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1505 E. Park Ter PLRS19-0218 water treatment system permit PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER I t CITY OF ATLANTIC BEACH PLRS19-0218 v 800 SEMINOLE ROAD ISSUED: 11/25/2019 it ATLANTIC BEACH, FL 32233 EXPIRES: 5/23/2020 MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION. ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • ' CODE, ' OF ATLANTIC , CH CODE OF ORDINANCES . ALL •NDITIONS 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: PERMITTYPE: DESCRIPTION: VALUE OF WORK: 1505 E PARK TER PLUMBING RESIDENTIAL WATER TREATMENT SYSTEM $66.00 TYPE OF • • GROUP: 171951 0000 SELVA MARINA UNIT 02 CESS: CITY: STAIM.• . D• AFFORDABLE 3760 KORI RD JACKSONVILLE FL 32257 WATER/KINDER INC • ADDRESS: ANDREWS DAVID B 1505 PARK TER E 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 • . • 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 4S5-0000-322-1000 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: 11/25/2019 1 of 2 PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER r CITY OF ATLANTIC BEACH PLRS19-0218 � x 800 SEMINOLE ROAD ISSUED: 11/25/2019 ATLANTIC BEACH, FL 32233 EXPIRES: 5/23/2020 Issued Date: 11/25/2019 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 Q Q z JOB ADDRESS: ,Se�s l_f�bl= , PERMIT# 1 NEW OR REPLACEMENT INSTALLATION: Project Values 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 _ 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 ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans) ❑ Lawn Sprinkler System-Number of Heads ❑ 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��(j _ Phone Number341- g Plumbing Company A FFD R.D A S L E WAWA�"ERZ Office PhoneZ�2-Ci 9 7 Fax � � 2114 - Co. Address: 3 rl to O KO R I R c"Ci City JAC- ar'lui t�� StateFL�-- Zip &2 Z 5rl License Holder(Print): m A 6 K 0 - K 1�J D EX State Certification/Registration# ODG 618(r, Notarized Signature of License Holder - Sworn and subscribedrbetme this day of 20�ya tate ce FwWa bNaevore Signature of Notary P GG 081383 021 XFFORDABLE WATER (9 -Z6- iq MGM 911111111111 W III C101 lot 120-411118INTM Ir " 3760 Kori Road • Jacksonville, FL 32257 tT15 a��J �J 3 (904) 262-0197 Fax (904}260-6292 TA AffordableWater@AffordableWaterJax.com '��'"' NAME --J DATE ( ' ( Z lit ADDRESS_ n CITY, _ f iC N— STATE ' t ZIP > PHONE - — '1 — Water Supply City ❑ Well ❑ Install Date�'►�� I �q'Z-`� Loop ✓ 5. �� Hardness Total (lime)...:. ,.,,,,,,,,, ( g,p.g. 1,, J Iron (rust)............................... p.p.m. ra n Pipe pH....................................... Hydrogen Sulfide....................... Electric Faucet TDS... ' , r Free Chlorine ........................... 4 _Z_ P.P.M. Number of Persons in Family.......... g X 3.� j V SALT ROUTE Call First ❑ Drop Off ❑ _ � - "'^ ` f Location of Equipment r--4 4,41s- Cross Streets A L Area DESCRIPTION 'MODEL PRICE WARRANTY Labor: J ��.►�'�" _ Tanks: Y '57Valve Body: C7 `1 ren � t All Parts:` YZ'a..�r - - Sub Total ... ...... .................... Z Z. -- '' " ✓"t Sales Tax �`' 7`i 5 J SAS , (s, ; Permit/Coun r= - /Non-Taxable Total.................t,.................�.J .Down Payment .......... ... -- t. c I Balance Due.hh .....�./,,, �. .............. C�b�QO Terms �P��t U n�� !'.? ` J �f-�l 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,changes in mineral content or color of water supply,outside drainage,pump, sand,weather,or conditions beyond the seller's control. Purchaser`hall be responsible for weather protection. i Date Representative r c� "c ` Purchaser 'r RegisterCash Receipt Receipt Number City of Beach • • DESCRIPTION PermitTRAK $66.00 PLRS19-0218 Address: 1505 E PARK TER APN: 1719510000 $66.00 PLUMBING $62.00 PLUMBING BASE FEE j 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: R11146 $66.00 Date Paid: Monday, November 25, 2019 Paid By: AFFORDABLE WATER/KINDER INC Cashier: CT Pay Method: CREDIT CARD 03846C Printed: Monday, November 25, 2019 3:32 PM 1 of 1 1