1941 (1943) Beach Ave bath kitchen remodel sliding door 2014 CITY OF ATLANTIC BEACH
N
J 800 SEMINOLE ROAD
s) ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00000118 Date 1/31/14
Property Address . . . . . . 1941 BEACH AVE
Tenant nbr, name . . . . . . UNIT 1943
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . RES GEN MF DISTRICT
Application valuation . . . . 43000
------------------------------------------
Application desc
REMODEL KITCHEN AND BATHS
----------------------------------------
Owner Contractor
-
------------------------
-----------------------
DREW, WILLIAM CARK HORN BUILDERS INC
1632 S BAYSHORE DR 12 HOPSON RD
MIAMI FL 33133 JACKSONVILLE BEACH FL 32250
(904) 673-4860
--- Structure Information 000 000 REMODEL KITCHEN BATH
Occupancy Type . . . . . . RESIDENTIAL
----------------------------------------
Permit . . . . . . RESIDENTIAL ALT/OTHER
Additional desc . .
Permit Fee . . . . 265 . 00 Plan Check Fee 132 . 50
Issue Date . . . . Valuation . . . . 43000
Expiration Date . . 7/30/14
----------------------------------------------------
Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 NATIONAL ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
---------------------
---------
Other Fees STATE DCA SURCHARGE 3 . 98
STATE DBPR SURCHARGE 3 . 98
Fee summary Charged Paid Credited Due
----------
--------- ---------- -
Permit Fee Total 265 . 00 265 . 00
. 00 . 00
Plan Check Total 132 . 50 132 . 50 . 00 . 00
Other Fee Total 7 . 96 7 . 96 . 00 . 00
Grand Total 405 .46 405 .46 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
�., ri -�
ILDING PERMIT APPLICATION & v L�
k CITY OF ATLANTIC BEACH JAN 2 7
FILECOP18 91 Seminole Road,Atlantic Beach,FL 32233
�Office (904) 247-5826 Fax(904)247-5845 lRy
Job Address: r-L- Permit Number: —
Legal Description Lv 1 5-3' /. 4-12-*A+ r-�-L 91c-1wef jr�, ackwc- 15�Parcel#
oor Area o q. t. s� q. t
Valuation of Work$ Proposed Work heated/cooled non-heated/cooled
3,1046
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one):. Commercial �Residen 'If an existing structure,is a fire sprinkler system installed? (Circle one N /A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: �NOP%`E fit )
/i el� P pt—Ditg_ &A t N 4' 57-re-t4cru&-,4 L_ L,� K
Property Owner Information: /
Name: Address: 1(o3-2- See Tk 3-4YSrr-z& vc- oZ
City 0_6 CtD Nt.1, G,IZ6✓f State��Zip 33f 3 3 Phone 26 — 7 S3 -�,�Z SS
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Qualifying Agent: CN)ge- E S v.2 N
Address: 1/33 S owa� D-a 645 Ci �,c rst•�Vs2-C C-' State C Zip 3
Office Phone690y0 2 2 - 7_l ab Job Site/Contact Number goy)(
.z.3 3 - 51M o 9p4)I
State Certification/Registration# C 6 C 0-5$9'0 z
Architect Name&Phone# ,-j
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address .�
Bonding Company Name and Address "64
Mortgage Lender Name and Address I a/,.
Application is hereby made to obtain a permit to do the work and installations as indicated I certify that rzo work or installation has commenced prior et
o the
issuance of a permit and that all work will be performed to meet the standards of all laws rpegulating construction in thpis jurisdiction. TJzis permit becomes null
work isdmzmenced.of I understandNthatzseparate per s must be secured for Electrics!Workd Plums ng�Slgns,aWel(soPoo(sxuTnaczes, Boile stziYeaiersr
Tanks and Air Conditioners,eta
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby certify that I have read and examined this application and know the sante to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
Si nature of Owner Signature of Contractor
g tJ
W-/l,-w»r stir r� t`tyr .�,4� ..
Print Name Print Name
Sworn to and subscribed before me Sworn to and subscribed before me 20
this 27 Day of "S"PrNµAa 20 Y this z-7 Day of
Notary Pu lie ' Notary Public
PATRICK RICH , �!:.,�� PATRICK RICH
rOMMISSIO,,N_`#wIFF VA75 # MY COMMISSION#FF 05 Revised 01.26.10
* '!S.Septembe 15,207
�� EXPIRES:September 15,2011
s
rt.er�� eaNwkuIOU soot Notary Senices �'+rf�,ye`° BorbedTMuBudpetNaluyS4niW
Doc # 2014023913, OR BK 16677 Page 94 , Number Pages: 1, Recorded 01/31/2014
at 12:23 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00
NOTICE OF COMMENCEMENT
Permit No. Tax Folio No.
Jq
State of Florida,County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement.
40
L Description of property(legal description of property and address if available):
LG S5 /� ATG r4rsTis iz t 7#� G/r�r T Ad r
2. General Description of improvements: a ;�e-�J CA- i�.,-TTrt
61
�L�UrH C li ���E ~ 'n ayL1�, rCrtEN o 1Gc
3. Owner Information: T �.,yu✓�f=e
a)Name and Address: (Z Ltr�oln-r �2�'^r /G 3` �c+u rrt 8t;YS"ree J Z-
b)Interest in property: 33 i"3 3
c)Name and address of simples titleholder(if other than owner):
r � A
4. Contractor Information:
twC.Su.i iIY Lt.r- �4 `,
\ a)Name and Address: 3 A
3 5->zytn'a rc� �/L
)Phone Number: z
5. Surety Information:
a)Name and Address: N ZA
b)Phone Number:
C)Amount of Bond:$
6. Lender Information: or
a)Name and Address:
b)Phone Number: '
7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13(1)(a)7,Florida Statutes:
a)Name and Address: 4.4
b)Phone Numbers of Designated Person:
8. In addition to himself/herself,Owner designates of to receive h;
a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes. r
r:=
a)Name and Address:
b)Phone Number of person or entity designated by owner: t
9 Expiration date of Notice of Commencement(The expiration date is one(1)year from the date of Recording unless a '6
different date is specified: "
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART
1, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR g
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 COMMENCING WORK OR RECORDING �z
YOUR NOTICE OF COMMENCEMENT. ra
The foregoing instrument was acknowledged before me this 27 day of '3-nrL%A c-1 20�
g g
NOTARY PUBLIC,STATE OF FLORIDA ��►*;; PATRId(RICH
MY COt�+IiSSION t FF 054075
Print Name: t+? ` EXPIRES:Sooembx 15,2017
YPersonally Known 10""', �
o Boded ThruBWONdWYSenkq
U Identification/Type:
Verification pursuant to Section 92.525,Florida Statutes.Under penalties of perjury,I declare that I have read the .
foregoing and that the fact stated in it are true to the best of my knowledge and belief.
Signature of Property Owner
Revised 10/1/2009
*VP :' +wF!'riF� if"kt'B."'moi,," +'C :;::.;t « �5:leaaa:'+mat. .ti"..:3ar�.S... is'1,.<iKM,*�?z�>-r.^';
City of Atlantic Bean-h APPLICATION NUMBER
S Building Department (To be assigned by th Building Depa ent.)
800 Seminole Road �— Q �,
c� Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845 / 7
E-mail: building-dept@coab.us Date routed:
City web-site: hUp://www.coab.us
APPLICATION REVIEW AND TRACKI G FORM
kfi
l9 3
Property Address: r ent review required Ye No
Buildin
Applicant: 4�z-7) &tanning Zoning
Tree Administrator
Project: dZZ 6 7-'Z/- Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept.of Environmr I Protection
Florida Dept.of Transport
St.Johns River Water Ma :ment District
Army Corps of Engineers
Division of Hotels and Re, giants
Division of Alcoholic Beve is and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Revievq. Approved. []Denied.
(Circle one.) Comments: YV O L
BUILDIN
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Revie QApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
CITY OF ATLANTIC BEACH
\ ii1
J 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00000117 Date 1/31/14
Property Address . . . . . . 1941 BEACH AVE
Tenant nbr, name . . . . . . UNIT 1943
Application type description WINDOW AND/OR DOOR
Property Zoning . . . . . . . RES GEN MF DISTRICT
Application valuation . . . . 2000
--------------------------------------
Application desc
SLIDING DOOR
-------------------------------------
Owner Contractor
-----------------
------------------------
DREW, WILLIAM CARK HORN BUILDERS INC
1632 S BAYSHORE DR 12 HOPSON RD
MIAMI FL 33133 JACKSONVILLE BEACH FL 32250
(904) 673-4860
-----------------
Permit . . . . . . WINDOW AND/OR DOOR PERMIT
Additional desc . 30 . 00
Permit Fee 60 . 00 Plan Check Fee 2000
Issue Date Valuation
Expiration Date . . 7/30/14
------------------------------------
Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 NATIONAL ELECTRIC CODE
*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
--
---------------------------------
STATE DCA SURCHARGE 2
Other Fees 2 . 00
STATE DBPR SURCHARGE
Fee summary Charged Paid Credited Due
- . 00----------
----------
Permit Fee Total 60 . 00 60 . 00 00 . 00
Plan Check Total 30 . 00 30 . 00 00 . 00
Other Fee Total 4 . 00 4 . 00
Grand Total
94 . 00 94 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
F-, 1LDING PERMIT APPLICATION
F CITY OF ATLANTIC BEACH JAN 27
1 L, E C 01 k,%'800 Seminole Road;Atlantic Beach, FL 32233
Office (904) 247-5826 Fax(904)247-5845RV
3L.z-33
r--L--Permit Number: / ' l 17
Job Address: %�'IG/3 ��/a �"`�, ��'� y
Legal DescriptionLv moo a oAcrt q t"r5q t
Proposed Work heated/cooled non-heated/cooled
Pro
Valuation of Work$��� P
x000 . �d
Class of Work(circle one): New Addition =AlterationRepair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residen N /A
If an existing structure,is a fire s Lir system . stalled. (Circle one : es
Florida Product Approval#
For multiple products use product approval orm JL/r-8p'n
Describe in detail the type of work to be performed:_
Property Owner Information:
Name:
Address: 1�3z 5�...�Ti-c /jt►YSrl�2� j�Y-'vtr �' oz
CityCe,Lr�—,- 4:;a-6"'f Stateri-Zip 33i l3
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: yr>a.N ��C�z�c '_' Z^ Qualifying Agent: CN rq e.t�S ri c�Z N
-�✓sic t States Zip
Address: 1/33 5��'':•� ut D z. +_g- Ci .�€�c�cs�'
Office Phone�ga`t) �Y z - Zl�� _ v Fax#/4jo�F ZqZ— zwo
Job Site/Contact Number %o,I,�. 7 3 YgL (
State Certification/Registration
Architect Name&Phone# 1 k
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address •�
Bonding Company Name and Address_ -
Mortgage Lender Name and Address _ ''
n work or
llation has
mmenced
rior
Applicaioon is hereby
rm t ant d that al work wzll betperfad�:ed tothe omee therk and L standards of all tions as indicated.
aws regulating construction in this juaisdiction. This pernLit beconsesontul
issuancef p
and void if work is not commenced within six e r:cmed or e construction or work is suspended or abandoned for a ertod of six 16)months at any time ate
work is commenced I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells, Pools, t urnaces, Boilers,Fleaters
Tanks and Air Conditioners,etc
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR
OBTAIN FINWANCING, CONSULT WITH
E FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
1 hereby certify that I have read and examined this ap piication and know the same to be true and correct. All provisions give
autho d ordinances toviiolategor cancel thi
th
type of work will be complied with whether sppecified herein or not. The granting of a permit does not presume to d h'
provisions of any other federal,state, or local Inv regulating construction or the perfornuince of construction.
Signature of Owner Signature of Contractor p�
Print Name �:/t�AP- ice / ...... �r.
Print Name -..................
...._......................................................................... ...........................
Sworn to and subscribed before me Sworn to and subscribed before me 20 fir,
this 2.-7 Day of ,=rJ20 this z? Day of
'
Notary
Nota blic�o„rp� PATRICK RICH ,�Nrn r�4 PATMARai
f°: OMMISSION 'P' # MY COMMISSION#FF
I 054075Revised 01.26.10
Iv r. I FF 054075
*
='-S:September 15,2017 EXPIRES:September 15,2017
•
al'rE�Rke�\ 6'(,Aq f hru Budget Notary Serv'axe �r''re.,�aoa��! Bonded Thru Budget Notery SMIM
City of Atlantic Be;.!;--i APPLICATION NUMBER
f� Building Departme,." (To be assigned by the Building Department.)
800 Seminole Road ��
Atlantic Beach, Florida 22:%:33-5445
Phone(904)247-5826 • ax(904)247-5845 '
Oil E-mail: building-dept@c. b.us Date routed:
City web-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1�1_Atcg 6 Department review required Yes No
Applicant: Ate 77r/o���s fanning &Zoning
Tree Administrator
Project: Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review c;r Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept.of Environmental Protection
Florida Dept. of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Res" rants
Division of Alcoholic Beve and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First ReviewApproved. ❑Denied.
(Circle one.) Comments:
BUILDIN
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN. Second Review: ❑Approved as revised. ❑De Wed.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Revie ❑Approved as revised. ❑Denied.
Comments-
Reviewed by: Date:
Revised 05/14/09
CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
rl ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
J3
14-00000118 Date 2/04/14
Application Number . .
Property Address . . • ' '
UNIT 1941 BEACH AVE
Tenant nbr, name . . . . .
1943
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . RES GEN MF DISTRICT
Application valuation 43000
-------------------------------
Application desc
REMODEL KITCHEN AND BATHS
-----------------------
-- --------------------------------------------------
Owner Contractor
_ _ ------------------------
DREW, WILLIAM CARL ET AL HORN BUILDERS INC
1632 S BAYSHORE DR 12 HOPSON RD
MALLOY, JENNIE S T/C JACKSONVILLE BEACH FL 32250
MIAMI FL 33133 (904) 673-4860
Structure Information 000 000 REMODEL KITCHEN BATH
Occupancy Type
RESIDENTIAL
----- ----------
Permit .
ELECTRICAL PERMIT
Additional desc
Sub Contractor AMERICAN ELECTRICAL CONTRACTOR . 00
Permit Fee 90 . 00 Plan Check Fee 0
Issue Date Valuation
Expiration Date . . 8/03/14
--------------------------------
---------- ---------------------------------
Special Notes and Comments
2010*REPORT OANY UNFORSEEN STRUCTURAL DAAMpAGEATOETHE TRIC O
BUILDING
DEPARTMENT IMMEDIATELY.
2 . 00
Other Fees _ STATE ELEC DCA SURCHARGE
STATE ELEC-DBPR-SURCHARGE
---------------
Paid Credited Due
Fee summary Charged
_ . 00-------
Permit Fee Total 90 . 00 90 . 00 . 00
. 00
Plan Check Total 00 . 00 . 00 4 . 00 . 00 . 00
Other Fee Total 4 . 00 00 . 00
Grand Total 94 . 00 94 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
( I Ph (90�G'(.r-\(AU
247-5826 Fax (904) 247-5845
n,
. ADDRESS: VI`1 ( �" PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE
VALUE OF WORK$
NEW SERVICE ❑ Overhead ❑ Underground ❑1 Underground up Pole
Residential(Main) Service
0-100 amps 101-150amps '1151-200amps amps #of Meters
Commercial(Main) Service
0-100 amps 101-150amps 1151-200amps amps CT Service amps
Conductor Type Size
Multi-Family(Main) Service
0-100 amps 101-150amps 1151-200amps amps #of Unit Meters
Temporary Pole 1 amps
SERVICE UPGRADE amps CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
100 amps 71150amps 200amps amps 1 CT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-30amps 31-100amps 101-200amps
Appliances: 0-30amps 31-100amps 101-200amps
. A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
Swimming Pool , Sign (Smoke Detectors_Qty Ll Transformers KVA Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
Replace Burnt/Damaged Meter Can ❑Safety Inspection i
�P]anel Change OH to UG
Other: KII I � Q Tip t-0 Y'\ Q.,m
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. I I
Property Owners Name Q t`6 �(! ti ` Phone Number
Electrical Company e--' �oy��r��tI"� 11bffice Phone "16"(-ri 7-r0 7c Fax
Co. Address: S- ��� X15 D Cit State F( Zip
L' -,e Holder (Print): EGr I �f Ce ification/Registration#
N r' !derma
�,► ►w Notary Public State of Florida Sworn and subscribed befor me this O 20
�p Anna M Daly
aad'` Expires 01!25!2017 le
My Commission EE 850790
Signature of Notary Public
CITY OF ATLANTIC BEACH
1 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
JF31�•
Application Number . . . . . 14-00000118 Date 2/04/14
Property Address . . . . . . 1941 BEACH AVE
Tenant nbr, name . . . . . . UNIT 1943
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . RES GEN MF DISTRICT
Application valuation . . . . 43000
---------------------------------
Application desc
REMODEL KITCHEN AND BATHS
--------------------------------
Owner Contractor
--------------
----------
DREW, WILLIAM CARL ET AL HORN BUILDERS INC
1632 S BAYSHORE DR 12 HOPSON RD
MALLOY, JENNIE S T/C JACKSONVILLE BEACH FL 32250
MIAMI FL 33133 (904) 673-4860
Structure Information 000 000 REMODEL KITCHEN BATH
Occupancy Type .
_ RESIDENTIAL
--------------------------------
Permit . . . . . . PLUMBING PERMIT
Additional desc . -
Sub Contractor TURNER PLUMBING CO.
Plan Check Fee 00
Permit Fee . . . . 104 . 00 0
Issue Date Valuation
Expiration Date . . 8/03/14
--------------------------------
Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 NATIONAL ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
--
2 . 00---------------------------------
Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE
STATE PLBG DBPR SURCHARGE 2 . 00
_ ________ -----
Fee summary Charged
Paid Credited Due
_ _ ----------
---------- ------ --
Permit Fee Total 104 . 00 104 . 0000 00 . 00
00 . 00
Plan Check Total • 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00
Grand Total
108 . 00 108 . 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
Jos ADDRESS:
5'e-raC_L'�_ 6 0L . ,� ��+- c 014 3 PERMrr#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE of FIXTURE QTY TYPE of FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher I Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink t Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Z 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
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS: gallons(Requires 3 sets of plans)
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap)
❑ Lawn Sprinkler System-Number of Heads ❑ Well
** SIRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ Other
is suspended or abandoned for six months.I hereby certify that I have read
Permit becomes void if work does not commence within a six month period or work
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
Plumbing Company I �''^L'� `'` �' " r
Office Phone 31J` � Fax 31('_-734�0
c1 3 Int .t"I L s � City h`ILS t,3111E State F( zip 3 22
Co. Address: _
� State Certification/Registration# L I`�-- 0 7-`��`�"�
License Holder(Print): �--' ✓rte 3 I '"v-
11\
-
Notarized Signature of License Holder a
e this da 20J---
Notary Public State of F oda
Shirley L Graham 1gna a of Notary Publ'
�` My Commission FF 086990
a Expi—02/14!2018 r_l /o
7 � �