325 4TH ST - GSRS20-0004 MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
PERMIT GSRS20-0004
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CITY OF ATLANTIC BEACH ISSUED: 2/13/2020EXPIRES: 8/11/2020
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:
325 4TH ST MECHANICAL RESIDENTIAL GAS BURY 120 GAL. PROPANE $1370.00
TANK FOR ADDITION
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169833 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
D & D Gas, Inc. 7709 Alton Ave Jacksonville FL 32211
OWNER: ADDRESS: CITY: STATE: ZIP:
KLINE CHRISTOPHER JOHN 325 4TH ST 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.
0
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
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 120 $20.00
TOTAL:$79.00
Issued Date:2/13/2020 1 of 2
.-,.air?;.• Mechanical Permit Application "ALL INFORMATION
�� HlGHLIGHTED IN
'1 City of Atlantic Beach Building Department GRAY'S REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
°''e Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: �1 SIZSp� �(�U
JOB ADDRESS: 32 5 i- 4' 5 PROJECT VALUE$ I 7 O no
_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
❑REPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI#(REQUIRED)
0 Air Handling Equipment Only 0 Condenser Only p 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)
LI FIRE PLACES MISCELLANEOUS:
Prefabricated Fireplace (Qty) Automobile Lifts
Gas Piping Outlets Boilers BTUs
Elevators/Escalators
FiALL OTHER GAS PIPING Heat Exchanger
Quantity of Outlets Pumps
#Vented Wall Furnaces Refrigerator Condenser BTUs
#Water Heaters Solar Collection Systems
Tanks (gallons) /'l
Wells
OTHER: lar ro K r 0vc- X IS 41., ‘ k r ^ i" ;✓tie-
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 tree 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 constructicn.
Owner Name: S V VI t o 'A< ( i►rim f Phone Number: Zit- 116)r1- 64/68
Mechanical Company: D 4- D`' ' �' in r Office Phone: :'7 2_ ~'-qI yy Fax 721-F 3 416,
Co.Address: -1 7 O; Li '-. :ai City .t)'t ' -State: Ft--Zip: 32 ao
License Holder: ,•A .e 4. :..,s State Certification/Registration#':_(.0.40 9
Notarized Signature of License • • er--. +x:1:)1 .S c )2 i;i"- *N��. '::•. " :lw;.;
The foregoin instrument was acknowledged before me this ((O-day of ) , 20 ?�, in the Stat of Florida,
County of DU✓a.( J
Signature of Notary Public yf� `,"%/9/ ( ,_
,..,.. Notary Public State of Flontla
y , Stephanie Renee McGuire [l]-Personally Known OR [ ] Produced Identification
1 C A. My Commission GG 123258
`• '�►0.,.., Expires 08io,/2021 Type of Identification:
l
Updated 10/9/18
JS ,' Cash Register Receipt Receipt Number
City of Atlantic Beach R11725
-a,3 9'
DESCRIPTION I ACCOUNT I QTY PAID
PermitTRAK $79.00
GSRS20-0004 Address: 325 4TH ST APN: 169833 0000 $79.00
MECHANICAL $75.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
TANKS GAS OR LIQUEFIED PETROLEUM 455-0000-322-1000 120 $20.00
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: R11725 $79.00
Date Paid: Thursday, February 13, 2020
Paid By: D & D Gas, Inc.
Cashier: CT
Pay Method: CREDIT CARD 5
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Printed:Thursday,February 13, 2020 1:41 PM 1 of 1 '`