Permit 416 Irex Road CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . .
Property Address 10-00000419 Date 4/12/10
. . . . . . 416 IREX RD
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . .
---------------------------------------------0
Application desc -------------------------------
REPLACE EXISTING SEWER
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Owner
Contractor
DANCEL, FELIPE ------------------------
416 IREX ROAD STEEG PLUMBING
1601 MAIN STREET
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 249-5191
Permit . . . . . . PLUMBING PERMIT ----------------------------------
Additional desc . .
Permit Fee . . . . 62 . 00 Plan Check Fee
Issue Date . . . . Valuation . . . . . 00
Expiration Date . . 10/09/10 0
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Fee-summary------ Charged Paid Credited Due
--- ------- ------- ---------- ---------- ----------
Permit Fee Total 62 . 00 62 . 00 . 00
Plan Check Total . 00 . 00 . 00
Grand Total 62 . 00 62 . 00 . 00 . 00
. 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: - — -nEpmm 5117
NEW OR REPLACEMENT INSTALLATION: Project Value
TYPE OF FixTuRE QTY TYPE OF FixTu" QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain
Floor Drain Slop Sink
Floor Sink Three Compartment Sink
Hose Bibs Toilet
Kitchen Sink Urinal
Laundry Tray Vacuum Breakers
Lavatory Water Connected Appliances
Other Fixtures Water Heater
Water Treating System
RE-PIPE:
TYPE oF FrxTuRE QTY TYPE oF FixTuRE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain
in
Floor Dra: Slop Sink
Floor Sink Three Compartment Sink
Hose Bibs Toilet
Kitchen Sink Urinal
Laundry Tray Vacuum Breakers
Lavatory Water Connected Appliances
Other Fixtures Water Heater
Water Treating System
MISCELLANEOUS:
Xsewer Replacement El Back Flow Preventer F-1 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
Lawn Sprinkler System-Number of Heads o Well
SJR WD Well Com
El Other pletion Form. Completed—form to be submitted to tKe—Building Department for final inspection.**
Permit becomes void if work does not comme—nce 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.
Property Owners Name Phone Number 7o�:I'Z>
Plumbing Company
-7;,e_- Office Phone Fax :Z
Co.Address: -4-
AVA-/ city State
zip
License Holder(Print): State Certification/Registration#
Notarized Signature OF I F 'C r
A-MITE
ME
-n
yCONMISSIONODWMS rn an ubscribed efore dav of 2@/3
be
EXPIRES'MaY 21,2011 Iture
d d Thru NO�,y public Und9l"le 0 y Pu
Bon 0 ature of Notary P bli,
'0*
R.O.W. Permit Attachment of for
R.O.W. Permit#-i�sued 200
Atla�iiie Beach, FL 32233
Owner's Name:
Property Address: Y
Subdivision:
Lot 4/Block#:
R.E. #:
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this _7"_day of
204A by Atlantic Beach, Florida, a municipal corporation organi-zed ,1nd existing
under tWlaws of the State of Florida, hereinafter referred to as "CITY" and
of Atlantic Beach,Florida, hereinafter referred to as "USEW'.
WITNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the
right to enter upon the property of the City of Atlantic Beach for the purpose as described in the City of
Atlantic Beach Right-of-Way/Easement permit numbers noted above (copies attached).
This work is generally described as: V V
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted
remains subject to relocation or removal on thirty (30) days notice by CITY to the USER, said notice to
USER shall be given by certified mail, return receipt requested, to the following address:
The depositing of said notice of cancellation in the United States mail shall constitute the notice of
cancellation and the burden is upon USER to keep the CITY informed of USER's proper address.
The USER shall promptly make any and all necessary repairs to any facility erected or maintained in
the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe
condition.
In the event it is necessary for the CITY or the City's approved representative or other franchised
utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's
sole expense, any and all material necessarily displaced during the action of maintaining, repairing,
operating,replacing, or adding to of the utilities and facilities of the CITY or franchise utility provider.
The facilities allowed by the permit shall meet the current requirements of the City Code, Building
Codes, Land Development Code, and all other land use and code requirements of the CITY, including
City Code Section 19-7 (h) which states "'Driveways that cross sidewalks: City sidewalks may not be
replaced with other materials, but must be replaced with smooth concrete left natural in color so that it
matches the existing and adjoining sidewalks."
Page I of 2
The USER, prior to making any changes from the approved plans and/or method, must obtain
written approval from the City of Atlantic Beach, Public Works Department, for said change. The
USER shall, at the discretion of the CITY, be requested to submit as-built drawings showing the change
within thirty(3 0) days after the day of completion.
This permit shall inure to the benefit of, and be binding upon, the USER and their respective
successors and assigns.
USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY
laws and/or specifications, to include utilities locate requirements and use limitations/requirements of
public rights-of-way and other public land. USER further agrees that the CITY and its officers and
employees shall be saved harmless by the USER fi-om any of the work herein under the terms of this
permit and that all of said liabilities are hereby assumed by the USER.
DATED and SIGNED this dayof T(tri14,4r_y 20V.
By:
Property Owner Jarwai-Ad-ti Dauj)ierAf
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this day of 20kO, personally appeared before me, a Notary
State, I)u
Public in and for said nty and State, (A VOt , F106 d 6L the property owner of
1930 Cou
94. , Atlantic Beach, Florida, known to me to be the person(s)
described in and who executed the foregoing instrument; who acknowledged to me that he or she
executed the same freely and voluntarily and for the uses and purposes therein mentioned.
DONM L BARTM
My COMMISSION#DD&W4
Notary Public in :)r said County and State EXPIRES:March 30,2013
Bonded Thru Notary Rft undewIt"
CITY OF ATLANTIC BEACH,FLORIDA, a
municipal corporation:
Appro
Ricycy t/Carpe . ublic Works Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Jim Hanson, City Manager
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