2019 1 of 2
MECHANICAL RESIDENTIAL HVAC PERMIT NUMBER
ACRS19-0214
PERMIT
ISSUED: 6/20/2019
a CITY OF ATLANTIC BEACH EXPIRES: 12/17/2019
issued Date:6/20/2019 2 of 2
Mechanical Permit Application "ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
full Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOBanDRESS: -7-20 TCZ�24 ZU PROJECTVALUE$
�NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI#(REQUIRED)
El Air Handling Equipment Only El Condenser Onl kX'ir Handling Unit& Condenser
Air Conditioning: Unit Quantity Tons per Unit 4V4
Heat: Unit Quantity BTUs per Unit 0/ Seer Rating (REQUIRED)
Duct Systems: Total CFM 21&()
t
FIREPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI#(REQUIRED)
ii Air Handling Equipment Only El Condenser Only El 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 (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-�FIRE PLACES F-1 MISCELLANEOUS:
Prefabricated Fireplace (Qty)_ Automobile Lifts
Gas Piping Outlets Boilers BTUs
Elevators/Escalators
E]ALL 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: ZOC,'71X� &2A "0409 Phone Number:(-q 0�13 9 2 -,2 7 13
, - eu -e I ,
Mechanical Company: 0(4)n Office Phone: Fax
Co.Address: /,//0(,) City:40cex-04 111li(e State: F/ Zip: 322'1)6'
:X 6� 1 1 (/ -4z"
License Holder: State Certification/Registration#
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this ). -0 day f-,Jkk(\J�- ,20Afj in the State of Florida,
County of I)L&,j,-L Signature of Notary Public
y N'4�'r JENNIFER JOHNSTON
K4-<rsonally Known OR Produced Identification
MY COMMISSION#GG 042984
EXPIRES:October 27,2020 Type of Identification:
B.rd.d Thru N.t.ry Public Underwriters Updated 1019118
Owner Builder Affidavit "ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-DeptIfIcoab.us PERMIT#:
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1"CONSTRUCTION CONTRACTING" REQUIRES
OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED
FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER
OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A
LICENSE.
YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF.
YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY
ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS.
THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE
CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH
IS IN VIOLATION OF THIS EXEMPTION.
YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS.
IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES
Bf_QVIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. I
11. INJURY LIABILITY;SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT
SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. .
Ill. IRS WITHHOLDING;OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING
TAX AND/CIR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT
TO$5,000 PENALTY UNDER FLORIDA STATUTE NO.455-228(l). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY"OR THE FLORIDA"CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US ) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: 7 4V
.2o Ir n
Owner Name: 2,2 r-22 12a 6�_ Phone Number: -7 1
W;e5l City: 3;a(,A, tate: 3.Z21
MailingAddress: L490 �� _& C/ - FIL zip:
Notarized Signature of Owner Ileem 6�5�
The foregoing instrument was acknowledged before me this 13'-D ch/y of JLAA_k_ 20A'r
in the State of Florida, County
of bu�\j C-L k
Signature of Notary Public
[UAI,'e-rsonally Known OR Produced Identification
JENNIFER JOHNSTON
My COMMISSION#GG 042984
0 0]
EXPIRES:October 27,2:020 Type of Identification:
)n
Bonded Thm Notary Public Underwritem
Updated 10124118