Permit Plumbing 1163 Beach Ave 2012 CITY OF ATLANTIC BEACH
1j 800 SEMINOLE ROAD
J ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000490 Date 10/18/12
Property Address . . . . . . 1163 BEACH AVE
Application type description RESIDENTIAL ADDITION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
2nd story addition and remodel
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Owner Contractor
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ADAMS CHARLES P WORSHAM CONSTRUCTION CO INC
1163 BEACH AVE 2329 URBAN RD
ATLANTIC BEACH FL 322335727 JACKSONVILLE FL 32210
(904) 545-2357
--- Structure Information 000 000 ADDITION 452 SF AND REMODEL
Construction Type . . . . . TYPE 5-B
Occupancy Type . . . . . . RESIDENTIAL
Flood Zone . . . . . . . . ZONE AO
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Permit . . . . . . PLUMBING PERMIT
Additional desc 21 FIXTURES AND REPLACE SEWER
Sub Contractor CRABTREE PLUMBING INC
Permit Fee . . . . 209 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 4/16/13
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Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 NATIONAL ELECTRIC CODE
*SUBMIT "CERTIFICATE OF COMPLIANCE" BY A LICENSED PEST
CONTROL COMPANY PRIOR TO C.O.
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
WINDOW AND DOOR INSPECTION:
*INSTALLATION INSTUCTIONS REQUIRED
*ALL STICKERS ARE TO REMAIN ON THE WINDOWS
*PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS
Roll off container company must be on City approved list
and container cannot be placed on City right-of-way.
Contact Public Works (247-5834) for Erosion and Sediment
Control Inspection prior to start of construction.
Roll off container company must be on City approved list
and container cannot be placed on City right-of-way.
Contact Public Works (247-5834) for Erosion and Sediment
Control Inspection prior to start of work'.
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PERMIT Qt1Te1rOe6695LY IN ACCORDANCE XVITH THE FLORI)A 14
BUILDING CODES.
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Page 2
Application Number . . . . . 12-00000490 Date 10/18/12
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Other Fees . . . . . . . . . STATE PLBG DBPR SURCHARGE 3 . 14
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 209 . 00 209 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 6 . 28 6 . 28 . 00 . 00
Grand Total 215 . 28 215 . 28 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE, WITH ALI, 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: f'/(, Qecoc..1 4(.•v— PERMIT# 12-,- S'9()
NEW OR REPLACEMENT INSTALLATION: Project Value $la, cn.au
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 2 Septic Tank& Pit
Clothes Washer Shower
Dishwasher t Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet _
Hose Bibs Z Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray / Water Connected Appliances
Lavatory — - Water Heater
Other Fixtures Water Treating System
RE-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 lJ ,
Lavatory Water Heater (/
Other Fixtures Water Treating System
MISCELLANEOUS: 27i
fewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ 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.
Property Owners Name egoa'o• 1' Phone Number
Plumbing Company Office Phone Fax 3' 9,/YS
Co. Address: 23 V v((0,q . F2. city State ti State C-.-e—Zip &'Le 0
License Holder(Print): State Certification/Registration 9 ore asTzti�—
Notarized Si natur dere:'
[00!L
: DEBORAH AMANDA WHITE
MYCAMMISSION#EE057349 w r u scribed before this day of 20_z�EXPIRES:May 21,2015
�� ' 13,dedThruNotia�ypwkUrAetw�l ignature of Notary Public