599 STURDIVANT AVE PLRS19-0065 PLUMB SH PAN PERM PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0065
800 SEMINOLE ROAD ISSUED: 3/28/2019
1'~ ATLANTIC BEACH. FL 32233 EXPIRES: 9/24/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENTr • OF • • rA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF ♦ r 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:
599 STURDIVANT AVE PLUMBING RESIDENTIAL install shower pan $2250.00
TYPE OF BUILDING
• • GROUP:
170636 0210 SALTAIR SEC 03
COMPANY: ADDRESS: CITY: STATE: ZIP:
ALDRIDGE & SONS
PLUMBING CONTRACTORS 5151 SUNBEAM RD #5 JACKSONVILLE FL 32256
INC
• ADDRESS:
WILBY JAMES R 1015 ATLANTIC BLVD 101 ATLANTIC BEACH FL 32233-3313
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.
OF . r •
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 4SS-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
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $66.00
Issued Date:3/28/2019 1 of 2
rt-L`j-i g Application Permit A lication **ALL INFORMATION
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#: )LQ-51 C7- �
JOB ADDRESS: .5-99 6 &irJ 1 ve' v, f A✓e PROJECT VALUE $ 2,Z_5-6
F-1 NEW OR REPLACEMENT INSTALLATION and/or El RE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower
Dishwasher Shower Pan _L
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 **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: ame5 W; 16v Phone Number: 909 3.75 833Z-
1
Plumbing
33z-
Plumbing Company: aldr�jge 5or,5 PILO Inra Office Phone: 90Y.297 3$55 Fax
Co. Address: /s-L�„ beim R�. city: Ja,c State: 1 Zip: 32459
License Holder: CrC 14 216 235- W di..u»11U j— State Certification/Registration # CFO 1Y26 Z35
Notarized Signature of License Holder T
The foregoin instrum t was acknowledged before me this day of , 20[ I , in the State of Florida,
County of
qicr ature of Notary Public V1 ���► �' Ir� t
E
sk':li7} JOSETTE A RETHMEL
Cornmission#FF 218261 [ ] personally Known OR [ Produced Identfication
gig: Expirer.T yF7,2019�r„„a �' aA.dT.,,T�,Fweoo�-�y e of Identification:
Updated 10/17/18
l Cash
City yr
ofAtlanticBeach • •
DESCRIPTION • QTY PAID
PermitTRAK $66.00
PLRS19-0065 Address: 599 STURDIVANT AVE APN: 170636 0210 $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: R8596 $66.00
Date Paid:Thursday, March 28, 2019
Paid By: ALDRIDGE &SONS PLUMBING CONTRACTORS INC
Cashier: LE
Pay Method: CREDIT CARD 5
Printed:Thursday, March 28,2019 2:00 PM 1 of 1
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