2009 Selva Madera Ct PLRS21-0162 10 Plumb Fixtures S' '''''r' PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
J4`;� , PLRS21-0162
, ,� r, CITY OF ATLANTIC BEACH
�r 800 SEMINOLE ROAD ISSUED: 11/8/2021
0'i1`''` ATLANTIC BEACH. FL 32233 EXPIRES: 5/7/2022
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: j PERMIT TYPE: } DESCRIPTION: VALUE OF WORK:
2009 SELVA MADERA CT PLUMBING RESIDENTIAL REMODEL— 10 FIXTURES $12000.00
TYPE OF ' REAL ESTATE BUILDING USE
ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: a i GROUP:
169506 1654 SELVA NORTE UNIT 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
STEWART IAN ALEXANDER 2009 SELVA MADERA CT ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT II`
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.
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 10 $70.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$129.00
Issued Date:11/8/2021 1 of 1
" PlumbingPermit Application **ALL INFORMATION
' HIGHLIGHTED IN
-3 ��
v City of Atlantic Beach Building Department GRAY IS REQUIRED.
''�" - 800 Seminole Rd, Atlantic Beach, FL 32233
.910, Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:PLRSZ( -(jl (5,
JOB ADDRESS: 24-"e 9 ce LIt'iq PC C:1 PROJECT VALUE$ (Zi COO
C NEW OR REPLACEMENT INSTALLATION and/or C]RE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub I. Septic Tank& Pit
Clothes Washer Shower Z.
Dishwasher I Shower Pan Z
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 2,
Hose Bibs Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
LI MISCELLANEOUS
Sewer Replacement
Back Flow Preventer
Lawn Sprinkler System (number of sprinkler heads)
Grease Interceptor(Trap) gallons (Requires 3 sets of plans)
Well **SIRWD 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.A
Owner Name: Y 0L fir Phone Number: '7u -117‘3- 7527
Plumbing Company: Lam " Office Phone: Fax
Co. Address: City: State: Zip:
License Holder: State Certification/Registration ti
Notarized Signature of License HolderN. 74-7
The foregoi trument s acknowledged before me this 2 lay • , 20-4 in the State of Florida,
County of 11irc
411
Signature of Notary Public L-_ illi "(-----
TONIGNi7LE5tERGER O Personally Known OR [ I Produced Identification
',. MYCOMMISSION TMGo353t7s Type of Identification: -
L.—
'
EXPIRES:October 6,2023 Updated 10/17/18
` Bonded Thrl tttar,Public Underwriters
Owner Builder Affidavit **ALL INFORMATION
,
�
'. CiHIGHLIGHTED IN
ty of Atlantic Beach Building Department GRAY IS REQUIRED.
t 800 Seminole Rd, Atlantic Beach, FL 32233
``j"=` Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT U:
I. FLORIDA STATUTES;CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES
OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED
FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER
OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A
LICENSE.
YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF.
YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY
ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS.
THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE
CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH
IS IN VIOLATION OF THIS EXEMPTION.
YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS.
IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES
REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES.
II. 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.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT
TO$5,000 PENALTY UNDER FLORIDA STATUTE NO.455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY"OR THE FLORIDA"CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON ISA LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US) IF IN DOUBT.
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.
Job Address: Zoaci cu-VP fricti2E,M CT
Owner Name: AtfK S ` I Phone Number: 770-E7E- 3-Z7
Mailing Address: 2-00‘i' 1EL-1A; /1111PC144 Cr City: f°Tl.ik1'71C- /En v4' State: rt._ Zip: ZZ3 5
Notarized Signature of Owner �1�/` __�
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The - oing instru ent was acknowledged before me this clay of C2-4,- , 20Z (in the State of Florida, County
Signature of Notary Public —0 C✓ -
[ ] Personally Known OR [ I Produced Identification
Tyapm
.+.�:e of d t ffi
TONI GINDLESPERGEP, Updated 10/ 4/]8
ti: MY COMMISSION#GG 333178
EXPIRES:October"n,2023
it •.f - Bonded Thi Notary Puthc Undef ttltars