2299 N Fairway Villas Ln PLRS19-0210 Sewer Replacement '\''l PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
r S'�' "� PLRS19-0210
CITY OF ATLANTIC BEACH
ISSUED:SEMINOLE ROAD 11/6/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 5/4/2020
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: I PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
2299 N FAIRWAY VILLAS LN PLUMBING RESIDENTIAL SEWER REPLACEMENT $2100.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169398 1100 FAIRWAY VILLAS
COMPANY: ADDRESS: CITY: STATE: ZIP:
DAVID GRAY PLUMBING 6491 POWERS AVENUE JACKSONVILLE FL 32217
INC.
OWNER: ADDRESS: CITY: STATE: ZIP:
HERNANDEZ TOMAS R 2299 N FAIRWAY VILLAS LN 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.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
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: 11/6/2019 1 of 2
s
%'0,AJ'fe. PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER 1
.61
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CITY OF ATLANTIC BEACH PLRS19-0210
1)1111":
800 SEMINOLE ROAD ISSUED: 11/6/2019
`'i31� ATLANTIC BEACH. FL 32233 EXPIRES: 5/4/2020
Issued Date: 11/6/2019 2 of 2
- ,'IUmt,lirig Permit Application "*AL1.mIF011IWIaTa:o
e .,y 1-11(iHLIGH1E) IN
City of Atlantic Beach Building Department GRAY IS REQLIREG.
(--..?I,
M, grE ):
a : .300 Seminole Rd, Atlantic Beach, FL 32233 (fir;,—Rl9_UZ
'`''' ' `
' Phone: (904) 247-5826 Email: Building-Dept .«@coab.us PERMIT#:._ __ _____._... . . _
JOB ADDRESS: 22.1:9 Fairway Villas Ln N PROJECT VALUE $2,100.00
✓?Iji:w OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit _________
Clothes Washer Shower _____
Dishwasher Shower Pan _
Drinking Fountain Slop Sink _______
Floor Dain Three Compartment Sink _______
Floor S nk _ Toilet ______
Hose Bibs Urinal ____
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances__._.
Lavatory Water Heater __._
Other Fixtures _ Water Treating System ______
dlli ISCELLANEOUS
;hewer Replacement
[]Back Flow Preventer
El Lawn Sprirkler System (number of sprinkler heads)
[urease Interceptor (Trap) gallons (Requires 3 sets of plans)
; ]Well **SJRWD Weil completion Form. Completed form to be submitted to the Building Department for final inspectior. **
_]Other
11111111111111 - IiiY1s11101lin!Illiii I ill
Perrr ir. becomes void if work does not commence within a six month period or work is suspended or abandoned for s x 11 r'ii. .
I heroby certify that I have read this application and know the same to be true and correct. All provisions of laws and ord ii:rices
governing this work will bE complied with whether specified or not. The permit does not give au-:hority to violate the provisions
of any other state or local aw regulation construction or the performance of construction.
Owner NamE:Thomas Herlandez Phone Number: (30f:$)7ä3-0751) -_-�
Plurr bing Co span i: David Gray Plumbing Office Phone: (904) 724-7211 =ax(904)724-5925
Co. Address: 6491 ower3 Av<cnue City: Jacksonville State: -Lzip; 32217
License Holder: ?t 1f rC FcJO?2;;r3ic
, 1G.—TEA State Certification/Registration It _ ___.____.__
iiyi
Notarized Signature of License Holder (A;A-d - ��
The foregoing instrument was acknowledged before me this (Y day of ht [hi,1:10✓, :?O Li, in the Sta+.e of Florida,
County of_i__
);41(11/V-4/1.A. ,
Signature of Notary Public 4
go+�* Notary Public State of Florida
nman Rivera ersonall Known OR Produced Identificaticn
y
M
r_ My Commission GG 242920 y
0a*dy Expires 07/30/2022 Type of Identification:
Updated 10/17/18