357 12th St PLRS23-0049 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
William Murphy 357 12TH ST ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
TDG PLUMBING 4426 LOYS DR JACKSONVILLE FL 32246
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171989 0115 SELVA VERDE
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
357 12TH ST PLUMBING RESIDENTIAL 8 Fixtures $9000.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 8 $56.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $115.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other
governmental entities such as water management districts, state agencies, or federal agencies.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 2Issued Date: 3/27/2023
PERMIT NUMBER
PLRS23-0049
ISSUED: 3/27/2023
EXPIRES: 9/23/2023
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 3/27/2023
PERMIT NUMBER
PLRS23-0049
ISSUED: 3/27/2023
EXPIRES: 9/23/2023
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
s
A4•;Plumbing Permit Application ALL INFORMATION
sL
HIGHLIGHTED IN
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City of Atlantic Beach Building Department GRAY IS REQUIRED.
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800 Seminole Rd, Atlantic Beach, FL 32233 PL S23 —00141\` ` `'~
j` ~ Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:y2CS2` W5
JOB ADDRESS: -3'--7 \fin --\----
PROJECT VALUE$ q10 0.00
NEW 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 2Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS
Sewer Replacement
Back Flow Preventer
Lawn Sprinkler System (number of sprinkler heads)
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
locallom
law regulation construction or the performance of construction.
tOwnerName: i,), :s rx 0'\ Urp/-I Phone Number:
Plumbing Company: TO Co C LL, c'- A7 Office Phone: S'4i S-? 19 Fax 1at3.-
Co. Address: "l y.L. Lo'. -DP- City: `Z Al State: 'FL Zip:ay L,
License Holder: ir At) c S A Tv€-7' State Certification/Registration# (' Ft (T2----/C62-
Notarized Signature of License Holder`' 4 r—
The foregoing instrument was acknowledged before me this 2 7 day of nfla t 1 , 20 23, in the State of Florida,
County of Wu-kJ
Signature of Notary Public
p` VANESSA ANGERS Personally Known OR [(Produced Identification
iti t '_ MY COMMISSION#HH 244118
o". EXPIRES Mendt23,2o2s
Type of Identification: ft. DL e75V0 8C4-)5--41A-0 TrAv,'s Elcuheii
Updated 10/17/18