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393 3rd St ACRS19-0233 HVAC permit MECHANICAL RESIDENTIAL HVAC PERMIT NUMBER tr, ACRS19-0233 PERMIT ISSUED: 7/5/2019 CITY OF ATLANTIC BEACH EXPIRES: 1/1/2020 MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION. ALL WORK CONFORM • THE CURRENT . EDITION OF FLORIDA CODE, •DOF 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: MECHANICAL RESIDENTIAL install two 2-ton 24K-BTU 393 3RD ST HVAC AHUs & 800 CFM duct $4000.00 system TYPE OF CONSTRUCTION: ! i • ' 169825 0010 ATLANTIC BEACH COMPANY: ADDRESS: STATE: ZIP: • ADDRESS: STEVENS MICHAEL L ET AL 393 3RD ST ATLANTIC BEACH FL 32233-5231 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. 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 4 $32.00 AIR DUCT SYSTEM 455-0000-322-1000 800 $20.00 FURNACES AND HEATING 455-0000-322-1000 48000 $24.00 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 TOTAL:$135.00 Issued Date: 7/5/2019 1 of 2 PERMIT NUMBER MECHANICAL RESIDENTIAL HVAC r s ACRS19-0233 PERMIT ISSUED: 7/5/2019 CITY OF ATLANTIC BEACH EXPIRES: 1/1/2020 Issued Date: 7/5/2019 2 of 2 ALL Mechanical Permit Application **HIGHLI HIGHLIGHTED ON HIGHLIGHTED IN City of Atlantic Beach Building Department GRAY IS REQUIRED. sr 800 Seminole Rd, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: C�S JOB ADDRESS: 7:1 A-3 � tit XtZ ��. PROJECT VALUE $ �UBD— NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI#(REQUIRED) C 5 �y / ❑ Air Handling Equipment Only w`''' --L ❑ Condenser Only Z �" ;4ir Handling Unit& Condenser 62 Air Conditioning: Unit Quantity Tons per Uniti` Heat: Unit Quantity �;�- BTU�pe Unit -c`c Seer Rating (REQUIRED) 3, Duct Systems: Total CFM ❑REPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI#(REQUIRED) ❑ Air Handling Equipment Only ❑ Condenser Only ❑ 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 ❑ MISCELLANEOUS: Prefabricated Fireplace (Qty) Automobile Lifts Gas Piping Outlets Boilers BTUs Elevators/Escalators ❑ALL OTHER GAS PIPING Heat Exchanger Quantity of Outlets Pumps #Vented Wall Furnaces Refrigerator Condenser BTUs #Water Heaters Solar Collection Systems Tanks (gallons) Wells DOTHER: 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: V � (�—L Arf-- L Phone Number: 9 092J7 377 `L Mechanical Company: L-c>[�1 � Office Phone: Fax Co.Address: City: State: Zip: License Holder: (` State Certification/Registration# Notarized Signature of License Holder The foregoing instrument was acknowledged before me this S- day of JoLu , 20 11"rn the State of Florida, County of b� t U` � _ Signature of Notary Public K JENNIFER JOHNSTON [ ] Personally Known OR [U Produced Identif'cation MY COMMISSION#GG 042984 1 Vc EXPIRES:October 27,2020 Type of Identification: (' t; (n (t �,A Bonded Ttw Notary Public Underwriters Updated 10/9/18 Owner Builder Affidavit **ALL INFORMATION HIGHLIGHTED IN City of Atlantic Beach Building Department GRAY IS REQUIRED. 800 Seminole Rd, Atlantic Beach, FL 32233 �ta'r Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: I. 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 PERSONAS 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 REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. II. INJURY LIABILITY;SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. . III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR 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(1). 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: 3X13 3iu2 57, 14 AN7(_- 6e_71EL- 33- 2--3 � Owner Name: 1 iC ae- Phone Number:MailingAddress: 2 f3 31.0 !St City: A�c P)eEXH State: k_ Zip: 2-12- 3 Notarized Signature of Owner The foregoing instrument was acknowledged before me this S day of i.11(1 20 L lin the State of Florida, County of C1 tj Ct l ignature of Notary Public o� JENNIFER JOHNSTON COMMISSION#GG 042984 ] Personally Known OR [L�Produced Identification October 27,20 •*� a EXPIRES:Oct 20 N9 °` Notary Public Underwriters pe of Identification: f �� ('� ` L S •oQr BondedThru � (,� ( V (, Updated 10124118 Cash Register • Number City of Atlantic Beach R10034 DESCRIPTION ACCOUNTCITY PAID PermitTRAK $55.00 ACRS19-0233 Address: 393 3RD ST APN: 169825 0010 $55.00 MECHANICAL HVAC FINAL"08/27/2019 RBE $55.00 MECHANICAL HVAC FINAL"08/27/2019 455-0000-322-1002 0 $55.00 RBE •TAL FEES PAID BY RECEIPT: R10034 $55.00 Date Paid: Friday, August 30, 2019 Paid By: STEVENS MICHAEL L ET AL Cashier: CB Pay Method: CREDIT CARD 900334 /� Printed: Friday,August 30, 2019 10:52 AM 1 of 1