CAPELLA CT 5403 - WATER HEATER PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0032
ISSUED: 2/4/2019
..,�� 800 SEMINOLE ROAD EXPIRES: 8/3/2019
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:
5403 CAPELLA CT PLUMBING RESIDENTIAL WATER HEATER $810.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169397 0200 SECTION LAND
COMPANY: ADDRESS: CITY: STATE: ZIP:
DAVID GRAY PLUMBING 6491 POWERS AVENUE JACKSONVILLE FL 32217
INC.
OWNER: ADDRESS: CITY: STATE: ZIP:
NAVAL CONTINUING CARE
RETIREMENT 1 FLEET LANDING BLVD ATLANTIC BEACH FL 32233-4599
FOUNDATION INC
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 0 $0.00
PLUMBING FIXTURES 455-0000-322-1000 1 $7.00
STATE DBPR SURCHARGE 45S-0000-208-0700 0 $2.00
Issued Date: 2/4/2019 1 of 2
Sy\rl;;�, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0032
��rj
�" ISSUED: 2/4/2019
K : 800 SEMINOLE ROAD
'` ATLANTIC BEACH. FL 32233 EXPIRES: 8/3/2019
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $66.00
Issued Date: 2/4/2019 2 of 2
;.-r,-.;-\-,',-,,,,,, **ALL INFORMATION
Plumbing pnp
HIGHLIGHTED IN
!. ,\`s,i City of Atlantic Beach Building Department GRAY I5 REQUIRED.
' 800 Seminole Rd, Atlantic Beach, FL 32233
jPRSPiOCA
`"s,. Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 5403 Capella Court PROJECT VALUE $810.00
\- leek La. ,.cti/-1�J
UVEW OR REPLACEMENT INSTALLATION and/or ORE-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 1
Other Fixtures Water Treating System
❑VIISCELLANEOUS
El 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:Fleet Landing Retirement Living Phone Number: (904)246-9900
Plumbing Company: David Gray Plumbing, Inc. Office Phone: (904) 724-7211 Fax(904) 724-5925
Co. Address: 6491 Powers Avenue City: Jacksonville State: FL Zip: 32217
License Holder: pv/h NI State Certification/Registration # CFCO22586
Notarized Signature of License Holder P(1,04 .iiii/ty
The foregoin instrument was acknowledged before me this day ofFe/4/AI, 2011, in the State of Florida,
County of )Gt�
49,0a out, Notary Public stateoffonda Signature of Notary Public
Gnmaris Rivera
;. �• My Commission GG 242920 Personal) KnownORProduced Identification
S d' Expires 07/3012022 Personally enon
OP fk
l
'Type of Identification: �'CJYI-\
Updated 10/17/18
,0_,..,./0;
.. Cash Register Receipt Receipt Number
', -, City of Atlantic Beach R8O4O
DESCRIPTION I ACCOUNT QTY PAID
PermitTRAK $66.00
PLRS19-0032 Address: 5403 CAPELLA CT APN: 169397 0200 $66.00
PLUMBING $62.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 1 $7.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R8040 $66.00
Date Paid: Monday, February 04, 2019
Paid By: DAVID GRAY PLUMBING INC.
Cashier: CB
Pay Method: CHECK 1108
Printed: Monday, February 04, 2019 10:07 AM 1 of 1 I.
TWIT