158 16TH ST - PLUMBING \V CITY OF ATLANTIC BEACH
, ;7 ,? 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS18-0098
Description: PLUMBING -28 FIXTURES
Estimated Value: 0
Issue Date: 4/16/2018
Expiration Date: 10/13/2018
PROPERTY ADDRESS:
Address: 158 16TH ST
RE Number: 171879 0000
PROPERTY OWNER:
Name: OSSI CONTRACTING LLC
Address: 13349 STONE POND DR
JACKSONVILLE, FL 32224
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: B & G PLUMBING, HEATING &AIR CONDITIONI
Address: 2232 CORPORATE SQUARE BLVD 2232 CORPORATE
SQUARE BLVD
JACKSONVILLE, FL 32216
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.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions
applicable to this property that may be found in the public records of this county, and there may
be additional permits required from other governmental entities such as water management
districts, state agencies, or federal agencies.
* 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$7,500.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax (904) 247-5845 PL Rs I g - oePO
TOB ADDRESS: 159 1 tfth St , P lig ht i c teCIttitri.. 32.233 PER1v1Tr#
NIEW OR REPLACEMENT INSTALLATION: Project Value$ •
TYPE OF FIXTURE OTY TYPE OF FIXTURE QTY
Bathtub 3 Septic.Tank&Pit _
Clothes Washer f Shower 1
Dishwasher I. Shower Pan __LI_
Drinking
--
Drinking Fountain Slop Mink `
Floor Drain I Three Compartment Sink
Floor Sink Toilet at
Hose Bibs 4 Urinal
Kitchen Sink l Vacuum Breakers _ —
Laundry Tray 1 Water Connected Appliances I*
Lavatory _. Ce --"" Water Heater a.
Other Fixtures Water Treating System 1
RE-PIPE: 1e)
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit _._.____
Clothes Washer Shower
Dishwasher Shover Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink --
Floor Sink V Toilet _..__.
Hose Bibs Uritul
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other FixturesWater Treating System
MISCELLANEOUS:
❑ Sewer Replacement 0 Back Flow Preventer 0 Grease Interceptor(Trap) gallons (Requires 3 sets of plans;
❑ Lawn Sprinkler System-Number of Heads 0 Well g:*
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.*
❑ OtherMEM 1 •11111.1111111111111111111311217` •11=222215EMESTNIMMEEM IMMIENZEMSZIOM'
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 rea
this application and know the same to be true and correct. All provisions of laws and ordir antes 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 Osc l CahIrvae{ih 9 L1-L Phone Number (1°4)553 -3o95"
Plumbing Company B & G P110661)11 CO. _Office Phone (40M) 23-3 SFax (4o10223-34 0
Co. Address: 2:13-2- CDYPoV ate S4,NaVe !SIVA City TackSohvill e State rL Zip -2,i3
License Holder (Print): Clem, C• how, �.r;, tate Certification/Registration# GAG 0115413
Notarized Signature of License Holder Or ‘ `
,x u,N LORI S.NORDGREN
Sworn and subscribed befor .411!this / A day of Ity, ./ 0
tit'i, N Commi sotary oon#c- tFF 947336ate of da Signature of Notary Publi/ er s+ ' MyComm.Expires Mar 10.2020 ' /1,-17,:-.7.,-;-,,e
h� ` ;'' Bonded through National Notary Assn
14,40,
Cash Register Receipt Receipt Number
City of Atlantic Beach R4787
DESCRIPTION ACCOUNT QTY I PAID
PermitTRAK $257.28
PLRS18-0098 Address: 158 16TH ST APN: 171879 0000 $257.28
PLUMBING $251.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 28 $196.00
STATE SURCHARGES $6.28
STATE DBPR SURCHARGE 455-0000-208-0600 0 $3.77
STATE DCA SURCHARGE 45500002080700 0 $2.51
TOTAL FEES PAID BY RECEIPT: R4787 $257.28
CITY OF ATLANTIC BEACH
800 SEMINOLE RD
ATLANTIC BEAC,FL 32233
04/16/2018 15:42:35
CREDIT CARD
VISA SALE
CARD# ;000100008414
:INVOICE 0013
SEQ#: 0011
Batch#: 000777
Approval Code: 021752
Entry Method: Manual
Mode: Online
Tax Amount: $0.00
Card Code: M
SALE AMOUNT 5257,28
CUSTOMER(OPY
Date Paid: Monday, April 16, 2018
Paid By: B & G PLUMBING, HEATING &AIR
Cashier: CB
Pay Method: CREDIT CARD 021752
Printed: Monday,April 16,2018 3:44 PM 1 of 1
MOOT