5110 POLARIS CT - PLUMBING rs 1:Lyr ,jr,
�� ' CITY OF ATLANTIC BEACH
fr; - '"� : > 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
x;3}9%' INSPECTION PHONE LINE 247-5814
PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
0 PERMIT INFORMATION:
PERMIT NO: PLRS17-0058
Description: re-pipe 12 fixtures
Estimated Value: 0
Issue Date: 7/19/2017
Expiration Date: 1/15/2018
PROPERTY ADDRESS:
Address: 5110 POLARIS CT
RE Number: 169397 0200
PROPERTY OWNER:
' Name: NAVAL CONTINUING CARE RETIREMENT FOUNDATION INC
Address: 1 FLEET LANDING BLVD
ATLANTIC BEACH, FL 32233-4599
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
IPhone:
Name: DAVID GRAY PLUMBING INC.
Address: 6491 S POWERS AVE
JACKSONVILLE, FL 32217
0 Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
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 RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
PLUMBING PERMIT APPLICATION 0"
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845 •--) .f__s -00,(x'
JOB ADDRESS: L.57/0 !" '� ` 0//i/(2-16 6 PERMIT# ''"" ��
NEW OR REPLACEMENT INSTALLATION: Project Value$
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
RE-PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub a 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 I Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory ~� Water Heater a
Other Fixtures Water Treating System
MISCELLANEOUS:
o Sewer 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 provigions of any other state or local law regulation construction or the performance of construction.` �
Property Owners Name_beef-`L&12 4) �1e 117, G/77 -j1 Phone Number gO 51-o?4....g90
Plumbing Company ba.,UiG� U/'- l /l.Lmb11]y , mc, Office Phone Qv7'72V`7ZI I Fax yo-7v7
Co. Address: (o I /'t�Lvrd5 4 ,r-, f P ,/ City JO CA5GIV.n e State Zip 3,2,.x./
License Holder(Print): Ddu/D G A 1 State Certification/Registration# eiG02.2.S3(o
•
Notarized Signature of License Holder tj/% i
,tom0N% Notary Public State of F.'•da worn and subscribed before m this 1 v n `day of J 2013
Wendy Rayte
yofAp41 MxCreosm06s7io20F1F8 133678 .i nature of Notary Public