1355 Ocean Blvd PLRS21-0145 1 FixtureOWNER:ADDRESS:CITY:STATE:ZIP:
JOSH NUSSBAUM 1355 OCEAN BLVD ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
Mandarin Plumbing Inc.3737 Indian Princess RD JACKSONVILLE FL 32257
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171841 0020 MANDALAY
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1355 OCEAN BLVD PLUMBING RESIDENTIAL PLUMBING - ONE FIXTURE $14310.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 1 $7.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $66.00
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: 9/23/2021
PERMIT NUMBER
PLRS21-0145
ISSUED: 9/23/2021
EXPIRES: 3/22/2022
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 9/23/2021
PERMIT NUMBER
PLRS21-0145
ISSUED: 9/23/2021
EXPIRES: 3/22/2022
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $66.00
PLRS21-0145 Address: 1355 OCEAN BLVD APN: 171841 0020 $66.00
PLUMBING $62.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 1 $7.00
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: R17303 $66.00
Printed: Thursday, September 23, 2021 1:38 PM
Date Paid: Thursday, September 23, 2021
Paid By: Mandarin Plumbing Inc.
Pay Method: CREDIT CARD 515843612
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R17303
PlumbingPermit Application ALL INFORMATION
ii-,,,,HIGHLIGHTED IN
j City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
JJPhone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 'LRSZj'(5145
JOB ADDRESS: 1355 Ocean Blvd. PROJECT VALUE $14,310.00
JEW OR REPLACEMENT INSTALLATION and/or EIRE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures 1 Water Treating System
MISCELLANEOUS
Chewer Replacement
Back Flow Preventer C 0 in C4S c , (\L__
Lawn Sprinkler System (number of sprinkler heads)
Erease Interceptor (Trap) gallons (Requires 3 sets of plans)
Well **SJRWD Well Completion Form.Completed form to be submitted to the Building Department for final inspection. **
Other
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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:Josh Nussbaum Phone Number: / /7" Vz J"-- zr 7 2-
PlumbingPlumbing Company: Mandarin Plumbing Office Phone: FaxFax
Co. Address: 3737 indiam Princess Rd City: Jacksonville State: FL Zip: 32257
License Holder: Steve Siegler State Certification/Registration # CFC1428316
Notarized Signature of License Holder 4mi.
The foregoing ' strumept was acknowledged before me this, A day o .4, j i 20,L( , in the State of Florida,
County of
0
o.'':'°ae, PATRICIA D.HURD
Signature of Notary Public FA, 'LLaI
i.,;* Commission#HH 115411
N ''T r
Personal) Known OR P oduced Id-ntification
o Expires August 8,2025 Y
Po°,"°°> °°"°'°Ilya Bodgo'Notary Service3 Type of Identification: 4..A 1. :-_;
Updated 10/17/18