1761 SEMINOLE RD PLRS24-0061 - �t"'" PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
Js 4t ._„.. c,J
CITY OF ATLANTIC BEACH PLRS24-0061
ISSUED: 4/11/2024
800 SEMINOLE ROAD
`'i31� ATLANTIC BEACH. FL 32233 EXPIRES: 10/8/2024
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.
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: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
1761 SEMINOLE RD PLUMBING RESIDENTIAL PLUMBING - 4 FIXTURES $2300.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169636 0400 OCEAN GROVE UNIT 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
Clay County Master
Plumbing LLC 706 Charles Pinckney St Orange Park FL 32073
OWNER: ADDRESS: I CITY: STATE: ZIP:
SHADDEN ELIZABETH B C/O ELIZABETH SHADDEN POSR ATLANTIC BEACH FL 32233
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.
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 4 $28.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $87.00
Issued Date:4/11/2024 1 of 2
Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
"•' City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:FURS Z4-no&
JOB ADDRESS: 1161 . sninc,k, ad PROJECT VALUE $ Z3OO.°
NEW OR REPLACEMENT INSTALLATION and/or ❑RE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower
Dishwasher Shower Pan I
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet I
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances Z
Lavatory Water Heater
Other Fixtures /\ Water Treating System
❑MISCELLANEOUS I
D Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler heads)
❑ Grease Interceptor (Trap) gallons (Requires 1 set of digital 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: ElgittbrAh Shadciec Phone Number: gact-3tc -8158
Plumbing Company: 4.4 tc6nAci rfr-sir elonnloin3 Office Phone: g04-584 -°t.toto Fax
Co. Address: -c(o &e., P;ncltnel Ave. City: pita-5r pita-5rpart,, State: cl Zip: Ba0-13
License Holder: St+ylr QAkle " State Certification/Registration# ty&DQgp
Notarized Signature of License Holder 1,4 4a.Ze--
The foregoiftg4Qstrument yras acknowledged before me this / ( da f l� )\-i ( , 202 , n the State of Florida,
County of V�1
Signature of Notary Public
4;, TONIGINDLESPERGER
MY COMMISSION#HH 407122 [ l Personally Known OR [ Produced Identification
EXPIRES:October 6,2027
Type of Identification: C.-F•�•a,`'
Updated 10/11/23