142-146 OCEAN BLVD PLUMB PERM PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0036
800 SEMINOLE ROAD ISSUED: 2/13/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 8/12/2019
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.
DESCRIPTION: VALUE OF WORK:
JOB ADDRESS: ,----i PERMIT TYPE: i
142-146 OCEAN BLVD PLUMBING RESIDENTIAL INSTALL WATER HEATER $810.00
TYPE OF REALES
TATE BUILDING USE
ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1702020000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE:
DAVID GRAY PLUMBING 6491 POWERS AVENUE JACKSONVILLE FIL 32217
INC.
Ti 0 14 ADDRESS: CITY: STATE:
ELLA PAPPAS LIVING C/O JANET D PAPPAS NEWBERRY FL 32669
TRUST
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 4SS-0000-322-1000 I $7.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 4SS-0000-208-0600 0 $2.00
TOTAL:$66.00
Issued Date:2/13/2019 1 of 2
PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0036
800 SEMINOLE ROAD ISSUED: 2/13/2019
ATLANTIC BEACH, FL 32233 EXPIRES: 8/12/2019
Issued Date:2/13/2019 2 of 2
"ALL INFORMATION
Plumbing Permit Application
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 142 Ocean Blvd Atlantic Beach, FL 32233 PROJECT VALUE $810.00
OYEW OR REPLACEMENT INSTALLATION and/or [IRE-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
EMSCELLANEOUS
E]Sewer Replacement
E]Back Flow Preventer
ElLawn Sprinkler System (number of sprinkler heads)
ElGrease Interceptor (Trap) _gallons (Requires 3 sets of plans)
F-1 Well **SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.
ElOther
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:ELLA PAPPAS FAMILY TRUST Phone Number: (904)247-3530
Plumbing Company: David Gray Plumbing, Inc. Office Phone: (904) 724-7211 Fax(904) 724-5925
Co. Address: 6491 Powers Avenue City: Jacksonville State: FIL Zip: 32217
License Holder: State Certification/Registration # CFCO22586
Notarized Signature of License Holder
The foregoin * t e f Ge��6t!:l in the State of Florida,
ins ruTent was acknowledged before m this day o 20
County of "0'(
Signature of Notary Public
,01% Notary Public state of Florida
40 <6 Grimaris Rivera
my commission GG 242920
Expires 07130/2022 Personally Known OR Produced Identification
Type of Identification:
Updated 10/17118