368 4th St ACRS19-0284 MECHANICAL RESIDENTIAL HVAC PERMIT NUMBER
' ACRS19-0284
PERMIT
�~ ISSUED: 8/21/2019
CITY OF ATLANTIC BEACH EXPIRES: 2/17/2020
CODE,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
OF ' CH CODE OF • '
ALL CONDITIONS OF PERMIT APPLY, PLEASE
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:
368 4TH ST MECHANICAL RESIDENTIAL HVAC- 1 A/C, 1 AHU, 2 TON $4700.00
HVAC
TYPE OF
• iGROUP:
169824 0005 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
DONOVAN HEATING & AIR 315 6TH AVENUE SOUTH JACKSONVILLE FL 32250
CONDITIONING BEACH
01:1 ADDRESS: CITY: STATE: ZIP:
CHRISMAN LIVING TRUST 4100 QUEEN EMMAS DR PRINCEVILLE HI 96722
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 455-0000-322-1000 2 $16.00
FURNACES AND HEATING 455-0000-322-1000 24000 $24.00
MECHANIC ALBASE FEE 4S5-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 4SS-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
Issued Date: 8/21/2019 1 of 2
MECHANICAL RESIDENTIAL HVAC PERMIT NUMBER
r � ACRS19-0284
PERMIT
ISSUED: 8/21/2019
rj;j,; CITY OF ATLANTIC BEACH EXPIRES: 2/17/2020
TOTAL: $99.00'
Issued Date:8/21/2019 2 of 2
Mechanical Permit Application "At trWORfJATIQ't
1116141G1HTEDIN
City of Atlantic Beach Building Department _,�"x tErx,u1ta,,
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email; quill lanR_D+�1�r�ricvab.us pFkMIr it;
J013 ADDRESS: LgK n :M PROIFCT VALUE � 14-11(w_). +�
NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION AHI N(REQMRED) _
0 t-e i lr:rl,Wing Equipment Only ❑Condenser Only ❑Air Honciling Unit& Coi-ideosee
Air(,rr ,caning: Unit Quantity ___ Tans per Unit �•�
NC,aI Unit Quantity BTUs per Unit Seer Rating(REQUIRED)-_
rr %, Total CFM
EREPLAC:EMENT AIR CONDITIONING&HEATING SYSTEM INSTALLATION ARl a(RtQUIRFD) rj{l jWj i�
�?orldh'vtq Equipment Only ❑ Condenser Only ■Air Hondling Unit& Condenser
Air t ,t thminst; Unit Quantity t Tons per Unit 4 _
Hatil Unit Quantity BTU's Per Unit 2 Seer Rating(REQUIRED) 1,:;
Duct Systems: Total CFM
FIRE PREVENTION
Fire Sprinkler System Quantity (Requires 3 sets of plans)
Fire S,Andpipe Quantity (Requires 3 sets of plans)
Underground Fire Main Value __T (Requires 3 sets of plans) r
Fire IIL)%#t Cabinets Quantity _ (Requires 3 sets of plans)
Commercial Hoods Quantity „ !Requires 3 sets of plans)
Fire Supprmsion Systems Quantity Y_ (Requires 3 sets of plans)
[FIRE PLACES MISCELLANEOUS:
arefabricaced Fireplace(Qty) Automobile Lifts
Gas P a raj.; Outlets Boilers BTUs
Elevators/Escalators
QALL OTHER GAS PIPING Heat Exchanger
Quanttr.y of Outlets _ Pumps
#Vented Wall Furnaces Refrigerator Condenser BTUs
u Wa1vt Heaters _ Solar Collection Systems
Tanks (gallons) -
wells
OTH E 1?
I+elrr t •vnid it wort toes not curnmr-nrr•vnthi-i a s x month perod or work is suspended or trtandoned for slx(north.. thereby
certlf•r th -•,e rr +,t this ap;sttcadon and known the sarr.e to be true and correct, All provisions of low%and ordrnarces soverning tn,..
work i The emit does rot Slvr authority to violate the provisions of any other state or
lacalldw+ • . . lir, i ::+f+•�tfuCtlSftil'itlP{Efr�f.•r+5;1+%i:eofi6n5tf�in0r.
4a:ner r,4. � L1Vi �l(
� PhoN Number:
"hechan, Ofice Phonc:
Pax
Co Addr, .�L�_4Pz1iJA>l� C.,ty: ,1,6Z Ej A it' State_ zip:judQ _
ticenset Holdt•r: 1 QI%.l.iL%'k C�otitn sAa _ State Certlf citloofRegistration# _
Notarized.Si;;,rnture of Lrcense Holder :�✓%k�if.�_ ,(�.��,�_ �+q r
I tr:,: t•. „ n4trument was acknowledged before me this ?a; day of . 20 in the State of Florida,
Signature Qf Notary Public A (L ixr_c. '1,11.
R.+crs RD L.TCMPRAS M Personally Known OR[ I Produced Identification
r t CumnasionfGG11AW6 rypeof Identification:
JO 29.10' Updurrd:e }i^_8
r.+Yr&W 0iS+3b�P711
Cash Register Receipt Receipt Number
City of
• • • ,
DESCRIPTION • QTY PAID
PermitTRAK $99.00
ACRS19-0284 Address: 368 4TH ST APN: 169824 0005 $99.00
MECHANICAL $95.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
AC AND REFRIGERATION 455-0000-322-1000 2 $16.00
FURNACES AND HEATING 455-0000-322-1000 24000 $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: R9903 $99.00
Date Paid: Wednesday, August 21, 2019
Paid By: DONOVAN HEATING &AIR CONDITIONING
Cashier: CB
Pay Method: CREDIT CARD 066921
Printed:Wednesday,August 21, 2019 2:04 PM 1 of 1 6