345 Belvedere St PLRS22-0069 Plumbing Permit 6 r�# r J PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS22-0069
L‘ 800 SEMINOLE ROAD ISSUED: 5/16/2022
ATLANTIC BEACH, FL 32233 EXPIRES: 11/12/2022
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 FLORIDABUILDING
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: I PERMIT TYPE: I DESCRIPTION: VALUE OF WORK:
345 BELVEDERE ST PLUMBING RESIDENTIAL PLUMBING - 13 FIXTURES $6000.00
REAL ESTATE . I
TYPE OF BUILDING USE ZONING: SUBDIVISION:
CONSTRUCTION: I NUMBER: GROUP:
170703 0268 SEASPRAY
COMPANY: ' ADDRESS: I CITY: @ STATE: I ZIP:
Bradley Home 3721 DuPont Station Court South Jacksonville FL 32217
Improvements LLC
OWNER: , ADDRESS: CITY: I STATE: I ZIP:
GAMMAGE KEVAN R 345 BELVEDERE ST ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT II\
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.
---�-- - -_ ---
LIST OF CONDITIONS �------ —� - -
Roll off container company must be on City approved list. Container cannot be placed on City right-of-way.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 13 $91.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.84
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.56
WORK WITHOUT PERMIT 455-0000-322-1000 0 $110.00
TOTAL:$262.40
Issued Date:5/16/2022 1 of 2
Plumbing Permit Application **ALL INFORMATION
r ,� HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
4.1. -t--- 800 Seminole Rd, Atlantic Beach, FL 32233
it' Phone:/ (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: I PLR-S22-090
:5
JOB ADDRESS:' 5 Se 46°,(//"—c -- PROJECT VALUE$ 6 l(
❑NEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub I Septic Tank& Pit
Clothes Washer —I- Shower —2 —
Dishwasher 1 Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 3
Hose Bibs Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 3 Water Heater
Other Fixtures Water Treating System
❑MISCELLANEOUS \
❑ Sewer Replacement
o Back Flow Preventer
❑ Lawn Sprinkler System (number of sprink - eads)
❑ Grease 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
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:, kat/e.,
!4 /j/e,�_7G�/h ,,,- Phone Number:
Plumbing Company:f `4cal ,2 L.OVP If4V/ ir4nO Jffice Phone:,7,6/ 3g-o" 0 Fax
Co.Address:, TOWS 0/4/�lt° J — City: ✓a State: Zip:, -Z Z Z.
License Holder:' J. - g G/// State Certification/Registration#' /r. /c74 ,
Notarized Signature of License Holder ._/41001 ---111. --------
The
The foregoi strumen�f was acknowledged before me this 1 (tda • lig ; 20ZZJn the State of' Florida,
County of L)Vrx-1
O
il( c_..1
Signature of Notary Public • EAk _
j. °•••:••��; roNIGINOLESPERGER [ ] Personally Known OR [ ] Produced Identification4
_ : ,�,, ;., MYCOMA issioN#GG 353178
�:�' ,�. Type of Identification: � L
�''FboP EXPIRES:October 6,2023
Bonded Thru N Updated 10/17/18
,,. orary Public Underwriters