50 Simmons Rd PLRS21-0075 7 Fixtures i: Tr PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
r -iill' PLRS21-0075
j� CITY OF ATLANTIC BEACH ISSUED: 1-007 21
, t 800 SEMINOLE ROAD EXPIRES: 10/31/2021
''t"1-Ji31� ATLANTIC BEACH. FL 32233
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:
50 SIMMONS RD PLUMBING RESIDENTIAL Plumb: 7 Fixtures $1500.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172173 0000 DONNERS R/P
COMPANY: ADDRESS: CITY: STATE: ZIP:
ROLLAND REASH 11606 COLUMBIA PARK DRIVE EAST JACKSONVILLE FL 32258
PLUMBING
OWNER: ADDRESS: CITY: STATE: ZIP:
MCGURRIN JUSTIN A 7100 WILDER AVE JACKSONVILLE FL 32208
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT If\
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 0 $0.00
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:$108.00
Issued Date:5/4/2021 1 of 2
"sem"%.,, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
3PLRS21-0075
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ISSUED: 5/4/2021
\,..,-,n v ATLANTIC BEACH, FL 32233 EXPIRES: 10/31/2021
Issued Date:5/4/2021 2 of 2
A U 1V11Dj11 t1Y £ JZJ trifid r LILA HON
CITY OF ATLANTIC BEACH
•
00 Seminole Rd Atlantic Beach,FL 32233
h(904)247-5826 Fax(904) 247-5845
Jos ADDRESS: �/11 a,ris -n; PERMIT# PL RS2 I -00-E
•
NEW OR REPLACEMENT INSTALLATION: Project Value$ -�U` c)U
TYPE OF
FIXTURE QTY TYPE OF FIXTURE QTY
•
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain SlopSink
Floor Drain Thre Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laun4 Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
RE-PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer / Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink _I Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures � G44e Water Treating System
'70i i— /
MISCELLANEOUS:
o Sewer Replac ent ❑ Bask Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans
❑ Lawn Sprinklr System-Number of Heads 0 Well **
**SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.*
0 Other
i
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 e ret
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 specifies
or not. The permit does not give authority to violate the provisi of an,other state or local law regulation construction or the performance of construction.
Property Owner,Name 4--- --5.7"-it,�O% i Cl,P f'/i✓ Phone tunberaV.5 -+/`.27
Plumbin Company O 1�, Ye0i—
g P y / /--if Office Phone .x Eo—7o 9 Fax es -+z�q/-
Co. Address: �`� � � 'AZ- :�
�__ "Atr. ,1 .v Irs,, ,
.-._ , E. City vX. State Z• ZipLicense!oider(Print): U. � , ✓n S Certification/Registration# O —7�
Notarized Sig tare of License Holder(C. f
•'',;aY°�z. MELODY L.DEMPSEY sworn and subscribed before me this1-1-N----day of (�'���L kAipk
20 I
_ •• d, MY COMMISSION#GG 259422
v _i
Signature of Notary Publi �1 ,
:: EXPIRES:September 17,2022
"'•:F Bonded ThrtI Notary Public Underwriters