465 Inland Way PLRS21-0002 Permit PacketOWNER:ADDRESS:CITY:STATE:ZIP:
NEWBERN AMY T 465 INLAND WAY ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
KELLEY'S PLUMBING
CONTRACTING 3866 VALENCIA RD JACKSONVILLE FL 32205
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
169463 1537 OCEANWALK UNIT 04
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
465 INLAND WAY PLUMBING RESIDENTIAL PLUMBING - 8 FIXTURES $16000.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 8 $56.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $115.00
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: 1/5/2021
PERMIT NUMBER
PLRS21-0002
ISSUED: 1/5/2021
EXPIRES: 7/4/2021
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 1/5/2021
PERMIT NUMBER
PLRS21-0002
ISSUED: 1/5/2021
EXPIRES: 7/4/2021
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $115.00
PLRS21-0002 Address: 465 INLAND WAY APN: 169463 1537 $115.00
PLUMBING $111.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 8 $56.00
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: R14502 $115.00
Printed: Tuesday, January 5, 2021 2:58 PM
Date Paid: Tuesday, January 05, 2021
Paid By: KELLEY'S PLUMBING CONTRACTING
Pay Method: CREDIT CARD 410803330
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R14502
t!..AlvI,, Plumbing Permit Application ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 LEZ( -000 Z.
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: /q'--exY>3
JOB ADDRESS: ' krAl PROJECT VALUE $ /`
Y l
Aro "L-
NEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE5e1,41Y- QTY
Bathtub Se.p+e-Tarrk-&Pit/..?rr- r
Clothes Washer Shower 77a MC, 1
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs 1 Urinal
Kitchen Sink L_— Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater t
Other Fixtures Water Treating System
111 MISCELLANEOUS j 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
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: ()L ir.) jitt7431 " Phone Number:
Plumbing Company: ICelf/6'A -Tko- L c v,)(9N,Office Phone: qi,y-3 2'V7OS"' Fax
Co. Address: 36 69(.a vA- 'nI )' - 'T City: State: F— Zip: ' - ,ac—
License Holder: Mtc L: 1/A,/ !bake, State Certification/Registration # (Zt'1(P l0?ccj
Notarized Si•nature of License Holder /7 ...(--X,--
The fore:sing in rument .s acknowledged before me this 7` d i\ , 20 - , in the State of Florida,
County of Ilk
TONIINDLESP-ature of Notary Pub 'v
tRGER
MY COMMISSION#GG 353118
J':
11
EXPIRES:October 6,
23052331
023 [ Personally Known OR [ ] Produced Identificatio
riled Thru NotaryPublic Underwrite T pe of Identification:
Updated 10/17/18
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