1753 Live Oak Ln PLRS19-0189 29 Fixtures rs�L.> PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
's!v PLRS19-0189
CITY OF ATLANTIC BEACH
ISSUED: 10/1/2019
800 SEMINOLE ROAD
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:
1753 LIVE OAK LN PLUMBING RESIDENTIAL PLUMBING - 29 FIXTURES $18500.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172020 0186 SELVA MARINA UNIT 06
COMPANY: ADDRESS: CITY: STATE: ZIP:
HALL AND SONS 837 ORANGEWOOD RD JACKSONVILLE FL 32223
OWNER: ADDRESS: CITY: STATE: ZIP:
SCOTT JOSEPH M 1201 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 29 $203.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.87
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.58
TOTAL: $264.45
Issued Date: 10/1/2019 1 of 2
-,-A','' PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
f ti CITY OF ATLANTIC BEACH PLRS19-0189
LI,. �" ISSUED: 10/1/2019
800 SEMINOLE ROAD
-0109r ATLANTIC BEACH. FL 32233 EXPIRES: 3/29/2020
Issued Date: 10/1/2019 2 of 2
Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
- City of Atlantic Beach Building Department GRAY IS REQUIRED.
J 800 Seminole Rd, Atlantic Beach, FL 32233 ���� S1 - O(o
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 1
JOB ADDRESS: 1-7 53 ( 7,✓;.-- c...., i
t/L ii- PROJECT VALUE $ / g So a - o
✓INEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 2. Septic Tank & Pit
Clothes Washer ____L_ Shower 2
Dishwasher _L___ Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet `t
Hose Bibs —4--
Urinal
Kitchen Sink ___L— Vacuum Breakers
Laundry Tray —1— Water Connected Appliances 7
Lavatory C. Water Heater 2
Other Fixtures /— - Water Treating System (
❑VIISCELLANEOUS i 9
❑Sewer Replacement
OBack Flow Preventer
❑Lawn Sprinkler System (number of sprinkler eads)
❑Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
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.
Owner Name: .-1:J ,2$'z f-1--- - s Phone Number:
Plumbing Company: t.4.,__- 4-1a Sys pc,„.r.y-€, Office Phone: 'lb((-7LS 9>y-7 Fax
Co. Address: 3?7 CVA-'C-F-- (^14,�-)5 1-O City: S r Ta4-►1 State: r L Zip: ?Z-Z--Y-7
License Holder: OA/ I, _ it. i( C.- StateCertification/Registration # FC-- /' ' 'O
Notarized Signature of License Holder 1,--).,' L /
I. '( C
The foregoi g in trumentvra s acknowledged before me this qday • , L.:' 20 (. , n the State of Florida,
County of ),
III
Signature of Notary Public _ 111111—gage
,off; '.Ny.., TONIGINDLESPERGER j, ] Personally Known OR [ ] Produced Identification
.: - ''4' MY COMMISSION#FF 924951
:3: ' :v Type of Identification:
fir;j� EXPIRES:October 2019 yp
%F ........... Bonded Thr:Notary Public Underwriters
Updated 10/17/18