511 Ocean Blvd PLRS20-0001 Install 4 Fixtures PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS20-0001
�V / 800 SEMINOLE ROAD ISSUED: 1/6/2020
ATLANTIC BEACH, FL 32233 EXPIRES: 7/4/2020
MIST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM .C)' NEXT DAY INS' CTION.
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:
INSTALL 4 FIXTURES
511 OCEAN BLVD PLUMBING RESIDENTIAL BATHROOM REMODEL AND $2800.00
WINDOWS
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170143 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
STYLES SMITH PLUMBING 1537 PENMAN RD SUITE A JACKSONVILLE FL 32250
BEACH
OWNER: ADDRESS: CITY: STATE: ZIP:
GRISWOLD SCOTT J 511 OCEAN BLVD ATLANTIC BEACH FL 32233-5339
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 4 $28.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
Issued Date: 1/6/2020 1 of 2
CPERMs';''''`'`%' PLUMBING RESIDENTIAL PERMIT
IT NUMBER
PLRS20-0001
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ISSUED: 1/6/2020
��D.roy V ATLANTIC BEACH, FL 32233 EXPIRES: 7/4/2020
[ TOTAL:$87.00
Issued Date: 1/6/2020 2 of 2
0
Plumbing Permit Application **ALL INFORMATION
Plumbing �� HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 PLQ 1,ED._ 000 ` _
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: R E S I I " O 3-
5
JOB ADDRESS: // OGe04 i�I V U PROJECT VALUE 2- (:6/• 00
ANEW OR REPLACEMENT INSTALLATION and/or EIRE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit ,
Clothes Washer Shower 'L
Dishwasher Shower Pan .-
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.**
❑ Other of,-();A A l f.5(At h rav-M / Re I o(+e-d I) tn/V a,,,d wA4ef ‘ ,/(2/7/y
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: G ft StiJOI d / 5G0 + T Phone Number:
j7 c, �
Plumbing Company: 5+-y1 e S Sm i F i✓Mhf,Lt office Phone: ;7 U1 - 1113/t Fax --
Co. Address: 1537 ; e/i sw rd City: .14 ),,ec,cA State: FL. zip: 32, SO
License Holder: Sii/e C> 9/v1 r 117 State Certification/Registration # GCC.- I Y 060,2
Notarized Signature of License Holder _X-- -
The foregoing instrument was acknowledged before me this day of l&f\t&C - , 20 aOin the State of Florida,
County of .)IA-4 r'l.l
Signature of Notary Public , .......__ �
JENNIFER JOHNSTON [ ] Personally Known OR [ od,e•dentification
MY COMMISSION#GGO84 Type of Identification: �L . ( ,�Jy�S \c(,Q4.5 k
,,.,.1"..„,11 .o EXPIRES:October 2i,2 2020
'.,E'F;o?, Bonded Thru Notary Public Underwriters Updated 10/17/18