1958 BEACHSIDE CT PLUMB PERM PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
X11 PLRS19-0023
CITY OF ATLANTIC BEACH
n
800 SEMINOLE ROAD ISSUED: 1/24/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 7/23/2019
INSPECTIONMUST CALL • 914) 247-5814 BY 4 PM FORDAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT ! • 1 OF • ' ! • BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, !
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.
• : ! •N: VALUE OF •
1958 BEACHSIDE CT PLUMBING RESIDENTIAL PLUMBING - 7 FIXTURES $1000.00
TYPE OF BUILDING
• • GROUP:
169542 0588 BEACHSIDE
COMPANY: ADDRESS: '
J WHITEHEAD PLUMBING 12811 BEAUBIEN RD JACKSONVILLE FL 32258
INC
• ADDRESS: '
RICHTER GREGORY J 1958 BEACHSIDE CT ATLANTIC BEACH FL 32233
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 . !
'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 45S-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 0 $0.00
PLUMBING FIXTURES 455-0000-322-1000 7 $4900
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$108.00
Issued Date: 1/24/2019 1 of 2
Plumbin Permit A lication **ALL INFORMATION
g �� HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
N
800 Seminole Rd, Atlantic Beach, FL 32233 _
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: � . PROJECT VALUE $ 1 too
Elt n
❑NEW OR REPLACEMENT INSTALLATION and/or EIRE-PIPE P LI`S( /-00"_3
TYPE OF FIXTUREqTY TYPE OF FIXTURE QTY
Bathtub I 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
❑ 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: Phone Number:
Plumbing Company: iLftjA X1 Office Phone: F x
NV
Co. Address: � D v�� City:� �r �Statet Zip:
License Holder: State Certification/Registration # li 147,l7l¢�
Notarized Signature of License Holder
The forego* strument as acknowledged before me this ay of G' , 2�, in the State of Florida,
County of
Signature of Notary Pu
Tav+;INDLESPERGEIi p sonally Known OR [ ] Produced Identification
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Bonded IRES:Octru Notary Pu
ber 6,2ff yprse f Identification:
r Updated 10/17/18
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