150 12th Street PLRS19-0096 Install h20 System PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0096
800 SEMINOLE ROAD ISSUED: 5/20/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 11/16/2019
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.
NOTI E: 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: VALUEOFWORK:
150 12TH ST PLUMBING RESIDENTIAL install water treatment $66.00
system
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1702770000 ATLANTIC BEAM
COMPANY: ADDRESS: CITY: STATE: ZIP:
AFFORDABLE 3760 KORI RD JACKSONVILLE FL 32257
WATER/KINDER INC
OWNER: ADDRESS: CITY: STATE: ZIP:
Conklin Megan 150 12TH ST 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 CONDITIONS
Roll off container company must be on City approved list. Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT I QUANTITY PAID AMOUNT
PLUMBINIGBASIEFEE 455 0000-3224000 1 0 $5500
P UM8 ING FIXTURES 45S 000c322-1000 $7.00
MET �;PR SURCHARGE 455 MM208-07W 0
STATE DCA SURCHARGE 455 0000 208 0600 a $2,00
issued Date:5/20/2019 1 of 2 TOTAL$66.00
-*0"
XF-T—ORDALE wATER
3760 Kon Road Jacksonville, F L 32257 1z(I
(904) 262-0197 Fax (904) 260.6292
AffordableWater@Affordab[eWaterJax.com ?c
NAME DATE
ADDRESS CITY
STATE— ZIP_ PHONE
Water Supply City U Well U Install D
Hardness Total (lime)........ ........... g.p.g.
Iron (rust)...............................—P-P-m- Drall
pH.......................................
Hydrogen Sull......................
Electric Det —SA
TDS..................................... I
Free Chlorine........................... P.P.M. (-, -- t
Number of Persons in Family.......... i tJ (�IrARA(,;�-
SALT ROLIT�� Call First Drop Off Spigot
'L-daiii—of Equipment ARA sl
Cross Streets -t
Area A 4- �
DESCRIPTION MODEL PRICE WARRANTY
Ll L' Labor.
1 --2 Tanks:
Valve Body:
AlPartill
SubTotal ................................................
Sales Tax -�Iln5N 1-4 r2i
I PermitCou"Iff')?-91IT'l /Non-Taxable
Total......................................... At-.j-
Down Payment...... =.C-.k...............
Balance Due.�.......... ...................................
Terms
Bull RIGHT TO CANCEL. This is a home solicitation area and if you do not want the goods or seiwices, you may cancel this agreement
by mailing a notice to the wiler. This notice must Indicate that you do not were the goods and must be postmarked before midnight of the third
business day after you sign this agreement.
Affordable Water is responsible forrepairing equipment only underwamamVnd at a charge thereafter.Under no circumstances shall Affordable Water
be responsible for damages to any structure, not damaged by,Affordable star. specifically,Affordable Water shall net be liable for any damages,
direct or consequential,to persons or property not caused by its own negligence.
The mirmiship of the equipment covered in this order shall remain with the seller until equipment is paid for in full. It is further agreed by the
purchaser that the seller cannot be responsible for conditions resulting from existing facilities,changes in mineral content or coorof water supply,outside
drainage,pump, sand,weather,or conditions beyond the seller's control. Purchaser shall be responsible for weather protection.
Date
Representative Purchaser
I —..R IAI-qD --
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,Fl,32233
Ph(904) 247-5826 Fax (904)247-5845 PL-�N-Dcicf/c
JOB ADDRESS: I(a�) PERMIT N
ICA,tA I
NEW OR REPLACEMENT INSTALLATION: Project Value$-LL(D-j-20
TYPE OF FIXTURE QTY TYFE oF FIXTURE Qry
Bathtub — Septic Tank&Pit
Clothes Washer — Shower
Dishwasher — Shower Pan
Drinking Fountain — Slop Sink
Fluor Drain Three Compartment Sink
Fluor Sink Toilet
How Bibs — Urinal
Kitchen Sink — Vacuum Breakers
Laundry Tray — Water Connected Appliances
Lavatory — Water Heater
Other Fixtures Water Treating System
RE-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
How Bibs — Urinal
Kitchen Sink — Vacuum Breallars
Laundry Tray — Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
• Sewer Replacement 0 Back Flow Preventer o Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
• Lawn Sprinkler System-Number of Heads_ 0 Well —
** VRWD Well Completion Form. Completed form-to be submitted to tFe Building Department for final inspection.**
0 Other
Permit becomes wid if work does not wromence within a six roonts period or work is suspended or abandoned for six months.I hereby certify that I havered
this application and know the same in be true end correct. All provisions of laws end ordinances governing this work will be complied with whether spegiflod
or not The permit does not give authority to violate the provisions of my other sum,or lunal law regulation construction or the performance of construction.
Property Owners Name Phone Number=�� 4gL�,-
Ifo If- Cloy-
PlumbingCompany jQrr0)ZJ>AAIJE WA115A Officss Phone L2Y.2.f�Fax
Co. Address: 31c.0 KOW) RCad City J-6dSon6d le StateEL Zip 092-5
License Holder(Print): M)IRK A - 16 W D EP- Sta C fication/Registration# 0008/"
Notarized Signature of License Holder—_ - !Z
T� Sworn and subscribed be c thi 20a
4L vo%� =Mb�
Signature of Notary P,
PREPARED BY,RECORD AND RETURN TO:
Ossbornc&Shffild Title Sasr�iccg,LLC
4776 Hodges Boulevard,Suite 206 &RECORDED
Jacksonville,Florida 32224
In
File#: 2018-750K courdr.
Parcel Identificatioss N..bcr: Date
170277-0000
WARRANTY DEED
THIS WARRANTY DEED made effective the 19th day of February, 2019, by Kendall B.
Adkisson and John M. Stinson, wife and husband, hereinafter called Grantor, whose post office
address is 4776 Hodges Blvd., Ste 105, Jacksonville, FL 32224, to Edward R. Conklin and Megan
Conklin, husband and wife, hereinafter called Grantee, and whose post office address is 150 12th
Streets Atlantic Beach, FL 32233-5706.
(Wh��,r ened k.,al. (b. ,sc. ",causes" ad Wdad, .11 (as rtles V, this i�.truwoffl and the hOM 11.1
representatives and assigns ofindividuals and the succtssors and assigns ofoorporultas).
WITNESSETH:
THAT the Grantor, for and in consideration ofthe sum ofTen and No/]00 Dollars ($10.00) and
other valuable considerations, in hand paid by the said Grantee, the receipt whereof is hereby
acknowledged, hereby grants, bargains, sells, aliens, remises, releases, conveys and confirms unto the
said Grantee the following described land situate, lying and being in the County of Duval, State of
Florida,to-wit:
West 1/2 Lots 5 and 6, Block 43, ATLANTIC BEACH, according to
the plat thereof as recorded In Plat Book 6, Page 1, of the Public
Records of Duval County,Florida.
SUBJECT TO taxes accruing subsequent to December 31,2017.
SUBJECT TO covenants, restrictions and easements of record, if an),, however, this reference
shalt not operate to reimpose same.
TOGETHER with all the tenernents, heredlitaments and appurtenances thereunto belonging or in
anywise appertaming.
TO HAVE AND TO HOLD the same in fee simple forever.
Page I of 2
Doc 0 2019045224, OR Bit 18702 Page 1135, Nmeaner Pace.: 2,
Recorded 02/27/2019 01:52 M, RONNIE FUSSELL CUM CIRCUIT COURT DWAL COUNTY
RECORDING $19.50 DEED DOC ST $0701.00
FREPARED BY,RECORD AM RETURN TO:
Dili&Sughki T.I.Seves,iAX
"76noias, sw.2.
neloci Florda 32224
Fit,#:MIS-750K
Pared ldcnd&aVw Bauder:
17"11�
WARRANTY DEED
THIS WARRANTY DEED made effective the l9fla day of lebmary�, 2019,by Kendall B.
Adkisson and John M. Stineum, wife and husband, hereinafter called (montor, whose post office
address is 4776 Hodges Blvd.,Ste 105,Jacksonville,Fl, 32224,to Edward R.Conklin and Megan
Conklin, husband ad wife,licansinafter erflbed Granim, and whom past ffl. Address is 150 12th
Street.Atlantic Besela,Fl, 3Z233-5706.
.,s i-,., ...o. ..o I—.'1-1...1'a.I'--I-O's st"
-ii,ma�i,ii iw--nor...'OurnOrrinsinmi-I
WITNESSETH:
THAT the Gramor,for and in oundidension Of the a fTrn and No,1100 Dollars($10,00i and
other valuable considerations, in hand paid by the aid Grantoo, the meeipt Odersof is hereby
Acknowledged.humby grands,bouggimi calls, aliens,mmim,relessids,convoy,a and confirms,unto the
mid Gmntm the following described ]-it situals, lying and being in the County of David, Same Of
Florida,to-wit
West 1/2 Let. 5 ad 6� Black 43,ATLANTIC BEACH......Wag to
rho Plat thereof as recorded in Plat Book 6, Page 1, or the Public
Records of Duval Coubty,Mariana.
SUBJECT TO tons Accruing subsequent to Decorator 31,2017,
SUBJECT TO covensints,reamemons and comments of tedurd,if my-,however,this reference
shall not operate to reimpose same.
TOGETHER with.11 the moment,herablaments and appimencances thmunto belonging or in
anysi spriermuning,
TO HAVE AND TO HOLD the same in fee simple forever,
_o_o_ Par I f I
AND the Grantor hereby covenants with said Grantee that the Grantor is lawfully seized of said
land in fee simple; that the Grantor has good right and lawful authority to sell and convey mid land; that
the Grantor hereby fully warrants the title to said land and will defend the same against the lawful claims
of all persons whomsoever;and that mid land is free of all encumbrances.
IN WITNESS WHEREOF, the said Grantor has set their hand and seal the day and year first
above written.
Signed, scaled and delivered
in our presence:
�ithess—#1 signature Kendall B. Adkisson
00-f�I e <-'ri "!�') , I I e -
witness#I printed nante
M'itn;es52 sionae
4� , ajD&J—
WitnesfiTprintod rn,nne
STATE OF FLORIDA
COUNTY OF DUVAL
The foregoing instrument was acknowledged before me this d o ebruary, 2019, by
Kendall R. Adkisson and John M. Stinson, wife and husband, o i e mortally known to me,
has/have produced a valid drivees license(s) or has/have produce as
identification.
No
b c
. ........ Zilsision Expires:
C'... %ION W,
�40fll,
�NI.2 (Notary Seal)
U
z
end
Pee2.f2
Cash Register Receipt Receipt Number
City of Atlantic Beach R9095
DESCRIPTION ACCOUNT lj=�zriiibm
Perm1tTRAK $66.00
PLR519-0096 Address: 150 12TH ST APN: 170277 0000 $66.00
PLUMBING $62.00
-PLUMBING BASE FEE 455-000-322-1000 $55.00
PLUMBING FIXTURES 455-0000-322-1000 $7.00
STATE SURCHARGES $4.1)0
STATE DBPR SURCHARGE 455-0000-20&0700 0
STATE )CA SURCHARGE 455-DOOO-208-0600 a
TOTAL FEES PAID BY RECEIPT: R9095 $66.00
Date Paid: Monday, May 20,2019
Paid By:AFFORDABLE WATER/KINDER INC
Cashier: CT
Pay Method:CREDIT CARD 01377C
Printed:Monday,May 20,2019 4:11 PM I of 1