559 Selva Lakes PLRS23-0039 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
GALEANI JOHN J 555 SELVA LAKES CIR ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
DOMPE'S PLUMBING LLC 2055 ALLEY RD JACKSONVILLE FL 32233
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
172027 5522 SELVA LAKES UNIT 02
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
559 SELVA LAKES CIR PLUMBING RESIDENTIAL 7 Fixtures $2300.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 7 $49.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $108.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other
governmental entities such as water management districts, state agencies, or federal agencies.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 2Issued Date: 3/7/2023
PERMIT NUMBER
PLRS23-0039
ISSUED: 3/7/2023
EXPIRES: 9/3/2023
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 3/7/2023
PERMIT NUMBER
PLRS23-0039
ISSUED: 3/7/2023
EXPIRES: 9/3/2023
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
PlumbingPermit Application ALL INFORMATION
4;,,...:\
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City of Atlantic Beach Building Department GRAY IS REQUIRED.
n
800 Seminole Rd, Atlantic Beach, FL 32233 pi,`aS23 -003
r
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: RESA2.3'Oo0y
JOB ADDRESS: 5S-c7 Selo Lakes PROJECT VALUE$ 23b0,
NEW OR REPLACEMENT INSTALLATION and/or RE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower l
Dishwasher I Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 1_
Hose Bibs Urinal
Kitchen Sink 1_ Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory a.Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS
Sewer Replacement
O Back Flow Preventer
Lawn Sprinkler System (number of sprinkler heads)
ii 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: S4e,rcr% Oovnee'.lo-.ePhone Number: clot-(- SLY-1 -C,'-) 3 5'
Plumbing Company: Dompe 5 P/vm b/e)y Office Phone: 904'- 50y-6qT 5 Fax
Co. Address: Ao55 Ailey R,0,1 City: AH. Bell. State: Ff. Zip: 32233
License Holder: 34cvc,i YJo•--,r State Certification/Registration # ( - 1y3O?,2'-1
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this 7 day of YVlu.rck. , 20_, in the State of Florida,
County of nu'[c
Signature of Notary Public
1 VANOW I$
SAANGERS
I4$HH2 Personally Known OR [ roduce• Identification
c `-: MY COMMISSION If HH 244118
r`' EXPIRES:Ila 23,2028 Type of Identification: TU. OL i75 ,Q 7 940-7Ll-CI12 `0UFfP
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Updated 10/17/18