2028 BEACH AVE PLRS19-0059 WATER HEATER PERMIT PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
PLRS19-0059
CITY OF ATLANTIC BEACH
ISSUED: 3/22/2019
800 SEMINOLE ROAD
EXPIRES: 9/18/2019
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:
2028 BEACH AVE PLUMBING RESIDENTIAL install water heater $3054.34
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1697010100 NORTH ATLANTIC BCH
UNIT 3
COMPANY: ADDRESS: CITY: STATE: ZIP:
B & G PLUMBING,
HEATING &AIR 2232 Corparate Square Blvd JACKSONVILLE FL 32216
CONDITIONI
OWNER: ADDRESS: CITY-: - STATE: ZIP:
RAPP MATTHEW H 1031 FIRST ST S#1001 JACKSONVILLE FL 32250
BEACH
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 1 $7.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
Issued Date: 3/22/2019 1 of 2
PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
PLRS19-0059
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 3/22/2019
ATLANTIC BEACH, FIL 32233 EXPIRES: 9/18/2019
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$66.00
Issued Date:3/22/2019 2 of 2
"ALL INFORMATION
Plumbing Permit Application
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Build ing-Dept@coab.us PERMIT#: L�S I( D 1)Sj
JOB ADDRESS: - 7.* PROJECT VALUE$
E)YEW 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 L, P
Other Fixtures Water Treating System
DMISCELLANECILIS
Osewer Replacement
E]Back Flow Preventer
E]Lawn Sprinkler System (number of sprinkler heads)
03rease Interceptor(Trap)_gallons (Requires 3 sets of plans)
F1 Well **SJRWO 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.
OwnerName: A1177VEW 919PID Phone Number:
Plumbing Company: P *C-,- IDIUM b;AIQ 0 ff i c e P h o n e: F a x
Co. Address: A-212 (-'Z)r1&9l!4_TL SQdWt7kDCitY: Ta)( F-,l State: Iq zip: 9,7;?1,&
CFC,4 R.�?593
LicenseHolder: (3-oe- C' State CetKification/Registration
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this I day of 17W 20/1?, in the State of Florida,
County of r1b UDI
LORI S.NORDGREN
"'PA-Y PL'*" Sign/at re of Notary Pub
Notary Public-State of Florida
Commission#FF 947336
P
Personally Known OR Produc�d Identification
My Comm.Expires Mar 10,2020
eri
"OF f�
Bonded through National Notary Assn. Type of Identification:
Updated 10117118
Cash Register Receipt Receipt Number
City of Atlantic Beach R8515
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $66.00
PLRS19-0059 Address: 2028 BEACH AVE APN: 1697010100 $66.00
PLUMBING $62.00
PLUMBING BASE FEE 455-0000-322-1000 $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 o $2.00
TOTAL FEES PAID BY RECEIPT: R8515 $66.00
Date Paid: Friday, March 22, 2019
Paid By: B & G PLUMBING, HEATING &AIR CONDITIONI
Cashier: CB
Pay Method: CREDIT CARD 11119
Printed: Friday, March 22, 2019 9:30 AM 1 of 1