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345 Ahern St Plumb 2015 . t1CITY OF ATLANTIC BEACH SJ 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 J v INSPECTION PHONE LINE 247-5814 PLUMBING PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 15-PLBG-797 Job Type: PLUMBING ONLY Description: shower pan for bath remodel Estimated Value: Issue Date: 4/7/2015 Expiration Date: 10/4/2015 PROPERTY ADDRESS: Address: 345 AHERN ST RE Number: 169726-1024 PROPERTY OWNER: Name: BTMJS LLC Address: 1635 EAGLE HARBOR PKWY SUITE 4 GENERAL CONTRACTOR INFORMATION: Name: BILL FENWICK PLUMBING Address: 11623 E COLUMBIA PARK DR QA WILLIAM K. FENWICK, JR Phone: - - FEES: State PLMG DBPR Surcharge $2.00 State PLMG DCA Surcharge $2.00 Plumbing Fixtures $7.00 Trade Permit Base Fee $55.00 Total Payments: $66.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph (904) 247-5826 Fax (904) 247-5845 .TOB ADDRESS: 3145 PERMIT# NEW OR REPLACEMENT INSTALLATION: Project Value$ 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 Vacuum Breakers Laundry 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 Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory Water Heater Other Fixtures Water Treating System MISCELLANEOUS: ❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans) ❑ Lawn Sprinkler System-Number of Heads ❑ 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. Property Owners Name L- S A. Pa m-e r Phone Number Plumbing Company Q.\\ re nw I�� 1M�tnc, Office Phone J2q-70272 Fax 7 2-4 -'aQ(,q Co. Address: 1 \ to Ca IJm 6t a Pork Or E City J fi--A State F L Zip 3zz�Fc License Holder(Print): i� 11 F c n w I State Certification/Registration# (:FC 0`100301 Notarized Signature of License Holder Before me this day of 20 Signature of Notary Public �J 's, CITY OF ATLANTIC BEACH f 800 SEMINOLE ROAD J - ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 LO)1119r RESIDENTIAL ALT/OTHER MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 15-RAAR-823 Job Type: RESIDENTIAL ALTERATION Description: durarock bath remodel Estimated Value: $1,000.00 Issue Date: 4/10/2015 Expiration Date: 10/7/2015 PROPERTY ADDRESS: Address: 345 AHERN ST RE Number: 169726-1024 PROPERTY OWNER: Name: PALMER, LISA . Address: 345 AHERN ST PERMIT INFORMATION: FEES: STATE DCA SURCHARGE $2.00 RE-INSPECTION FEE $55.00 STATE DBPR SURCHARGE $2.00 Total Payments: $59.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: DaN 4. ARMh4c 91tin 32?0 Permit Number: Legal Description Parcel # Floor Area o q. t, q, t Valuation of Work$ Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s) circle one): Commercial Residential If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A Florida Product Approval# For multiple products use product approval orm Describe in detail the type of work to be performed: 4WUbblV �hrdp- Property Owner Information: Name: k- � Address:345 n City State ELZip q2233 3 Phone — b E-Mail or Fax#(Optional) Contractor Information: CONTRACTOR EMAIL ADDRESS: Company Name: Qualifying Agent: Address: City State Zip Office Phone Job Site/Contact Number —Fax-# State Certification/Registration# Architect Name&Phone# Engineer's Name&Phone# Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void of work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six r6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical'Work,Plumbing,Signs, Weis,Pools,Furnaces,Boilers,Heaters, Tanks and Air Conditioners,eta WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I hereby certify that I have read and examined this qpplication and know the same to be true and correct. All provisions of laws and ordinances governing this type o work will be complied with whether s ect led herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal,state, or 1 cal w r gulating construction or the performance of construction. Signature of Owner Signature of Contractor PrintName k I �( , patvre-� Print Name......... ......................................................... ........................................................................................................................................ Befor / Before me this y of 20 this Day of 20 vvk.,.� —If _ YE tata of FloridaNotary uhamn FF 086990 018 Revised 01.26.10 F1r ~ r, CITY OF ATLANTIC C BEACH �Y��]1L cR / B i1J 1i1 DE tR -AFF JLlwln VI 11 1. FLORIDA STATUTES; CHAPTER 489,. FLORIDA STATUTES, PART -1 "CONSTRUCTION CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW- DISCLOSURE STATEMENT FOR SECTION 459.103(7),FLORIDA STATUTES: STATE LAV REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONIRACTORS. YOU ITAVE APPLIED FOR A PERMIT UNDER AN EXE M�°TION TO THAT LAW. TBE EXENII'TION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY.TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST tiCll'k.R VISI-TFIF Cl1NS I RUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE-OR TBU FAIVJJLY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR II IMPROVE A CON ViERCIAL BUILDING AT A COST OF$25.000.00 OR LESS. THE BUILDING N VIUSTBE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALT OR LEASE IF YOU SELL OR LEASE A BUILDING YOU I-IAVE BUILT YOURSELF WITTEN ONE YEAR AFTER TTS CONSTRUCTION IS CON�IPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEAS s_ WFUCH IS IN VIOLATION OF THIS=TVIPT-10N. YOU NIAY. N()I fIIRI AN UNLICENSf_1 PERSON AS YOUR CONTRACTOR YOUR CONSTRUCTION MUST BE DONE ACCORDING TO TELE BUILDING CODES AND ZONING REGULATIONS. I T YE] YOUR RI SI'ONSLBILI1 V TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES RE()UIIZf-D ;Y STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. It. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME: EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. I� IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER. FLORIDA STATUTE NO. 455-2208(1). AN"OCCUPA T ZONAL LICENSE" IS NOT ADEQUATE THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826) IF IN DOUBT. I V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN ' OWNER-BUILDER PERMIT. 8qJ Iva II ADDRESS PHONE NUMBER & . P se, PFIW NAME V I JVA ko/ljen��M q t l o'tS ISIGN j UP,E I DATE Before me this /O day of __ ,2�e country of Duval,State of Florida,has personal) i-, e ied herin by himself/herself and affirms that all statements and declarations are tru . jocurate- Notary Public at Large,State of ,County of T�P onslly Known roduced IdentifiC' - v I 7+ Notary public State of Flora Notary Signature: _ Shlf 8m My Commission FF 086990 o► Expires 02/14/2018 F:A3LUG/0—s,—Bui1da Aflad-a;REV 'EU: 4/j.,.-19 i