1280 W Plaza PLRS19-0018 PLUMBING PERMIT iP PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
' t PLRS19-0018
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 1/22/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 7/21/2019
MUST CALL INSPECTION •NE LINE (904) 2+ + BY 4 PM FOR + INSPECTION.
ALL • 'K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • ' D+ BUILDING
CODE, ' AND OF ATLANTIC BEACH • 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:
1280 W PLAZA PLUMBING RESIDENTIAL new single-family home $12700.00
TYPE OF
• • GROUP:
170979 0000 ATLANTIC BEACH SEC H
ADDRESS:
TDG PLUMBING 4426 LOYS DR JACKSONVILLE FL 32246
• ADDRESS:
BROWN JAMES W 4012 RUSTLING OAKS CT JACKSONVILLE FL 32277
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.
rw LIST OF • . •
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 $SS.00
PLUMBING FIXTURES 455-0000-322-1000 0 $0.00
PLUMBING FIXTURES 4S5-0000-322-1000 19 $133.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.82
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $192.82
Issued Date: 1/22/2019 1 of 2
PlumbingPermit Application **ALL INFORMATION
--''- �� HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 PLPS 19 �O C
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 0 141
JOB ADDRESS: k=2.Qf o w P�-A O PROJECT VALUE
❑NEW OR REPLACEMENT INSTALLATION and/or EIRE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 2- Septic Tank& Pit
Clothes Washer Shower
Dishwasher 1 Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs 4 Urinal
Kitchen Sink 1 Vacuum Breakers
Laundry Tray �_ Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
❑MISCELLANEOUS SCO' ; +find tjILL '"
❑ Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler heads)
❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
❑ 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.
Owner Name: �CaV Phone Number:
41
Plumbing Company: __TQ> (o Office Phone: X704 4`+7 Fax Eby
Co. Address: 4&,• City: ' SA')*- State: FL zip:
License Holder:—77i'hu-"S (0'*► C%e7 State Certification/Registration # CF'C- 141 7o"
Notarized Signature of License Holder �--
The foregoin strument as acknowledged before me this2day , 20LI in the State of Florida,
County of L—)V G�
Signature of Notary Public
" ." Personal) Known OR [ ] Produced Identification
i TONI GINDLESPERGER
MY COMMISSION#FF 924951 [ ] y
EXPIRES:october6.2019 Type of Identification:
moo?•' Bonded Thru Notary Public Underwriters
•Pf,St° Updated 10/17/18