380 12th St ACRS19-0244 HVAC MECHANICAL RESIDENTIAL HVAC PERMIT NUMBER
PERMIT ACRS19-0244
ISSUED: 7/15/2019
CITY OF ATLANTIC BEACH EXPIRES: 1/11/2020
MUST CALL INSPECTION PHONE LINE (904) 247-S814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • '
CODE, ' OF BEACH CODEOF • '
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: E OF WORK:
380 12TH ST MECHANICAL RESIDENTIAL HVAC - 2 A/C, 2 AHU, 2.5 & $19900.00
HVAC 3.5 TON
TYPE OF
ZONING: :D •
• • GROUP:
171930 0000 SELVA MARINA UNIT 01
• ® 'DDRCITY: .�
AIR FLOW DESIGNS INC PO BOX 180308 CASSELBERRY FL 32718
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 . .
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 6 $48.00
FURNACES AND HEATING 455-0000-322-1000 72000 $28.00
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: 7/15/2019 1 of 2
MECHANICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233 �i �
Ph(904) 247-5826 Fax (904)247-5845 5�� - Cz` +f
JOB ADDRESS: / , c !Z �f /�-f l�-r -6 44 , ,F/ 3a L 3 3 PERMIT# l° -Oa yS
PROJECT VALUE $ /91,0v. 00
NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION
Air Conditioning: Unit Quantity t Tons Per Unit 3.5 14.5
Heat: Unit Quantity�— BTU's Per Unit 3eoco Seer Rating 1q. 6
Duct Systems: Total CFM t gx4e° REQUIRED
REPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION
ARI#
Air Conditioning: Unit Quantity Tons Per Unit REQUIRED
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 Pumps
#Vented Wall Furnaces Refrigerator Condenser BTU's
#Water Heaters Solar Collection Systems '
Tanks (gallons)
Wells
OTHER:
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.
Property Owners Name Te lf#- s P o, �� I) A 1 C P �9
Phone Number 5- 4-2,to-S
Mechanical Company R/,r a� t-r: s __Office P'% S-530 Fax
Co. Address: S�/ S u s�'`N¢ City State 1`/ Zip
License Holder(Print): State Certification/Registration# e&C/g/Y`1z i
Notarized Signature of License Holder
Sworn and subscribed befme this &44- day of'�. /ter 2019
Signature of Not Public- DONNA L.THOMASON
Commission#GG 235372
a"Expires November Z 2022
BaMed TMm Troy Fele hu mice 8W V$-T919
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NE477NW&IVR COND/T/ON/NG STATE LICENSE:CAC042721
CENTRAL FLORIDA CORPORATE OFFICE
P.O.BOX 180308 • CASSELBERRY,FL 32718-0308 • (407)831-3600 • FAX(407)831-2893
AUTHORIZATION LETTER
I, TERRY BURD, contractor license number CAC 1814422 hereby authorize
CHRIS COHICK
GARY DUNCAN
JESSE BURD
to act as my agent for the purpose of obtaining permits in
This authorization is to remain in effect indefinitely, unless canceled by me in writing.
Contractor's Signature
Sworn to and subscribed to before me this day of 2016
Who is personally known to me . -
"'..'iI<;, WNt A L.THOMASQN
'•• `_ Co emission#Fr"138497
Exrires November2,2018
t
BRANCH OFFICES: CLERMONT, DAYTONA, JACICSEVYi TAMPA