1240 Seminole Rd PLRS20-0028 34 Fixtures �s> PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
r � , CITY OF ATLANTIC BEACH PLRS20-0028
-5?' ISSUED: 2/13/2020
800 SEMINOLE ROAD
15' ATLANTIC BEACH. FL 32233 EXPIRES: 8/11/2020
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:
1240 SEMINOLE RD PLUMBING RESIDENTIAL PLUMBING - 34 FIXTURES $21000.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171937 0005 SELVA MARINA UNIT 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
HALL AND SONS 837 ORANGEWOOD RD ST.JOHNS FL 32259
PLUMBING INC
OWNER: ADDRESS: CITY: STATE: ZIP:
NEIDHOLD SCOTT T 1627 BRICKELL AVE #2804 MIAMI FL 33129
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 21 $147.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.03
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.02
TOTAL:$207.05
Issued Date: 2/13/2020 1 of 2
PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS20-0028
z:
800 SEMINOLE ROAD ISSUED: 2/13/2020
ATLANTIC BEACH, FL 32233 EXPIRES: 8/11/2020
Issued Date: 2/13/2020 2 of 2
PlumbingPermit Apnpnlication **ALL INFORMATION
/;fr-----' , MM HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 Pt_RSZ_ 0028
Phone: (904) 247-5826 Email: Building-Dept@coah.us PERMIT#:
JOB ADDRESS: 1240 Seminole Rd House PROJECT VALUE $ L 1, a c7
ENEW OR REPLACEMENT INSTALLATION and/or EIRE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub L Septic Tank & Pit
Clothes Washer 2. Shower
Dishwasher Z Shower Pan i
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet '`
Hose Bibs 5 Urinal
Kitchen Sink 2- Vacuum Breakers
Laundry Tray _2 Water Connected Appliances
Lavatory 6 Water Heater
Other Fixtures f ,
Water Treating System i
❑MISCELLANEOUS 3"�
�
❑Sewer Replacement y
❑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
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:Riverside Homes Phone Number:
Plumbing Company: Hall and Sons Plumbing Inc Office Phone: (904)429-9747 Fax
Co. Address: 837 Orangewood Rd City: St John State: FL Zip: 32259
License Holder: Gary W Hall II State Certification/Registration # CFC1425980
Notarized Signature of License Holder lj\_\ -:-----1- -
The foregoi strument as acknowledged before me this [3 day 2070n the State of Florida,
County of l i v�`\
Signature of Notary Public --�' , <_ b-----
Tom GINDLES Personally Known OR [ ] Produced Identification
''.":,6','A:0‘. EBondedXPR STN 00�t78 r pe of Identification:
"1 11 No.
pU ? items Updated 10/17/18