1626 MARITIME OAK DR - PLUMBING (---
'S, CITY OF ATLANTIC BEACH
f 800 SEMINOLE ROAD
� . ,, ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
'p319'1'-
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-553
Job Type: PLUMBING ONLY
Description: 26 FIXTURES NEW SERVICE
Estimated Value:
Issue Date: 3/7/2016
Expiration Date: 9/3/2016
PROPERTY ADDRESS:
Address: 1626 MARITIME OAK DR
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: NELSON PLUMBING CO. INC.
Address: 11624 -1 DAV E DAVIS CREEK RD QA SCOTT GARY
NELSON
Phone: - -
FEES:
Trade Permit Base Fee $55.00
State PLMG DCA Surcharge $2.00
State PLMG DBPR Surcharge $2.00
Plumbing Fixtures $182.00
Total Payments: $241.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
fo
/ -/a CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
. \ Ph(904) 247-5826 Fax (904)247-5845
JOB ADDRESS: I /Yl$Q.jT i f►1c Mt_ n!L PERMIT# 16- $FIL-V 1
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub
1 Septic Tank&Pit
Clothes Washer 1 Shower a
Dishwasher l Shower Pan ____a__
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 4
Hose Bibs 3 Urinal
Kitchen Sink ____i_ Vacuum Breakers i'
Laundry Tray _____L___ Water Connected \.._-(-)°
Lavatory _— Water Heater
Other Fixtures Water Treating System 1
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:
D Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of pla
❑ Lawn Sprinkler System-Number of Heads D 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
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 specif
or not. The permit does not give authority to violate the provisions of any other state or local Iaw regulation construction or the performance of constructio
Property Owners Name i V 2n5)D E i- 0 i ' 5 Phone Number
Plumbing Company A/ELS iir f L ttni/3l h16 eo TN/L• Office Prone ?by 26 Z. 10Fax_r
Co.Address: I I tZ -( 'at 1, 4 IL I Ci Mit Son . State Zip ZZSL
' License Holder(Print): 3C c7'f NE(–S A A S : '- I - I' •cati on/Registration#=02.0 3)7
-_. e Solder )( I I �1
1
'.;%y• USA P.BASS •
+�' ;- MY COMMISSION r FF 900342 Sworn and subsc see 9 efore me • ay of M O/ 1. 20)6
EXPIRES'November 16,2019
7 A't�°:� Bonded Thru Notary Pubic Underwriters 1
Signature of Notary Public )/�