586 Timber Bridge Lane GSRS19-0097 gas-piping permit MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
� ? PERMIT GSRS19-0097
ISSUED: 11/25/2019
CITY OF ATLANTIC BEACH
EXPIRES: 5/23/2020
MUST CALL INSPECTION PHONE LINE (904) 247-S814 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 • • OF . .LY, PLEASE READ
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: PERMITTYPE: DESCRIPTION: VALUE OF WORK:
586 TIMBER BRIDGE MECHANICAL RESIDENTIAL GAS GAS PIPING - ONE OUTLET $120.00
TYPE OF +
ZONING: :D •
• • GROUP:
169505 2120 ATLANTIC BEACH
COUNTRY CLUB UNIT 02
COMPANY: ADDRESS:
AEI INTERNATIONAL CORP. 7709 ALTON AVE JACKSONVILLE FL 32211
• ADDRESS:
Mark& Becky Walden 586 Timber Bridge Ln Atlantic Beach FL 32233
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.
71
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
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
TOTAL:$69.00
Issued Date: 11/25/2019 1 of 2
MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
GSRS19-0097
PERMIT
ISSUED: 11/25/2019
"d�sf CITY OF ATLANTIC BEACH EXPIRES: 5/23/2020
Issued Date: 11/25/2019 2 of 2
t Mechanical Permit Application "ALL INFORMATION
HIGHLIGHTED
City of Atlantic Beach Building Department GRAY 15 REQU RIED.
800 Seminole Rd,Atlantic Beach, FL 32233 5��5 V: ► -0097
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:bV O&ACzuo&AU
JOB ADDRESS: fS�LO TIM 61�4tL)ff-- L14-V PROJECT VALUE
❑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 _
MALL OTHER GAS PIPING Heat Exchanger
Quantity of Outlets [ Pumps
#Vented Wall Furnaces Refrigerator Condenser BTUs
#Water Heaters Solar Collection Systems
Tanks(gallons)
Wells
BOTHER:
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. q/
Owner Name: ►/�t7t�.� -k W1t(NItU Phone Number: SC�— /c 0
Mechanical Company: Lei �—� c�f( '[�� Office Phone: 1�4—1 [ `I Fax
Co.Address: G 10/--/, A fU fpkV,eo0 city: J VU..C� Stateq:�Zip:3u(I
License Holder: rc.�z A 0A -3Pk- LAA) State Certification/Registration#
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this ay of MEi06e 2A
County of i the State of Florida,
_�lU V�_
Sig ture of Notary Public
Notary PuWic State of Ronde
Stephanie E Carter Personally Known OR[ j Produced Identification
My commlauon GG 779425 Type of Identification:
V.I.; EaDves 0711&2022
Updated 70/9/18
Cash Register Receipt Receipt Number
City�r
ofAtlantic Beach
•
DESCRIPTION • QTY PAID
PermitTRAK $69.00
GSRS19-0097 Address: 586 TIMBER BRIDGE APN: 169505 2120 $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
• ' $69.00
Date Paid: Monday, November 25, 2019
Paid By: AEI INTERNATIONAL CORP.
Cashier: CT
Pay Method: CREDIT CARD 025694
Printed: Monday, November 25, 2019 10:47 AM 1 of 1