462 AQUATIC DR - ACRS20-0309 Mechanical Permit Application **ALL INFORMATION
HIGHLIGHTED IN
/7;'
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 �r
1-1 --` S Zd-d f
Phone: (904) 247-5826 Email:nEiuilding-Dept@coab.us PERMIT#:
JOB ADDRESS: 'f/Q 2- ill " C-- f ril �4%6, PROJECT VALUE $ S-0. Ov
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 I#(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)
I AFIRE 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: C V l C _PliCf"/D4.46 11✓
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: CL- l'f (• 5u/g- l'J Phone Number: /-61�, 2(2<Ug27
Mechanical Company:// �]., Office Phone: lam(.g2.12,2C-2,4q1--7 Fax
Co. Address: `tf02 9 J C ��� City: 0P-4"4-2e- v�I� State: Zip: 3.2-2-3
License Holder: O r 1 p r b U L()Act 'P r State Certification/Registration#
Notarized Signature of License Holder / ti (e
The foregoi i trument kass acknowledged bef re me t is •. L
of _ , 214 �►the State of Florida,
County of Qua, .' k
d/---
Signature of Notary Publi -
.iv'.'''' TONI GINDLESPERGER
:, ��e: MY COMMISSION#GG353178 ] Personally Known OR [ ] Produced Identification
-��P7, EXPIRES:Cc':ber 6,2023 ype of Identification: (-
-F°r,,f;..• Bonded Thru Notary Public Underwriters Updated 10/9/18
" Owner Builder Affidavit **ALL INFORMATION
''�^ HIGHLIGHTED IN
Jly '� City of Atlantic Beach Building Department GRAY IS REQUIRED.
n
Vir" 800 Seminole Rd, Atlantic Beach, FL 32233
-Ent Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1"CONSTRUCTION CONTRACTING" REQUIRES
OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED
FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER
OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A
LICENSE.
YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF.
YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY
ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS.
THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE
CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH
IS IN VIOLATION OF THIS EXEMPTION.
YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS.
IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES
REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES.
II. INJURY LIABILITY;SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT
SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. .
III. IRS WITHHOLDING;OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING
TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT
TO$5,000 PENALTY UNDER FLORIDA STATUTE NO.455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY" OR THE FLORIDA"CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALL THEE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: g&'2 /? 77c Pa l tE� C g?& / 3 2-23 t/
Owner Name: I - t - 0 � r Phone Number:IU7, Z5 2• o7 2 7
Mailing Address:y4DZ d�Z( Pit{c' City:�Ei C reState: Zip: .P-L_Ls"
`
Notarized Signature of Owner L
#04The�o�,oing instrur lent was acknowle ged be re me th. day .`
/ , 2024h the State of Florida, County
` 11
of l Olio
Signature of Notary Public t`•' L �-
[ ] Personally Known OR [ Produced Identification
I l -
Type of Identification: •
Updated 10/24/18