130 5th St ACRS19-0405 1'`"''J'/ MECHANICAL RESIDENTIAL HVAC PERMIT NUMBER
Ii$f"' PERMIT ACRS19-0405
$f" ` ., �, ISSUED: 12/20/2019
,,,�1;�,; V CITY OF ATLANTIC BEACH EXPIRES: 6/17/2020
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:
130 5TH ST MECHANICAL RESIDENTIAL HVAC - 1 A/C, 1 AHU, 2 TON $3100.00
HVAC
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170168 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
AIR TO AIR 11578 DAVIS CREEK CT JACKSONVILLE FL 32256
OWNER: ADDRESS: CITY: STATE: ZIP:
DIAZ MICHAEL K 130 5th 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.
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 1 $8.00
FURNACES AND HEATING 455-0000-322-1000 24000 $24.00
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:$91.00
Issued Date: 12/20/2019 1 of 2
r
trLv ,, MECHANICAL RESIDENTIAL HVAC PERMIT NUMBER
j`- ACRS19-0405
';-.: PERMIT
v ISSUED: 12/20/2019 ,
,0.219CITY OF ATLANTIC BEACH EXPIRES: 6/17/2020
Issued Date: 12/20/2019 2 of 2
RCt2S t9 - moo`
Mechanical Permit Application "ALL INFORMATION
PM HIGHLIGHTED IN
`. City of Atlantic Beach Building Department GRAY IS REQUIRED.
\" 800 Seminole Rd, Atlantic Beach, FL 32233
\\,..-z°'� Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:Qec\ C) iCN)
JOB ADDRESS: \-'2,C) �� "4"\r) S- ti\ tC�l�kS 3 ROJECT VALUE$ 2,lC C)
❑NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI#(REQUIRED) -1 I h '-1 ((7Q d
❑Air Handling Equipment Only , ❑Condenser Only Air Handling Unit& Condenser
Air Conditioning: Unit Quantity Tons per Unit L— P
Heat: Unit Quantity I BTUs per Unit Seer Rating(REQUIRED) t
Duct Systems: Total CFM ci:5-c_,i" Y29 J 00 O
❑REPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI#(REQUIRED)
• ❑Air Handling Equipment Only 0 Condenser Only 0 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 0MISCELLANEOUS:
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 Heaters Solar Collection Systems
Tanks (gallons)
Wells
OTHER:
imimmimmimumi
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:'? \C '( �{-:�U^u�n t Phone Number: C{C14-7-((2 LIZ:1c
Mechanical Company: PM" "\T )PK( ` Office Phone:QC -2-42- 1. x
Co.Address:\0 ?' ' i C `QAC Ck - City: X State: \ Zip:?ZJl.C?
License Holder: ��,( \\CjOSc� N. • . Certification/if gistration# .,.32a"
EIRC__(;:?..(1 b
_
Notarized Signature of License Holder A r
qt1
The foregoin instr iment was acknowledged before me this I day of Lc:-_- \ , 20 0, intheState of Florida,
••; :w•••, RICKEY D.HOWARD Signature of Notary Public rf J ` ..)cUxJ
1.e MY COMMISSION#GG 085851
's;• :;,1 EXPIRES:June 19,2021 [Personally Known ORE I Produced Identification
'..'"1-.4:. Bonded 11'n H°t"Pubic Underrnitcrs
,,,' Type of Identification:
Updated 10/9/18
rs
Cash Register Receipt p p Receipt Number
,� -,
City of Atlantic Beach R11337
-tr A 9.:-/
DESCRIPTION I ACCOUNT QTY PAID
PermitTRAK $91.00
ACRS19-0405 Address: 130 5TH ST APN: 170168 0000 $91.00
MECHANICAL $87.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
AC AND REFRIGERATION 455-0000-322-1000 1 $8.00
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: R11337 $91.00
Date Paid: Friday, December 20, 2019
Paid By: AIR TO AIR
Cashier: CB
Pay Method: CREDIT CARD 1
Printed: Friday, December 20,2019 8:18 AM 1 of 1