800 Seminole Rd PLRS19-0155 Ball Field 11 Fixtures rt_1 ''''' PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0155
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800 SEMINOLE ROAD ISSUED: 8/16/2019
»rEXPIRES: 2/12/2020
ATLANTIC BEACH. FL 32233
MUST ♦ LL INSPECTION • i • 1 ♦ ♦ ♦ BY 4 PM FOR ♦ INSPECTION.
ALL • ' K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • '
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:
800 SEMINOLE RD PLUMBING RESIDENTIAL AT THE BALL FIELD - 11 $1000.00
FIXTURES
TYPE OF
• • GROUP:
170389 0000 SALTAIR SEC 02
COMPANY: ADDRESS:
A TO Z CONTRACTING AND 406 HAMLET RD JACKSONVILLE FL 32221
PLUMB
• ADDRESS:
CITY OF ATLANTIC BEACH 800 SEMINOLE RD ATLANTIC BEACH FL 32233-5444
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 45S-0000-322-1000 0 $0.00
PLUMBING FIXTURES 4SS-0000-322-1000 11 $77.00
STATE DBPR SURCHARGE 4S5-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
Issued Date:8/16/2019 1 of 2
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
0
0 �
Ph (904) 247-58(26 Fax (904) 247-5845 n
JOB ADDRESS: �ioo semi r-4I e Rpt PERMIT# P L-RSI q —
O
NEW OR REPLACEMENT INSTALLATION: Project Value$ c? o%
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
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 57
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 ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ 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.
Property Owners Name CAq piC 14414r4 I &axJ-, Phone Number
Plumbing Company a-+02 C Ov4 LIr n C Office Phone 906'FQ0gQ') Fax 9AY__-9X y126
Co. Address: VUR --1arr%te4— 41 City Do1IL State;[ zip 3ZZ2/
License Holder(Print): ('f Tk,9A _-5 State Certifica gistration# 04:C-6(27' rL.
Notarized Si nature ofLicense Holder
SEAN HARKENREADER Sworn and subscribed before me this T day of Aar► 20�c _
Notary Public-State of Florida
Commission#66199327 Signature of No Public
My Commission Expires Mar 9, 2022 g �'