1878 Seminole Rd PLRS20-0142 Permit PacketOWNER:ADDRESS:CITY:STATE:ZIP:
MIDDLETON CATHERINE W 1878 SEMINOLE RD ATLANTIC BEACH FL 32233-5916
COMPANY:ADDRESS:CITY:STATE:ZIP:
Lou's Plumbing 821 N US HWY 1 Ormond Beach Fl 32174
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
172020 0522 SELVA MARINA UNIT 09
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1878 SEMINOLE RD PLUMBING RESIDENTIAL PLUMBING - 7 FIXTURES $5000.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 7 $49.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $108.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
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.
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.
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.
1 of 2Issued Date: 9/29/2020
PERMIT NUMBER
PLRS20-0142
ISSUED: 9/29/2020
EXPIRES: 3/28/2021
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 9/29/2020
PERMIT NUMBER
PLRS20-0142
ISSUED: 9/29/2020
EXPIRES: 3/28/2021
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $108.00
PLRS20-0142 Address: 1878 SEMINOLE RD APN: 172020 0522 $108.00
PLUMBING $104.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 7 $49.00
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: R13483 $108.00
Printed: Tuesday, September 29, 2020 2:23 PM
Date Paid: Tuesday, September 29, 2020
Paid By: Lou's Plumbing
Pay Method: CREDIT CARD 382132584
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R13483
~+; CENTRALSQUARE
PLRS20-0142
Plumbing Permit Application
City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab .us
**ALL INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED.
PERMIT#: _______ _
JOB ADDRESS: 1878 Seminole Road , Atlantic Beach , FL 32233 PROJECT VALUE $_5_,o_o_o._oo _____ _
(Zr.Jew OR REPLACEMENT INSTALLATION and/or □RE-PIPE
TYPE OF FIXTURE
Bathtub
Clothes Washer
Dishwasher
Drinking Fountain
Floor Drain
Floor Sink
Hose Bibs
Kitchen Sink
Laundry Tray
Lavatory
Other Fi xtures
Dv!ISCELLANEOUS
□sewer Replacement
□Back Flow Preventer
1
1
2
QTY TYPE OF FIXTURE QTY
Septic Tank & Pit
Shower 1
Shower Pan 1
Slop Sink
Three Compartment Sink
Toilet 1
Urinal
Vacuum Breakers
Water Connected Appliances
Water Heater
Water Treating System
D Lawn Sprinkler System (number of sprinkler heads) __ _
[l;rease Interceptor (Trap) ___ gallons (Requires 3 sets of plans)
D 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 he r eby 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: Cathrine & Dustin Middleton Phone Number: (912) 288-0012
Plumbing Company: _L_o_u_'s_P_lu_m_b_in.....:g;c__ ________ Office Phone: (386) 672-4091 Fax. ______ _
Co. Address: 821 N US HWY 1 City: Ormond Beach State:~ Zip: _3_2_17_4 ___ _
License Holder: Louis Anthon Vi liotti e Certification/Registration# CFC1430421
Notarized Signature of License Holder -->.c?-c:,c)
The foregojn~ irstrument was acknowledged l:iefore me this ~b~ay of ----""""--'i,;:,-,<,-'---'' 20~ in the State of Florida,
County of ~(J)\ \}., ~°"-
#" ,u., _ 8RH)GETTE MAR!AUNDSAY ~a (:omlliulorltHH043132 * : ExplreS September 16, 2024
~ ff 8Qallld111N~llailll1---··~o,f'IJ
Signature of Notary Public ~ \J.~
[~sonally Known OR [ ] Produced Identification
Type of Identification: ____________________ _
Up da ted 10/17/18