570 ORCHID CONNECT TO SEWER CITY OF ATLANTIC BEACH
7 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
IsA
' 19
PLUMBING PERMIT
MUST CALL BY 4PM FOR NE)Cr DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-PLBG-1 111
Job Type: PLUMBING ONLY
Description: CONNECT TO CITY SEWER ONLY
Estimated Value:
Issue Date: 5/28/2015
Expiration Date: 11/24/2015
PROPERTY ADDRESS:
Address: 570 ORCHID ST
RE Number: 170906-0100
PROPERTY OWNER:
Name: ENGRAV, THOMAS A
Address: 5281 EAGLE CLAW DR
FEES:
WATER CONNECT/TAP & METER $185.00
WATER CROSS CONNECTION $50.00
SEWER SDC-SYSTEM DEV CHG $4,050.00
Total Payments: $4,285.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
-N OF OTLANITC BEhCH
Cl
GOO SEMINOLE ROOD
FL
ATLANTIC BEACH'
pHONE (604) 247-5851
Cashier Id: asPE05t\at'bbja
e 5/28/2015
ReceiPt Dat - 66838
Rece j pt Number: NECT TO C SEW
Job ID, 15-PUG-lili -' CO/jOp � METER $18
R ONLy W3 - wR�ER CONNECT
5.00 )NNECT 10 Cl" SEWE
job ID: 15-PUG-11ii - C( - CTION $�-)G.00
R ONLY A wATER CROSS CONNE
-ONhEc-T To CI-N SEWE
Job ID: 15-PLBG-Illl
SDC-S�Swm DEV CHG $4'0
R ONLY S5 - SEWER
�,O.00
Due. $4,295-00 _�, # 476-31 $4�285�00
formation. Chec,
Tender In
CK -)85.00
�nder Type.
Tender Amount-
Change Due: $0,00
CITY OF ATLANTIC BEACH
MINOLE ROAD
800 SE
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-PLBG-1 106
Job Type: PLUMBING ONLY WER
Description: CONNECT TO CITY SE
Estimated Value:
Issue Date: 5/12/2015
Expiration Date: 11/8/2015
PROPERTY ADDRESS:
Address: 570 ORCHID ST
RE Number: 170906-0100
PROPERTY OWNER:
Name: ENGRAV, THOMAS A
Address: 5281 EAGLE CLAW DR
GENERAL CONTRACTOR INFORMATION:
Name: KIMBALL PLUMBING, INC.
Address: 12024 SUNOWA SPRINGS TR QA MARK EDWARD KIMBALL
Phone:
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $7.00
Trade Permit Base Fee $55.00
Total Payments: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Nov 03 01 12:34a Kimball and Ray Plumbing 904-387-1479 P.1
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itte$ 'Z':�OC9
STALL) TION: Project Val
p'E W OR RE4 PLACE MENT IN QTV
TYPE. 0Fr'1XT'U)TE OTY TYPE OF r'MMIZE'
Septic Tank&Pit
Bathtub shower
Clothes Waslicr Shower Pan
Distilvasilct Slop Sink
Drinking toontain Three Compartment Sitil
Floor Dram Toilet
Floor Sink Urinal
I-lose Bibs VaclIum Breakers
Kitelien Sink Water Connected Applia Ices
Laundry Tray Water Ueater
Lavatory Water Treating Systein
other Fixtures
-PIPE: Tyrff OF F,IXTURE QTY TYPE, or-riix-rURE QTY
Scptic Tank&Pit
Bathtiib Shower
clodles Washer shower Pail
Dishwasher Slop Sink
Drinking Foinitain Three Compatiment Sin
Floor Drain Toilet
Floor Sink Urinal
Hose Bibs Vacuum Breakers
Kitchen Sink Water Cortnec(ed Applil ices
LaundryTray Water Beater
Lavatory Water Treating Syste"'
Other Fixtures
ISCELLANEOM. tor(Trap) gallons(Requires 3 sets Of Plails)
Sewer Replacemcnt D Back Flow Pre venter Grease Intercep
Lawn Spitinkler Systern-Nurnber of He ds C1 Well ',partment for final inspectiatt."
�'SJRWD Well C0111plelion Fop-nj. Competed foin to be submitted to fh_el:�i_"Ing
enter Gre,,
ds
e t f
ed .01 �b c
C ' ttj I>t
Other
Oth
six months,I liereby cewify that 1 have fci�
.rr,it b s vcid7e,_,.rk-Od=,,not cornmence Mthii,8 six"1011thiperiod_or%,ork is sugpeti&d or abomdoned fo k 16vill be compliedwilh 1%41dher specified
11sol-laws and ardinartees goverritisig this wl
I rip'ic
,is applicatiorL and know lhv garne to be JFUC Eind COrrCLI A�
or not. The permit dines no,give 11tilliority to viOlolc 111c Provis Monvios�vny otlier wdc or local law reguintion consti iction or the performance orconstruction
?rope OwnersName Ph -ne Number
Al"t 04
Plumbing Company -Office Plione ISS( Faxc_]�-J�137r
Statel
Co.Address: j/\0J"kA k city �ck
khA:�V 4. - State Certificatior 'Registration 9 0
License Holder(Print):
Notarized Sigirature of License Holder 20
Befom me this day of
KOSKI
JEW
NotaTypublie--511111410IF19"da
(if 1;17 Signa ure of N ary Public
my Comm.E101146 Oct 27-20
ID
mission FF 01530
wn is I 4n.
ry ASSN.
Bonded Thfough Naliolla Noll