230 10th St PLRS19-0068 Install Fixtures PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLR519-0068
800 SEMINOLE ROAD ISSUED:4/2/2019
'r:o ATLANTIC BEACH, FL 32233 EXPIRES: 9/29/2019
INSPECTIONMUST CALL • 14FOR NEXT DAY INSPECTION.
CODE, NEC, IPIMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF 1
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: r • OF WORK:
23010TH ST PLUMBING RESIDENTIAL install 33 fixtures for new $10000.00
single-family home
TYPE OF BUILDING
CONSTRUCTION: GROUP:
ATLANTIC BEACH
170357 0000 PARKWAY
ADDRESS: CITY: STATE: ZIP:
NELSON PLUMBING CO. 11624-1 DAVIS CREEK ROAD EAST JACKSONVILLE FL 32256
INC.
1ADDRESS:
FRANCIS JAMES D 23010TH ST ATLANTIC BEACH FL 32233-5750
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 PAIDAMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455 LOW 322-1000 33 $23100
STATE DBPR SURCHARGE 455-WOP208-0700 0 $419
7STATE DCA SURCHARGE 455-0000-208-06W 0 $286
Issued Date:4/2/2019 1 of 2
PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0068
-
800 SEMINOLE ROAD ISSUED: 4/2/2019
ATLANTIC BEACH, FL 32233 EXPIRES: 9/29/2019
TOTAL:$293.15
Issued Date:4/2/2019 2 of 2
"ALLINFORMATION
PlumbinB Permit Application HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 P L(-S [41- C7 occ,$
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT a: 2E%(B -O Vla,
JOBADDRESS: 7,210 10 STAAh.T PROJECT VALUE $'tt 10, 000 • c'0
aEW OR REPLACEMENT INSTALLATION and/or EIRE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTy
Bathtub Septic Tank& Pit
Clothes Washer I Shower
Dishwasher 1 Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet r
Hose Bibs �_ Urinal
Kitchen Sink I Vacuum Breakers
LaundryTray l Water Connected Appliances_
Lavatory _]_ Water Heater I
Other Fixtures Water Treating System
DAISCELLANEOUS
[]Sewer Replacement
❑Back Flow Preventer
❑Lawn Sprinkler System (number of sprinkler heads)
grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑Well '*SIRWD Well completion Form.completed farm to be submitted to the Building Department for final inspection.**
[]Other
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.
I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances
governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions
of any other state/or local law regulation construction��o��r the performance of construction.
Owner Names 67S "�A./T6N - FWnAd ACt�$ I-E%ib:71K.E- Phone Number:
Plumbing Company:NFtcr�.0 �. gwil LO lbL Office Phone: g684 Fax
Co.Address: '''Z 191W% 0-W41 'ty: c State:a,Zip:��—
License Holder b H /Registration# 02037�
Notarized Signature of License Holder /i'��,/-�,�.A,,�
The foregoingmstrum nt was acknowledged before me this day of T 20 , in the State of Florida,
pLQ
County ofa� I
OBAP.BI% Signa ure of Notary Public
COMMI&SION l F=9W3a2
EXP 1E NaremOe:1e zmy [ Personally Known OR [ ] Produced Identification
�A,ii:,y.F eowmmN raan Pec *+ Type of Identification:
Updoreai0/17/1a