1912 N Sherry Dr GSRS19-0089 Piping S'v''`'r MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
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PERMIT GSRS19-0089
�� �" �" ISSUED: 10/24/2019
r,_ / CITY OF ATLANTIC BEACH
EXPIRES: 4/21/2020
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:
1912 N SHERRY DR MECHANICAL RESIDENTIAL GAS GAS PIPING ONE OUTLET $1000.00
AND 2 GAS CONTAINERS
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172020 0826 SELVA MARINA UNIT
10C
COMPANY: ADDRESS: CITY: STATE: ZIP:
FLORIDA PROPANE Griffis 461 TRESCA RD JACKSONVILLE FL 32225
Gas
OWNER: ADDRESS: CITY: STATE: ZIP:
KABLAWI RAWAN 1912 SHERRY DR N ATLANTIC BEACH FL 32233-4520
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.
FEES
s
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
GAS PIPING OUTLETS 455-0000-322-1000 1 $10.00
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
Issued Date: 10/24/2019 1 of 2
S -S'`L.1/2,4 MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
;,-,-. t GSRS19-0089
�� v PERMIT ISSUED: 10/24/2019
;`u,to, CITY OF ATLANTIC BEACH EXPIRES: 4/21/2020
TANKS GAS OR LIQUEFIED PETROLEUM 455-0000-322-1000 200 $20.00
TOTAL: $89.00
Issued Date: 10/24/2019 2 of 2
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Mechanical Permit Application **ALL INFORMATION
�,
' �'' HIGHLIGHTED IN
�, City of Atlantic Beach Building Department GRAY IS REQUIRED.
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800 Seminole Rd, Atlantic Beach, FL 32233 C' i c) _ oo69
,�J�t"r Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 0 Q_ Cy l'l^,.{ OC, N• PROJECT VALUE $ lo� a .
NEW 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 BTUs per Unit Seer Rating (REQUIRED)
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)
FIRE PLACES MISCELLANEOUS:
Prefabricated Fireplace (Qty) Automobile Lifts
Gas Piping Outlets Boilers BTUs
Elevators/Escalators
HALL OTHER GAS PIPINGHeat Exchanger
Quantity of Outlets I Pumps
#Vented Wall Furnaces Refrigerator Condenser BTUs
#Water Heaters Solar Collection Systems
Tanks (gallons) �- iOc; CLO.. e-s-% 01 &
Wells e``�
I 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 consti uction or the performance of construction.
Owner Name: ‘.11,“A 1- ,.., Ccc
Phone Number: c3-,S--c3-,S--,r2)6, ��-
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Mechanical Company: -- --1,...A,-b-,.. Prz, ,,.ee,iFncc) Office Phone: (7U` 731 sagI Fax r,`I711)--13
Co.Address: 9(o (krc S C, ick - City: 6„,,,,..„t,_
State: \ -Zip: .�?7 5
License Holder: -AL( c n -rel, 1:¢.rC- _+� - " . .; :istration# '3( lo 6
Notarized Signature of License Holder ,,,,,..------- Fir
The foregoing instrument wps acknowledged Ij re m: his - ;ay of an , 20 , in the State of Florida,
County of 'A v G-1 �_
Signature of Notary P.I blic vl / v
: :„:„.: TONI GINDLESPERGER
;. ‘A, i,4 MY COMMISSION#GG 353178
.5.;•,%- .o<; � s:October 2023 [ Personally Known OR [ ] Produced Identification
..m;° Bonded nruNotary Pubic Undentraers Type of Identification:
Updated 10/9/18