108 Seminole Rd PLRS20-0047 2 Fixtures irLvf�J PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
A t') CITY OF ATLANTIC BEACH PLRS20-0047
800 SEMINOLE ROAD
ISSUED: 3/4/2020
ATLANTIC BEACH. FL 32233 EXPIRES: 8/31/2020
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:
108 SEMINOLE RD PLUMBING RESIDENTIAL PLUMBING - 2 FIXTURES $1200.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170590 0140 SALTAIR SEC 01
COMPANY: ADDRESS: CITY: STATE: ZIP:
DARLEYS PLUMBING INC. 4472 PHILLIPS HWY JACKSONVILLE FL 32207
OWNER: ADDRESS: CITY: STATE: ZIP:
RODNEY AND LINDA 1349 GOLDENROD HILLSBORO KS 67063
PETERS REVOCABLE TRUST
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 2 $14.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $73.00
Issued Date:3/4/2020 1 of 2
li,A PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
rs'. PLRS20-0047
CITY OF ATLANTIC BEACH
Vr 800 SEMINOLE ROAD ISSUED: 3/4/2020
`'';v..)~ ATLANTIC BEACH. FL 32233 EXPIRES: 8/31/2020
Issued Date: 3/4/2020 2 of 2
i - riumoing Permit Application
HIGHLIGHTED IN
4 City of Atlantic Beach Building Department GRAY IS REQUIRED.
' y 4 800 Seminole Rd, Atlantic Beach, FL 32233
L-RSZI� -0047
c,5'="! Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 108 Seminole Rd.Atlantic Bch FL.32233 PROJECT VALUE$1,200.00
MEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower
Dishwasher 1 Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink 1 Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
il C.{VIISCELLANEOUS
❑Sewer Replacement
❑Back Flow Preventer
❑Lawn Sprinkler System (number of sprinkler heads)
D3rease Interceptor(Trap) gallons (Requires 3 sets of plans)
O Well **SJRWD Well Completion Form.Completed form to be submitted to the Building Department for final inspection.**
DOther Move Kitchen Plumbing 6" -Building Permit#RES20-0047
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:Home Space — Ped-C,C`S Phone Number: (904)631-6310
Plumbing Company: Darley's Plumbing Inc Office Phone: (904)727-1484 Fax(904)727-1485
Co.Address: 4472 Phillips Hwy City: Jacksonville State: FI Zip: 32207
License Holder: Dale or Carl Darley State Certification/Registration# CFC 056702
Notarized Signature of License Holder ai.----2----- CO C--....._,Ji
The foregoing instrument was acknowledged before me this - day of r13cG4^ , 2000 in the State of Florida,
County of bL!\'a�
�Signature of Notary Public 'F_4 41''. _01!
;;QA••E*. TIFFANY SNIDER
+�- -1 Notary Public-State of Florida 4 Personally Known OR [ I Produced Identification
va A:: Commission k GG 922377
. orc My Comm.Expires Oct 13,2023 Type of Identification: tJ
9onded through National Notary Assn. Updated 10/17/18
I
l 1
+ � Cash Register Receipt Receipt Number
:,::1%,,.: .�� i
City of Atlantic Beach R11899
DESCRIPTION I ACCOUNT QTY I PAID
PermitTRAK $73.00
PLRS20-0047 Address: 108 SEMINOLE RD APN: 170590 0140 $73.00
PLUMBING $69.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 1 455-0000-322-1000 2 $14.00
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: R11899 $73.00
Date Paid: Wednesday, March 04, 2020
Paid By: DARLEYS PLUMBING INC.
Cashier: CT
Pay Method: CREDIT CARD 8
Printed: Wednesday, March 04, 2020 1:44 PM 1 of 1
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