1571 Linkside Dr PLRS19-0178 Water Treatment r11-i-v .,,, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
u' i
' �\
' CITY OF ATLANTIC BEACH PLRS19-0178
� 800 SEMINOLE ROAD
ISSUED: 10/1/2019
Y.
`fl.c 1�~ ATLANTIC BEACH, FL 32233 EXPIRES: 3/29/2020
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:
1571 LINKSIDE DR PLUMBING RESIDENTIAL WATER TREATMENT SYSTEM $66.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172374 6083 SELVA LINKSIDE UNIT02
COMPANY: ADDRESS: CITY: STATE: ZIP:
AFFORDABLE
WATER/KINDER INC 3760 KORI RD JACKSONVILLE FL 32257
OWNER: ADDRESS: CITY: STATE: ZIP:
GREENE NATHAN 1571 LINKSIDE DR 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 E
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:$66.00
Issued Date: 10/1/2019 1 of 2
PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0178
800 SEMINOLE ROAD ISSUED: 10/1/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 3/29/2020
Issued Date: 10/1/2019 2 of 2
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845 'LRS (Q —o ( 7 S
JOB ADDRESS: IS1 I LIh iLSldQ, wVQ PERMIT# I v
NEW OR REPLACEMENT INSTALLATION: Project Value$ Le(42.°C'
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 I.
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
Hose Bibs Urinal
Kitchen Sink _ Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement 0 Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads 0 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 3€,Lyk kit e l l Phone Number/'(-201-33S 7
Plumbing Company A f Fo k DA 8 Lr- \AJA 4 E/Z Office Phone261-1,19 7 Fax
D 102 92
Co. Address: 3'74,0 K012.1 P O icJ City 3 c 105o11U t i le State FL Zip 322 5'1
License Holder(Print): MARK A • 1<1�0 C State Ce ification/Registration# 000 818(c'
Notarized Signature of License Holder �f't ',,
Sworn and subscribed be me this kiiir day of - it. 20 19
Notary Put:State of Florida
s j' � r: i cc os�se3 Signature of Notary P lic I I I l
a,. Expires 02/09/2021 I
q/g/c 'c��
AFFORDABLE WATER
CONDITIONING • SOFTENING • PURIFICATION
, 3760 Kori Road.• Jacksonville, FL 32257
{904) 262-0197 • Fax (904) 260-6292
Affordab1eWafe-at�AffordableWaterJax.com
NAME ---- r l , :-- . .- . DATE .
ADDRESS . . _ CITY
STATE ZIP PHONE C ' ' `'3 , 1
Water Supply City I Well ❑ Install Date ` / CJ,9 LOOP
Hardness Total (lime) g.p.g.'---.. ___ _.._-__...__/F
Iron (rust) --- p,p,m, Drain V Pipe
pH
Hydrogen Sulfide Electric \ ' Faucet
TDS _-_.
Free Chlorine p.p.m.
Number of Persons in Family
SALT ROUTE - Call First 1:1Drop Off f=1Sptgot
•
Location of Equipment - '
Cross Streets - . ..-
Area
DESCRIPTION MODEL PRICE WARRANTY .
.C,f ( *;. �? IIS; 14"-
_ 'r - Labor: •
-
• f Tanks: ' .
Valve Body:
All Parts:
Sub Total ___
: . 4)
Sales Tax �\ .
Permit/County /, r :� ..: : %Non-Taxable .
Totalr ''
r f
Down Payment -------
Balance Due
Terms
BUYER'(S') RIGHT TO CANCEL. This is a home solicitation sale and if you do not want the goods or services, you may cancel this agreement
by mailing a notice to the seller.This notice must indicate that you do not want the goods and must be postmarked before midnight of the third
business day after you sign this agreement.
Affordable Water is responsible for repairing equipment only under warranty and at a charge thereafter.Under no circumstances shall Affordable Water
be responsible for damages to any structure, not damaged by Affordable Water. Specifically,Affordable Water shall not be liable for any damages,
direct or consequential,to persons or property not caused by its own negligence.
The ownership 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,cha ges inmineral content or color of water supply,outside
drainage, pump,sand,weather,or conditions beyond the seller's control.Purchaser shall Date
``�� ,r// /barye 7oaib feather protection.
Representative - . i Purchaser 0_siir.ahjit.j2...____.
to
:, Cash Register Receipt Receipt Number
City of Atlantic Beach R10569
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $66.00
PLRS19-0178 Address: 1571 LINKSIDE DR APN: 172374 6083 $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: R10569 $66.00
Date Paid: Tuesday, October 01, 2019
Paid By: AFFORDABLE WATER/KINDER INC
Cashier: CB
Pay Method: CREDIT CARD 2
Printed:Tuesday,October 01,2019 10:05 AM 1 of 1