1878 Seminole Rd GSRS20-0087 1 Outlet MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
PERMIT GSRS20-0087
7 �1.0eISSUED: 12/2/2020
CITY OF ATLANTIC BEACH EXPIRES: 5/31/2021
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:
1878 SEMINOLE RD MECHANICAL RESIDENTIAL GAS GAS PIPING - ONE OUTLET $500.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172020 0522 SELVA MARINA UNIT 09
COMPANY: ADDRESS: CITY: STATE: ZIP:
Hall's Gas Services, Inc. 3047 St Johns Bluff Rd S#8 Jacksonville FL 32246
OWNER: ADDRESS: CITY: STATE: ZIP:
MIDDLETON CATHERINE W 1878 SEMINOLE RD ATLANTIC BEACH FL 32233-5916
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT If\
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.
I ..
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:12/2/2020 1 of 2
-- PermitM�
Mechanical Application **ALL INFORMATION
?a: r�, HIGHLIGHTED IN
Y StCity of Atlantic Beach Building Department GRAY IS REQUIRED.
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800 Seminole Rd, Atlantic Beach, FL 32233
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' Phone: (904) 247-5826 Email: Building-Dept@coab.usPERMIT#:GSI�S ZO ��
JOB ADDRESS: 1878 Seminole Rd PROJECT VALUE $500.00
❑NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION AR!#(REQUIRED)
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)
❑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 El MISCELLANEOUS:
Prefabricated Fireplace (Qty) Automobile Lifts
Gas Piping Outlets Boilers BTUs
Elevators/Escalators
✓❑ALL OTHER GAS PIPING Heat Exchanger
Quantity of Outlets 1 Pumps
#Vented Wall Furnaces Refrigerator Condenser BTUs
#Water Heaters Solar Collection Systems
Tanks (gallons)
Wells
OTHER: Gas piping for range only.
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: ► Vl\ t d c I p'41-(-) Phone Number:
Mechanical Company: Haws Gas Services,Inc Office Phone: (0762-7016 Fax
Co. Address: 3047 st johns bluff rd s#3 City: Jacksonville State: FL Zip: 32246
License Holder: Jason E Hall
/ State Certification/Registration# LI 32781
Notarized Signature of License Holder '' ��
i
The foreg�g-strumen was acknowledged before me this—Z-- dill
his d. • �, gOn the State of Florida,
County of 4_____) �
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Signature of Notary Public -- 01/111w ,,.._,-4-----
...................................................
,,,-ev,Pq c;, TONT GINDLESPER ER
353 1 ] Personally Known OR 1 I Produced Identification v
'. 44 ;�_ MY COMMISSION#GG 353178
&•)11 e EXPIRES:October 6,2023 Type of Identification: l.._
',TOFF° Bonded ThruNotary Public Underwriters Updated 10/9/18