1969 Seminole Rd PLRS19-0183 Water Heater r1r''" PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
4 �` CITY OF ATLANTIC BEACH PLRS19-0183
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800 SEMINOLE ROAD ISSUED: 9/27/2019
J1'°1119" ATLANTIC BEACH. FL 32233 EXPIRES: 3/25/2020
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.
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:
1969 SEMINOLE RD PLUMBING RESIDENTIAL PLUMBING - WATER HEATER $1336.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169542 0506 BEACHSIDE
COMPANY: ADDRESS: CITY: STATE: ZIP:
FLORIDA DELTA
MECHANICAL, INC. 2716 BROADWAY CENTER BLVD BRANDON FL 33510
OWNER: ADDRESS: CITY: STATE: ZIP:
KASPAR BRYCE A 1969 SEMINOLE RD 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 QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 0 $0.00
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: 9/27/2019 1 of 2
Plumbing Permit Application "ALL INFORMATION
HIGHLIGHTED IN
,�
fCity of Atlantic Beach Building Department GRAY IS REQUIRED.
t 800 Seminole Rd, Atlantic Beach, FL 32233 p(_(-ZS`ct _ 0 I g3
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 1969 SEMINOLE RD PROJECT VALUE $ 1.336 00
[NEW OR REPLACEMENT INSTALLATION and/or EIRE-PIPE
TYPE OF FIXTURE C2TY 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
LiVIISCELLANEOUS
[hewer Replacement
❑Back Flow Preventer
❑Lawn Sprinkler System (number of sprinkler heads)
Lrease Interceptor (Trap) gallons (Requires 3 sets of plans)
Well "S1RWD 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:KASPAR BRYCE Phone Number: (904)254-4009
Plumbing Company: FLORIDA DELTA MECHANICAL Office Phone: (866)219-0880 Fax!865)219-0729
Co. Address: 8402 LAUREL FAIR CIR SUITE 111 //�� City: TAMPA State: FL Zip: 33610
License Holder: DIMITRE BOBEV }� J r ( S e Ce ifica n/Registration #i CFC1425917
J , , I
Notarized Signature of License Holder j� "� '`
The foregoing instrumept was acknowledged before me this 2(O day of SP!)I , 20 1 7, in the State of Florida,
-
County of -l+ if S)Grbi-/J
I
"---'7,- ::-.--- EMILY H.MEDINA Signature of Notary Public /7(/'( ---il `Z�'�-
1-... .•...a.,..<%..".: MY COMMISSION k G0227056
wt;.:i EXPIRES:June 11,2022 personally Known OR [ ] Produced Identification
•f—,,,:.�t Bonded Thru Notary Public Underetera
Type of Identification:
Updated 10/17/18
trail%
Cash Register Receipt Receipt Number
4
Olvirr:
City of Atlantic Beach R10514
DESCRIPTION I ACCOUNT I QTY I PAID
PermitTRAK $66.00
PLRS19-0183 Address: 1969 SEMINOLE RD APN: 169542 0506 $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: R10514 $66.00
Date Paid: Friday, September 27, 2019
Paid By: FLORIDA DELTA MECHANICAL, INC.
Cashier: CT
Pay Method: CREDIT CARD 687515
044
Printed: Friday,September 27,2019 9:53 AM 1 of 1