1870 Live Oak PLRS18-0189 CITY OF ATLANTIC BEACH
_ 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: PLRS18-0189
Description: 4 FIXTURES
Estimated Value: 0
Issue Date: 8/13/2018
Expiration Date: 2/9/2019
PROPERTY ADDRESS:
Address: 1870 LIVE OAK LN
RE Number. 172020 1422
PROPERTY OWNER:
Name: ROSENBERG MARK D
Add1870 LIVE OAK LN
ATLANTIC BEACH, FL 32233-4549
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: COGBURN AND WAKEFIELD PLBG
Address: 5900 TOWNSEND BLVD APT 522 CIA JOHN COGBURN
JACKSONVILLE, FL 32211
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 pemut,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 esthnnted value of$7,500.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH � p" C� �C
800 Seminole Rd Atlantic Beach,FL L 32233
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Ph(904)247-5826 Fax(904)247-5845 ,jq/tel`cr
JoB ADDREss: L D [ 6 / t� oxit PERMTF# J 410
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NEW OR REPLACEMENT INSTALLATION: Project Value$ 3r --
s
TYPE oFF7XTuRE QTY TYPE oFFIXTuRE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet J—
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 oFFixTURE 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:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well
**SIRWD 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 provisions of any other stale or local law regulation construction or the performance of construction.
Property Owners Name s+e ut• r-I 05co i d� Phone Number -JOc/-2W-tl3Lo
Plumbing Company tai+�U (U h I` Office Phone C/OY -33`/X0 Fax
Co. Address: 0 CityLkX Stale FL Zip 3�2
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License Holder(Print): State Certification/Registration# 1`{tmo
Notarized Signature of License Holder
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TONI GINOIr3PEa0Fg Sworn t,'i�befirre m t ' y 2(YSZFA
ISExp'nNSocoear�l Signatureolit
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