265 3rd St GSRS21-0051 2 Outlets, Water Heater, TankOWNER:ADDRESS:CITY:STATE:ZIP:
HOWE ANDREW M 265 3RD ST ATLANTIC BEACH FL 32233-5210
COMPANY:ADDRESS:CITY:STATE:ZIP:
Blossman Gas, Inc 5923 Soutel Drive Jacksonville Fl 32219
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
172550 0000 ATLANTIC BEACH
TERRACE
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
265 3RD ST MECHANICAL RESIDENTIAL GAS 2 gas outlets, water heater,
250 gal tank $500.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
GAS PIPING OUTLETS 455-0000-322-1000 2 $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: 5/12/2021
PERMIT NUMBER
GSRS21-0051
ISSUED: 5/12/2021
EXPIRES: 11/8/2021
MECHANICAL RESIDENTIAL GAS
PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
VENTED WALL FURNACE WATER HEATER UNIT 455-0000-322-1000 1 $5.00
TOTAL: $94.00
2 of 2Issued Date: 5/12/2021
PERMIT NUMBER
GSRS21-0051
ISSUED: 5/12/2021
EXPIRES: 11/8/2021
MECHANICAL RESIDENTIAL GAS
PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $94.00
GSRS21-0051 Address: 265 3RD ST APN: 172550 0000 $94.00
MECHANICAL $90.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $55.00
GAS PIPING OUTLETS 455-0000-322-1000 2 $10.00
TANKS GAS OR LIQUEFIED PETROLEUM 455-0000-322-1000 250 $20.00
VENTED WALL FURNACE WATER HEATER
UNIT 455-0000-322-1000 1 $5.00
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: R15786 $94.00
Printed: Wednesday, May 12, 2021 3:17 PM
Date Paid: Wednesday, May 12, 2021
Paid By: Blossman Gas, Inc
Pay Method: CREDIT CARD 454967926
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R15786
GSRS21-0051