1280 W Plaza GSRS19-0091 Piping Firepit, Generator, Grill & Tanks a�o't'yf MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
.4
PERMIT GSRS19-0091
ISSUED: 10/30/2019
,,1,' CITY OF ATLANTIC BEACH EXPIRES: 4/27/2020
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:
GAS PIPING EXTERIOR
1280 W PLAZA MECHANICAL RESIDENTIAL GAS FIREPIT, GENERATOR, GRILL $2800.00
&TANKS
TYPE OF REAL ESTATE BUILDING USE
ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170979 0000 ATLANTIC BEACH SEC H
COMPANY: ADDRESS: CITY: STATE: ZIP:
D & D Gas, Inc. 7709 Alton Ave Jacksonville FL 32211
OWNER: ADDRESS: CITY: STATE: ZIP:
BROWN JAMES W 4012 RUSTLING OAKS CT JACKSONVILLE FL 32277
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
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
GAS PIPING OUTLETS 455-0000-322-1000 3 $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
TANKS GAS OR LIQUEFIED PETROLEUM 455-0000-322-1000 500 $20.00
Issued Date: 10/30/2019 1 of 2
rl?I'`'' •
�� MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
r, PERMIT GSRS19-0091
ISSUED: 10/30/2019
..rl , CITY OF ATLANTIC BEACH EXPIRES: 4/27/2020
TOTAL: $89.00
Issued Date: 10/30/2019 2 of 2
r-I Mechanical Permit Application DIN"
;0 ¢RAY IS REQUIRED.
i` 1":41,1City of Atlantic Beach Building Department . ,..:.
l800 Seminole Rd, Atlantic Beach, FL 32233 �a S R s ( 9 _009
F-on1 ' Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 1 1 e VO • P I c Z-c " • PROJECT VALUE$ 2 E�CSO. 0 (7>
[]NEW AIR CONDITIONING &HEATING SYSTEM INSTALLATION ARI#(REQUIRED)
0 Air Handling Equipment Only 0 Condenser Only 0 Air Handling Unit&Condenser
Air Conditioning: Unit Quantity Tons per Unit
Heat: Unit Quantity BTUs per Unit Seer Rating(REQUIRED)
Duct Systems: Total CFM
DREPLACEMENT AIR CONDITIONING& HEATING SYSTEM INSTALLATION ARI#(REQUIRED)
0 Air Handling Equipment Only 0 Condenser Only D 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
DARE 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)
0FIRE 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 HeatersSolar Collection Systems
Tanks(gallons) Sc c�
OTHER:1-rms-}--u I l `�C i t r,c {-v c re_ _), r rr t I S 17.-1,,t —3(..c. r u c he G-rk_ l e_ „✓„ cf
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.
a;: .•vi;:; Phone Number t lc - e 35?
Owner Name: `}�i'N��s� ��rc� -i �,�... ..
Mechanical Company: -4--D 6.1 . ) Office Phone: - f_ 1'/ Fax-7Z/ -. J'71‘,c7
Co.Address: 1 .41P 441 .1.47, City: Jetty bite Stater— Zip: 32_Z//
License Holder: V• e ,. a .:‘ - State Certification/Registration# ,ICC 40 9
ike
I_-e-Lc)'-( .)' ` ` "
Notarized Signature of License . • •er � r `•'°z °� �" �`T'^
t
The foregoi : instrumen was acknowledged before me thi �y of OC1°�.,(,20 l f in the Stat of Florida,
C• ‘ • . _r. . r c
%t Notary Public State of Floritla Signature of Notary Public i 7 V\ , c\'r-- . CO-1
f Stephanie E Carter
litdi EZ Commission 22 2 9425 Personally Known OR[ 1 Produced Identification
Expues 07nti/2022
a� Type of Identification:
Updated 10/9/18
ci%%�+yr
l�
r �
,s ` Cash Register Receipt Receipt Number
City of Atlantic Beach R10895
!J
-L>Fi J'•
DESCRIPTION I ACCOUNT I QTY PAID
PermitTRAK $89.00
GSRS19-0091 Address: 1280 W PLAZA APN: 170979 0000 $89.00
MECHANICAL $85.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
TANKS GAS OR LIQUEFIED PETROLEUM 455-0000-322-1000 500 $20.00
GAS PIPING OUTLETS 455-0000-322-1000 3 $10.00
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: R10895 $89.00
Date Paid: Wednesday, October 30, 2019
Paid By: D & D Gas, Inc.
Cashier: CT
Pay Method: CREDIT CARD 03019C
Printed:Wednesday,October 30, 2019 9:25 AM 1 of 1