275 5TH ST - PLUMBING ,...,..,..,,,
410, }rig CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
6� ��
ATLANTIC BEACH, FL 32233
''.40;351%' INSPECTION PHONE LINE 247-5814
PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS18-0232
Description:
Estimated Value: 1600
Issue Date: 9/28/2018
Expiration Date: 3/27/2019
PROPERTY ADDRESS:
Address: 275 5TH ST
RE Number: 172558 0000
PROPERTY OWNER:
Name: KUBIAK LAVINIA HARVEY LIVING TRUST
Address: 275 5TH ST
ATLANTIC BEACH, FL 32233-5311
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
,
Phone:
Name: JERRY NOLAN PLUMBING INC
Address: 3115 HAMPSTED DR QA JERRY JAMES NOLAN
JACKSONVILLE, FL 32225
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$7,500.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
/RPh(904)247-5826 Fax(904)247-5845
JOB ADDRESS: r S !" i- M1 _5PERMIT# PLP-51 8'0132-
NEW
'0132NEW OR REPLACEMENT INSTALLATION: Project Value$ % 0006
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 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 **
**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 provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name L,, K&7 h\\ct e Phone Number 5 L fl-/c-2 3
Plumbing Company aPt7 ci /Uo (( v Nt.b � �x Office Phone r1 y --UDS"/ Fax 6-54f(,
Co. Address: 3 ( 4^-ri cY City J4,--kroq0,111 State FL Zip-3-2-)J f
License Holder(Print): ' ''`1 State Certification/Registration# 6E( 65-7 QFC
Notarized Signature of License Holder in—
Y:, JAMIED.sMini Sworn and subscribed before me this Za y o '�• ( 201&
MY COMMISSION#GG 255331
;�� EXPIRES:September 5,2022 Signature of Notary Publi l
... . Bonded Tin Notary Pulbc Urde voiters