475 Palmwood Ln GSRS20-0044OWNER:ADDRESS:CITY:STATE:ZIP:
JOHN DODSON 475 PALMWOOD LN ATLANTIC BEACH FL 32233-5607
COMPANY:ADDRESS:CITY:STATE:ZIP:
FLORIDA PROPANE-Griffis
Gas 461 TRESCA RD JACKSONVILLE FL 32225
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
172020 0194 SELVA MARINA UNIT 06
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
475 PALMWOOD LN MECHANICAL RESIDENTIAL GAS GAS PIPING - 3 OUTLETS
AND 250 GAL TANK $2000.00
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 250 $20.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
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.
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.
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.
1 of 2Issued Date: 7/15/2020
PERMIT NUMBER
GSRS20-0044
ISSUED: 7/15/2020
EXPIRES: 1/11/2021
MECHANICAL RESIDENTIAL GAS
PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
TOTAL: $89.00
2 of 2Issued Date: 7/15/2020
PERMIT NUMBER
GSRS20-0044
ISSUED: 7/15/2020
EXPIRES: 1/11/2021
MECHANICAL RESIDENTIAL GAS
PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $89.00
GSRS20-0044 Address: 475 PALMWOOD LN APN: 172020 0194 $89.00
MECHANICAL $85.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
TANKS GAS OR LIQUEFIED PETROLEUM 455-0000-322-1000 250 $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: R12324 $89.00
Printed: Wednesday, July 15, 2020 9:21 AM
Date Paid: Wednesday, July 15, 2020
Paid By: FLORIDA PROPANE-Griffis Gas
Pay Method: CREDIT CARD 345032291
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R12324
Updated 10/9/18
Mechanical Permit Application **ALL INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED. City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT #: _____________________
JOB ADDRESS: ______________________________________________ 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
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:
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 go verning 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: ____________________ _______ Phone Number:
Mechanical Company: Office Phone: _________________ Fax
Co. Address: City: State: Zip:
License Holder: _______ ___ State Certification/Registration #
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this _____day of ___________, 20___, in the State of Florida,
County of _________________
Signature of Notary Public __________________________________________________
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: _____________________________________________________