Permit 1640 Sea Oats DriveCITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number 10-00000883 Date 7/14/10
Property Address 1640 SEA OATS DR
Application type description IRRIGATION/SPRINKLER
Property Zoning TO BE UPDATED
Application valuation 0
Application desc
install 45 heads
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Owner
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PATTERSON JARED
1640 SEA OATS DRIVE
ATLANTIC BEACH FL 32233
Contractor
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OWNER
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Permit --------------------------------
PLUMBING PERMIT ---------------------
Additional desc SPRINKLER SYSTEM
Permit Fee 62.00 Plan Check Fee .00
Issue Date Valuation 0
Expiration Date 1/10/11
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Fee summary
----------------- -------------
Charged
---------- ----------------------------------------
Paid Credited Due
---------- --------
-
Permit Fee Total
62.00
62.00 -- -
--------
.00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 62.00 62.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING 1'EI2MIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845
ToB AnnRESS: /~i t~ S~~ Qa ~s F~R , ,¢~ft (~CQ~L ~L, 3~..~PER1vnT #
NEW OR REPLACEMENT INSTALLATION:
TYPE of FIXTURE
QTY
Bathtub
Clothes Washer
Dishwasher
Drinking Fountain
Floor Drain
Floor Sink
Hose Bibs
Kitchen Sink
Laundry Tray
Lavatory
Other Fixtures
RE-PIPE:
TYPE ofFrxTURE
Bathtub
Clothes Washer
Dishwasher
Drinking Fountain
Floor Drain
Floor Sink
Hose Bibs
Kitchen Sink
Laundry Tray
Lavatory
Other Fixtures
MISCELLANEOUS:
QTY
Septic Tank & Pit
Shower
Shower Pan
Slop Sink
Three Compartment Sink
Toilet
Urinal
Vacuum Breakers
Water Connected Appliances
Water Heater
Water Treating System
TYPE of FrxTURE
Septic Tank & Pit
Shower
Shower Pan
Slop Sink
Three Compartment Sink
Toilet
Urinal
Vacuum Breakers
Water Connected Appliances
Water Heater
Water Treating System
QTY
OTY
^ Sewer Replacement ^ Back Flow Preventer ^ Grease Interceptor (Trap//) gallons (Requires 3 sets of plans)
Lawn Sprinkler System-Number of Heads S Well ~k%S~t~' ,-**~~~~~~"~~ r',` ~~~;u ~~~'~:`~ ~{--:.~.~~ J
** SJRWD Well Completion Form. Completed be submitted to the Bui g 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. AlI provisions of laws and ordinances governing this work will be complied with whether specified
or not. The pem~it does not give authority to violate the provisions of any other state or local Iaw regulation construction or the performance of construction.
Properly Owners Name ~.uced , _ __ ~a-~f e.~c,%>,t Phone Number ~ ~ S - ~'~~ - fed y~
Plwnbing Company ~~~~ Office Phone Fax
Co. Address:
License
l~~a~c~a r'zed
BaidedThru
~2s
subscribed
Signature of Notary
Project Value ~
TYPE OF FXXTUdZE
City
State Zip
Certif cation/Registration
t
20 ~~
~ ^^
~'~ ~,: ~~ CITY OF ATLANTIC BEACH
~~
'` OWNER /BUILDER AFFIDAVIT
:+,,.t>
1, 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 AONE - 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.
Ili. 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 IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT (247-5826) IF IN DOUBT.
V. ACKNOWLEDGEMENT; (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.
IG,~"l~ S~~- f~a-f3 ~.~ , ~~~~~~ eent;, ~. 3.2a?~' a (~ qo t -t<6~~
ADDRESS PHONE NUMBER
PRINT
NATURE ATE
n
Before me this day of -.. 20~~n the county of
Duval, State of FI rida, has pers ally appeared rin by himself /herself and affirms that
all statements and declarations r nd acc r te.
Notary Public at Large, State of ;County of
! ~`z 2
sonallyKnown li'./, ~~ / ~~ ~ T .> ~ ~~ / r, ~~Rei, ~.-+'+rm
duced Identification - ~'~" ~- .*• ~ I~{y A. I~(
~, "_.~~,, ~ ~ ~~M1SS~ N ~ aD
~f,;,; ~ ~~ R~B.~ aY2t, &34~~
Notary Signature. {'~~~~ C " ~F~ ~...~_ mNoeryp~~U~'er>v~rers
F:BLDG/Owner-Builder Affadavit; REVISED: 4/16/2009