157 Belvedere St PLRS19-0146 Repipe 16 PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0146
v 800 SEMINOLE ROAD ISSUED:
ATLANTIC BEACH. FL 32233 EXPIRES:
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY NSPECTION.
ALL • 'K MUST CONFORM TO THE CURRENT ! • 1 OF • ' ! + 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.
• : ADDRESS: PERMITTYPE: DESCRIPTION: OF • • 1:
157 BELVEDERE ST PLUMBING RESIDENTIAL RE PIPE - 16 FIXTURES $5000.00
TYPE OF •
ZONING: : ! •
• • GROUP:
170584 0000 SALTAIR SEC 01
COMPANY: ADDRESS:
F W FAIR PLUMBING CO. P.O. BOX 51558 JACKSONVILLE FL 32240
• ADDRESS: STATE zip:
BURCH ROBERT 157 BELVEDERE ST ATLANTIC BEACH FL 32233-4106
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 . •
'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 0 $0.00
PLUMBING FIXTURES 45S-0000-322-1000 16 $112.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.51
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $171.51
Issued Date: 1 of 2
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845 PL t 1,41
JOB ADDRESS' PERMIT#
r
NEW OR REPLACEMENT INSTALLATION: Projec� Value S 5, 060
TYPE OF FIXTURE QTY TYPE OF /X y
Bathtub Septic Tank & Pit _
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray ater Connected Appliances
Lavatory ter Heater /
Other Fixtures Wa er Treating System
RE-PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower
Dishwasher / Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet _Z7_
Hose Bibs Ic I— Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray 4_ Water Connected Appliances
Lavatory L Water Heater — —
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer r=I Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
[-i Lawn Sprinkler System-Number of Heads ] Well
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
o Other
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby certify that I have read
this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified
or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name n Phone Number /Qs)
Plumbing Company i5U ) �A/ /" J✓yl�� Office Phone 7/_ V V
Co. Address: d S-1 �I Cityl�A MA � � Statim` Zip�Z Z' y a
License Holder (Print): JQ ale- tat Ce rtifi cat 10ii/Regi stratio4W3'7`$�b�
Notarized Signature of License Holder
Sworn and subscribed efore me this day of q 20114:L�
,aaVN& Notary Public State of Florida
Jacqueline Brooks
My CommissionGG204482 Signature of Notary Pu
a w Expires 04/08/2022