Permit Plbg City Water 635 Jasmine 2011 rl
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, . ` J rf CITY OF ATLANTIC BEACH
s ) 800 SEMINOLE ROAD
` ) s 3 "' ATLANTIC BEACH, FL 32233
`s INSPECTION PHONE LINE 247 -5814
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Application Number 11- 00002644 Date 9/19/11
Property Address 635 JASMINE ST
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
CONNECT TO CITY WATER
Owner Contractor
HARDING MITCHELL OWNER
635 JASMINE STREET
ATLANTIC BEACH FL 32233
Permit PLUMBING PERMIT
Additional desc . CONNECT TO CITY WATER
Permit Fee . . . 62.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 3/17/12
Other Fees STATE PLBG DCA SURCHARGE 2.00
STATE PLBG DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 62.00 62.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 66.00 66.00 .00 .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
JOB ADDRESS: ( g, 3 t , yk e- . r -€e-/ PERMIT # //-2 7=2
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 //,/
Hos Urinal (vv U�
Kitc Vacuum Breakers
Lau Water Connected Appliances
Lai I Water Heater
Otf '. Water Treating System
RE -PIPE:
LU I:Cr.-- --11'
n /
A TYPE OF FIXTURE QTY
Be / �- Septic Tank & Pit
Cl . Shower
D Shower Pan
D Slop Sink
F' Three Compartment Sink
F Toilet
F ( ,, ,t/1. �- '''� Urinal
E ` 1 Lit Vacuum Breakers
I V Water Connected Appliances
I # Water Heater
Other r txturvz 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. **
0/her /rJ C - j l q VC- - 7 - 6 (o, Ai 1..) rtA f-� - 0S - -0 11.16G-)\ 1 r r- -I4-U D
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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 P I -4 c– i i ( i ' L 4-/cLi Phone Number i 3s"g- 60 &2
Plumbing Company Office Phone Fax
off f sio City State Zip
Pr ;.-- - : • rm . _ .! /�� State Certification/Registration #
err r i
Notariz %- _fS ., u ,' . g , fi, wawa& d r
4 7 ,& ' .'s MY COMMISSION # EE 057345 1 t
1i EXPIRES: May 2 i 2015 rn and subscribed befor t is d o f ��
Signature of Notary Publi •
' �• Bonded Thni Notary Pubic Undf nvn! 2 0
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Fax (904) 247 -5845 City of Atlantic Beach APPLICATION NUMBER
J Buildin Department
1111( (To be assigned by the Building Department.)
r 8 00 hone Semino(904) le 247 -5826 Road t
Atlantic Beach, Florida 32233 -5445 ( .::::?),,,,/
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•
' x �r E -mail: building- dept @coab.us Date routed: '� !� '
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City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM ' tr
Property Address: / j i k 6 Y Department review required Yes No
c Building
Applicant: ( �''u s '` -- `- ( Planning & Zoning
;` Tree Administrator
Project: 6 6
- . \---}--,_,,,,,
.
. ' ' /' (. ,, 'i' C L ,. Public V,ylarks. -_.,.,
.-- Public Utilities ,2 �-
CR j ..
-- Public- Safety
Fire Services
Review fee;$ Dept :Sid fure ,
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: ['Approved. ['Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by: Date:
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ['Denied.
Comments: I
Reviewed by: Date:
Revised 05/14/09
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\SS CITY OF ATLANTIC BEACH
PUBLIC UTILITIES
1200 Sandpiper Lane
ATLANTIC BEACH, FL 32233
(904) 270-2535 or (904) 247-5874
NEW WATER/SEWER TAP REQUEST
Date: 3 Project Address:
1 1
No. of Units: / Commercial Residential k Multi-Family
New Water Tap(s) & Meter(s) Meter Size(s)
New Irrigation Meter Upgrade Existing Meter from to (size)
New Connection to City Sewer
Name:
Applicant Address: l;
City : I 4C-74 t. 4 State: (I/ , Zip: 3 t-2,
Phone Number: ( V Cell Number: 1/4-/ -/
Email Address t, 1 )(-) . 2 7 t:.' 0 fax:
/6 - --
Signature:
/
f
(Applicant)
CITY STAFF USE ONLY
Application#
Water System Development Charge $
Sewer System Development Charge $
Water Meter Only
Water Meter Tap
Sewer Tap
Cross Connection
Other
TOTAL
(notes)
APPROVED:
(Utility Director or Authorized Signature)
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CAN BE ASSESSED
CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
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 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 WITIBN 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.
11. INJURY UABIUTY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
111. 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; 1 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.
K 3 Sr J �. m e Sf.ree L 9 v
ADDRESS / az,�33 HONE NUMBER
( �� ( ( tg '
PRI T NAME ,
ir-
DATE
Before me is / of di 201 1 in the county of
Duval, State of orida, has personally'T herin by himself / herself and affirms that
all statements and declarations are 7 ,: nd accurate. � �
7�,. I)J $0 z DEBORAH AMANDA WHITE
Notary Public at Large, State of , County of r /r j � " " , .* MY COMMISSION # EE 057348
/ -^� EXPIRES: May 21, 2015
❑ P ovally Known I.L / ' /� 6 . ' Bonded Thru Notary Publ Underwriters
roduced Identification - r - ( l 74
1
Notary Signatu :.
F:BLDG /Owner - Builder Affadavit REVISED: 4/16/2009
Gmail - Water fees https: / /mail.google .com /mail / ?ui= 2 &ik= 13ad093413 &view= pt&search...
f Mitchell Harding <bicpd3527 mail.com>
Water fees
2 messages
Kaluzniak, Donna <dkaluzniak @coab.us> Thu, Sep 8, 2011 at 9:54 AM
To: "bicpd3527 @gmail.com" <bicpd3527 @gmail.com>
Hello Mitchell,
Here are the fees for connecting to water on Jasmine St. Feel free to call or email with any questions. Thanks,
Donna
System Development Charge (impact fee) - $1,140
Meter connection charge $ 185 ;f �4
Cross - Connection inspection fee $ 50
Total:
Donna Kaluzniak
Utility Director
City of Atlantic Beach
902 Assisi Lane
Atlantic Beach, FL 32233
PH: 904- 270 -2535
FAX: 904 - 242 -3475
dkaluzniak@coab.us
Please note: Florida has a very broad public records law. Most written communications to or from city officials
regarding city business are public records available to the public and media upon request. Your e-mail
communications may be subject to public disclosure.
Kaluzniak, Donna <dkaluzniak @coab.us> Thu, Sep 8, 2011 at 10:09 AM
To: "bicpd3527 @gmail.com" <bicpd3527 @gmail.com>
Mitchell — sorry total is $1375 - Donna
From: Kaluzniak, Donna
1 oft
9/19/2011 8:42 AM