355 3RD ST W - PLUMBING i""''' l
' PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
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M,¢"•..: CITY OF ATLANTIC BEACH PLRS19-0016
\' 800 SEMINOLE ROAD ISSUED: 1/17/2019
.: �, EXPIRES: 7/16/2019
�" ATLANTIC BEACH. FL 32233
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
355 W 3 ST PLUMBING RESIDENTIAL install 17 fixtures $6000.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170873 1000 ATLANTIC BEACH SEC H
ICOMPANY: ADDRESS: CITY: STATE: ZIP:
B & G PLUMBING,
HEATING & AIR 2232 Corparate Square Blvd JACKSONVILLE FL 32216
CONDITIONI
IOWNER: ADDRESS: CITY: STATE: ZIP:
BEASLEY GERALDINE ET AL 237 SOUTHERN ROSE DR JACKSONVILLE FL 32225
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR 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.
LIST OF CONDITIONS
Roll off container company must be on City approved list. Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 17 $119.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.61
STATE DCA SURCHARGE 45S-0000-208-0600 0 $2.00
TOTAL:$178.61
Issued Date: 1/17/2019 1 of 2
~L''r PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
"J`+ '^ tf CITY OF ATLANTIC BEACH PLRS19-0016
_')V.‘. -- f" ISSUED: 1/17/2019
\ 800 SEMINOLE ROAD
~�o't19'e ATLANTIC BEACH. FL 32233 EXPIRES: 7/16/2019
Issued Date: 1/17/2019 2 of 2
6
Plumbing Permit Application ""ALL INFORMATION
`_/f.:_ :,, umrj pp HIGHLIGHTED IN
-: City of Atlantic Beach Building Department GRAY IS REQUIRED.
/ 800 Seminole Rd, Atlantic Beach, FL 32233 Q L P Si CI " 00 4,0
Phone: (904) 247-5826 Email: Building-Dept( coab.us PERMIT#:�16>1 �'-a3 3
-;3y
JOB ADDRESS: #96 West 3rd street PROJECT VALUE$ (_000 0 D C)
✓d1IEW OR REPLACEMENT INSTALLATION and/or D1E-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 1 Septic Tank& Pit
Clothes Washer 1 Shower 2
Dishwasher t Shower Pan 2
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 2
Hose Bibs 2 Urinal
Kitchen Sink i Vacuum Breakers
Laundry Tray Water Connected Appliances 1
Lavatory Water Heater 1
Other Fixtures Water Treating System
I VIISCELLANEOUS
❑Sewer Replacement
❑Back Flow Preventer
❑Lawn Sprinkler System (number of sprinkler heads)
grease Interceptor(Trap) gallons (Requires 3 sets of plans)
❑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 state or local law regulation construction or the performance of construction.
Owner Name: 1 Ci;t1lC1 4 DD. I- L, 13 tee'S Icy, Phone Number: 9i & 'I —-2 11—�i c G�Z
r
Plumbing Company: B&G plumbing co Office Phone: (904)223-3585 Fax(904)223-3750
Co. Address: 2232 Corporate Square Blvd City: JacksonvilleState: FL zip:.32216
License Holder: Gene C. Rover 41„.1 State C ification/Registration tt CFC 022593
Notarized Signature of License Holder C.L1�xj-- '-- —'
The foregoing instrument was acknowledged before me this f�'day of 4,i,�/1., , 20 /9, in the State of Florida,
County of OdG1 i' z
LORI S.NORDGREN 0 Signature of Notary Public t /1 - n
a/ffie_Li
`��, Y pUg�
.:.:,.cm:.° Notary Public State of Florida
Commission M FF 947336
•
..s:-;,=6.i.-...:60,4...: My Comm.Expires Mar 10,2020 ' Personally Known OR [ ] Produced Identification
'' °j '' Bonded through National Notary Assn. ` Type of Identification:
Updated 10/17/18
Cash Register Receipt Receipt Number
34. City of Atlantic Beach R7863
j D.
DESCRIPTION I ACCOUNT QTY PAID
PermitTRAK $178.61
PLRS19-0016 Address: 355 W 3 ST APN: 170873 1000 $178.61
PLUMBING $174.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 17 $119.00
STATE SURCHARGES $4.61
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.61
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R7863 $178.61
CITY CE ATLANTIC BEACH
800 SENINOLE RD
ATLANTIC BEAC,FL 32233
0116;2019 16:05:21
CREDIT CARD
VISh SALE
Card» XXXXXXXXXXXX3386
SEQ u: 12
Batch#: 112
INVOICE 14
Approval Code: 014269
Entry Method: Manual
Mode: Online
Tax Amount: 80.00
Card Code: M
SALE AMOUNT $178.61
CUSTOMER COPY
Date Paid:Wednesday,January 16, 2019
Paid By: B &G PLUMBING, HEATING &AIR CONDITIONI
Cashier: BA
Pay Method: CREDIT CARD 14
Printed:Wednesday,January 16,2019 4:06 PM 1 of 1
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