1825 Live Oak Ln PLRS19-0202 3 Fixtures w"nk,,,. PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
'',1 _ 4 l' ', CITY OF ATLANTIC BEACH
PLRS19-0202
Villr 800 SEMINOLE ROAD ISSUED: 10/25/2019
41411P^ ATLANTIC BEACH. FL 32233
EXPIRES: 4/22/2020
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:
1825 LIVE OAK LN PLUMBING RESIDENTIAL PLUMBING -3 FIXTURES $2000.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172020 0738 SELVA MARINA UNIT
10A
COMPANY: ADDRESS: CITY: STATE: ZIP:
B &G PLUMBING,
HEATING &AIR 2232 Corparate Square Blvd JACKSONVILLE FL 32216
CONDITIONI
OWNER: ADDRESS: CITY: STATE: ZIP:
PENDLETON RONALD L 1825 LIVE OAK LN ATLANTIC BEACH FL 32233-4509
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.
FEES
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 3 $21.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
Issued Date: 10/25/2019 1 of 2
emirs PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
alk**** PLRS19-0202
CITY OF ATLANTIC BEACH
'1'
800 SEMINOLE ROAD ISSUED: 10/25/2019
'� '4ATLANTIC BEACH. FL 32233 EXPIRES: 4/22/2020
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $80.00
Issued Date: 10/25/2019 2 of 2
Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
r` City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
PERMIT it
JOB ADDRESS: i '625 L'Iv e 0a N Lh PROJECT VALUE$ 2 ✓ c'*1:- c�-,
dVEW OR REPLACEMENT INSTALLATION and/or ❑RE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower
Dishwasher Shower Pan I
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 1
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory I Water Heater
Other Fixtures Water Treating System
❑MISCELLANEOUS
❑Sewer Replacement
❑Back Flow Preventer
❑Lawn Sprinkler System (number of sprinkler heads)
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. *•
DOther
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: FCnei lei & Pc tv.Cl 61 pcncl1e -IDvt Phone Number: cicf - Soil—43V1
Plumbing Company: 4(1 PIUkoitli, LO. Office Phone: l'o4)22-3--3.85 Fax lel b-I-}223 -3isu
Co. Address: 2-2-32 Corpov,:cr-e Sc4,.Lim re. k3(ve4 City: 31Gi'cSohviy e State: FL Zip: 322-0
License Holder: G e h e L. t'o ✓e v State Certification/Registration # (I C 072 cc 3
CNotarized Signature of License Holder "C 0___)-(._
The foregoing instrument was acknowledged before me this 21 Hiday of DL ttlr t1 V , 20)1 , in the State of Florida,
County of P 14'lc' I
k�,,,, LORI S.NOROGREN SI natur of Notary Public + / /r,/' ,
i .:çu.e; NarYPubUCstMeofO(Idj [ ersonallyKnownOR [ ] Produced Identification
Type of Identification:
Updated 10/I7/18
a Al>./j
Cash Re ister Receipt Receipt Number
A g p
City of Atlantic Beach R10852
DESCRIPTION ACCOUNT QTY I PAID
PermitTRAK $80.00
PLR519-0202 Address: 1825 LIVE OAK LN APN: 172020 0738 $80.00
PLUMBING $76.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 3 $21.00
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: R10852 $80.00
Date Paid: Friday, October 25, 2019
Paid By: B & G PLUMBING, HEATING &AIR CONDITIONI
Cashier: CT
Pay Method: CREDIT CARD 037438
Printed: Friday,October 25,2019 2:27 PM 1 of 1