380 12th St GSRS19-0054 Piping MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
sr GSRS19-0054
v� PERMIT ISSUED: 7/10/2019
CITY OF ATLANTIC BEACH EXPIRES: 1/6/2020
MUST CALL INSPECTION . • • + PM FOR + INSPECTION.
ALL • ' K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • ' + BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL i • OF APPLY, + AD 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:
&
380 12TH ST MECHANICAL RESIDENTIAL GAS GAS PIPING - 5 OUTLETS 2 $1500.00
WATER HEATERS
TYPE OF
ZONING: : . •
• • GROUP:
171930 0000 SELVA MARINA UNIT 01
COMPANY: ADDRESS: CITY: STATE: ZIP:
SAWYER GAS OF THE 98 PENMAN RD JACKSONVILLE FL 32250
BEACHES BEACH
OWNER: ADDRESS: CITY: STATE: zip:
PETER & AMY POLLAK 380 12TH ST ATLANTIC BEACH FL 32233-5514
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
GAS PIPING OUTLETS 455-0000-322-1000 5 $12.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 4S5-0000-208-0600 0 $2.00
VENTED WALL FURNACE WATER HEATER UNIT 455-0000-322-1000 2 $10.00
Issued Date. 7/10/2019 1 of 2
MECHANICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845 �'1 J RJo
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sel
JOB ADDRESS: 3�r O jl+'% SA-. 4---L 32-133 PERMIT# l
PROJECT VALUE $ 1 5c. 00 ARI# REQUIRED
Air Handling Equipment Only Air Handling Unit & Condenser Condenser Only
NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION
Air Conditioning: Unit Quantity Tons Per Unit
Heat: Unit Quantity BTU's Per Unit Seer Rating
Duct Systems: Total CFM REQUIRED
REPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION
Air Conditioning: Unit Quantity Tons Per Unit
Heat: Unit Quantity BTU's Per Unit Seer Rating
Duct Systems: Total CFM REQUIRED
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)
FIRE PLACES MISCELLANEOUS:
Prefabricated Fireplace Qty Automobile Lifts
Gas Piping Outlets Boilers BTU's
Elevators/Escalators
ALL OTHER GAS PIPING Heat Exchanger
Quantity of Outlets 5 Pumps
# Vented Wall Furnaces Refrigerator Condenser BTU's
# Water Heaters 2 Solar Collection Systems
Tanks (gallons) 500
Wells
OTHER:
'ermit 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
his 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
iot. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name 1b11 Ak Phone Number RICH 21-3 31or73
Mechanical Company SowHe 6f,6 ort '-f`ke Office PhoneQlc% gboo Fax9;30 $ogy
-o. Address: M pu~l M City)&tA\\A0,Q(A6\ State EL Zip DZZ sv
License Holder(Print): erS State Certification/Registration# 7�0 j 4y
e Holder
I,��
Notary Public-State of Florida Before e this day 20 —
•_ Commission#FF 896938
My Comm.Expires Jul 16,2019 Signature of Notary Public
�ni�a• 8ondeddwough National Notary Assn