1625 Atlantic Beach Dr GSRS19-0093 piping to generator permit MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
GSRS19-0093
' PERMIT
s, ISSUED: 11/5/2019
CITY OF ATLANTIC BEACH EXPIRES: 5/3/2020
MUST CALL INSPECTION • • 1 • • PM FORDAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • ' ! BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT • • 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: ► • OF • •
1625 ATLANTIC BEACH DR MECHANICAL RESIDENTIAL GAS GAS PIPING - RUN LINE TO $700.00
GENERATOR
TYPE OF •
• : ► •
• • GROUP:
169505 1080 ATLANTIC BEACH
COUNTRY CLUB UNIT 01
COMPANY: ADDRESS: CITY: STATE: ZIP:
PROGASCO, CORP. 7709 ALTON AVE JACKSONVILLE FL 32211
• ADDRESS:
ADAM LEOPOLD AND
JENNIE D LEOPOLD FAMILY 1625 ATLANTIC BEACH DR ATLANTIC BEACH FL 32233-
TRUST
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 • ► •
I �
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
I
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
Issued Date: 11/5/2019 1 of 2
MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
GSRS19-0093
PERMIT ISSUED: 11/5/2019
".soil CITY OF ATLANTIC BEACH EXPIRES: 5/3/2020
STATE DCA SURCHARGE 455-0000-208-0600 0 52 00'
TOTAL:$69.001
Issued Date: 11/5/2019 2 of 2
i
Mechanical Permit Application **ALL INFORMATION
% R:;t': kL
HIGHLIGHTED IN RECIU
City Of Atlantic Beach Building Department RAY IS IRED.
!% 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: 13Llildinp-Dept@coab.us PERMITtt:
JOB ADDRESS: J �0a S -A+Ict,n4i r_ i�c� ir_L, PROJECT VALUE $ —]DO , pp
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 Sstems: Total CFM
a
❑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
ALL OTHER GAS PIPING Heat Exchanger
Quantity of Outlets Pumps i
# Vented Wall Furnaces Refrigerator Condenser BTUs
#Water Heaters Solar Collection Systems
Tanks (gallons)
Wells
OTHER: IrVyl e-)<+C1'► oC en, 0%,P ~o✓�t-��
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.
Owner Name: Ar ins r n o null :: Phone Number: 9yq—
Mechanical Company: Yr0QC,-SCV _Office Phone: �0y�'7a1—St/Zf Fax
Co. Address: -]70� A-M Dov atrC City: �CaG�cn v:�J� State:E Zip:
License Holder: Ci State Certification/Registration#�
Notarized Signature of License Holder
i
The foregoin instrument was acknowledged before me this Jr day of VClhbe-- 20 in the State of Florida,
County of_ _li va
Signature of Notary Public _ �.H-•�- %�-{�"
�.✓" Notary PuNic State of Flonda [LJ'Nersonally Known OR [ ] Produced Identification
Stephanie Renee McGuire Type of Identification: a
a� My Comm mon GG 123256
ar w Expres M01!2021 Updated 10/9/18
er
is
• . •• . • •
ofAtlantic Beach R10970
City
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $69.00
GSRS19-0093 Address: 1625 ATLANTIC BEACH DR APN: 169505 1080 $69.00
MECHANICAL $65.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
GAS PIPING OUTLETS 455-0000-322-1000 1 $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: 1 • 1 •
11
Date Paid: Tuesday, November 05, 2019
Paid By: PROGASCO, CORP.
Cashier: CB
Pay Method: CREDIT CARD 2
Printed:Tuesday, November 05,2019 9:51 AM 1 of 1