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Permit Bath Remodel 1473 Linkside 2012 CITY OF ATLANTIC BEACH ;, 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 J ; `,, ' INSPECTION PHONE LINE 247 -5814 Application Number 12- 00000030 Date 1/09/12 Property Address 1473 LINKSIDE DR Application type description RESIDENTIAL OTHER Property Zoning TO BE UPDATED Application valuation . . . 2300 Application desc BATHROOM REMODEL Owner Contractor WOODARD, DANNY OWNER ATLANTIC BEACH FL 32233 Permit RESIDENTIAL ALT /OTHER Additional desc . REMODEL BATH Permit Fee 65.00 Plan Check Fee . . .00 Issue Date . . . . Valuation . . . . 2300 Expiration Date . . 7/07/12 Other Fees STATE DCA SURCHARGE 2.00 STATE DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 65.00 65.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 69.00 69.00 .00 .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: 1-i 7 3 L .4 tes:c�t .1)4; tic f p -rt .rf,c C 4c4 F Permit Number: 17 - 30 Legal Description Parcel # • Floor Area of Sq.Ft. Sq.Ft Valuation of Work $ 43 S - 1) c Proposed Work heated /cooled non - heated /cooled Class of Work (circle one): New Addition Alteration CR 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 : o N /A Florida Product Approval # For multiple products use product approval form Describe in detail the type of work to be performed: PF r L c e cilia; e-z l 4;1e r) s ti .2 z {vc a c k . Uctl ve c.1Ne -1-a Lek& ; .4 . Property Owner Information: Name: 04 0d6v4Av..0 Address: 1u7 l !' liv City p9uph. +x 6.4 dell Statefl Zip 3123: Phone ,)-t/'7 q 6S" E -Mail or Fax # (Optional) ()hoc dirt i e e -I k,i'l is el e Contractor Information: Company Name: L :4[Lz s Qualifying Agent: Address: 44&2111P City ct State v 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 1 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 work sc a amenced. 1 commenced stand that separate permits or must be secured for Electrical Work, Plumbing, Si g s, a Wells, Po time Tanks and Air Conditioners, etc. 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 O OB � T �CORD RECORDING YOUR NOTICE F WITH YOUR LENDER OR AN ATTORNEY MMENCEMENT. I hereby certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified 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 local law regulating construction or the performance of construction. Owner Al • LJ � Signature of Contractor Signature of O Pit-- Print Name z 4 w` • t.30 e. id) Print Name Swornd subscril before me Sworn to and subscribed before me t ' !Day of Ssrsh r/i 21 72— this Day of , 20 At � ` _ , Y � , . w Notary Public otary Public :,tip M�CO adE W � Y 21,� e ry • • p public �*0 „, `_ TbN Moian Revised 01.26.10 W 3s3 L- " - --- O ::.. . -- . CITY OF ATLANTIC BEACH ®WNER / BUILDER AFFIDAVIT I. FLORIDA STATUTES; CHAPTER 489, TO ACKNOWLEDGE THE LAW: 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER / BUILDER DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE ALLOWS OD, AS THE OWNER OF YOUR PROPERTY TOOACT THAT LAW. THE EXEMPTION A AS L YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOBS — 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. f ,..13.,M .I.-31 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 RE n Ry O HT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE R LO UNI IP C Le LICEN E RESUIRED BY STATE LAW AND B . 1 ORDINANCES. T INJURY L NG u DEPARTMENT SUGGESTS WORKER'S INJURIES WORKERS COMPENSATION INSURANCE BE THE BUILD( PURCHASED. . IRS WITHHOLDING; OWNERS HIRING 1099 REQUIREMEN T WORKERS YERS AND SHOULD ALSO O TS ON THE E WORKERS THEY OBSERVE IRS WITHHOLDING TAX A ND /OR FORM 099 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 DEPARTMENT TA I IF IFPE ERSON IS DOUBT. A LICENSED CONTRACTOR. TELEPHONE THE BUIL DING S AT MENT AND I ( COMPLY WITH ALL THEER THAT I HAVE READ THE REQUIREMENTS FOR T EB DISCLOSURE ISSUANCE OF STATE OWNER- BUILDER PERMIT. 1113 LiKlt s Pi. )LPrI- 1 965~ PHONE NUMBER ADDRESS 04 IA) V iA. (5 0Nn • PRINT N• Y / /// A / .r - a) 0 , DATE IGNATU' / • , 20Z the county of D uval, me e this da p �� appeared erin by himself / herself and affirms that Duval, State o Florida, has Ily all statements and declarations true and accurate. Notary Public at Large, State of , County of + ' DEBORAH AMANDA WHITE As MY COMMISSION # EE 057349 ❑ Personally Known W 3 G '3 l7 3 � 3 C�7 O -� 1 ; s EXPIRES: May 21, 2015 ._,/ 2 • Bonded Thru Notary Public Underwriters I�1Produced Identification - 4 r _ j " Notary Signatu /1, PBLDG /Owner Affadavit; REVISED: 4/16/2009 ''S to l r`/ le 4 CITY OF ATLANTIC BEACH z 800 SEMINOLE ROAD z � NT BEACH, FL 3223 ,, INSPECTION ATLA PHONE IC LINE 247 -581 3 4 ._____,," Application Number 12- 00000028 Date 1/09/12 Property Address 1473 LINKSIDE DR Application type description PLUMBING ONLY Property Zoning TO BE UPDATED Application valuation . . . 1900 Application desc convert tub to shower Owner Contractor WOODARD, DANNY LARRY TEAGUE & SONS 203 OCEANFRONT ATLANTIC BEACH FL 32233 NEPTUNE BEACH FL 32266 (904) 270 -2289 Permit PLUMBING PERMIT Additional desc . CONVERT TUB TO SHOWER .00 Permit Fee . . . 62.00 Plan Check Fee . Issue Date . . . Valuation . . . • 0 Expiration Date . 7/07/12 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: 1 1 41 5 Li n1 I (IL,/ 1 i V 322.33 PERMIT # NEW OR REPLACEMENT INSTALLATION: Project Value $ / 4 D TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY Bathtub Septic Tank & Pit Clothes Washer Shower Dishwasher Shower Pan i 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. Property Owners All provisions of laws and ordinances governing this work will be complied with whether specified or not. The permit does not give thority to violate the rovisio s of an other state or local law regulation construction or the performance construction. e rs Name J {1115e.... 0 Q i Phone Number q v'T , 41 (4 . Plumbing Company La r w T U - ) voi l f • 1 0 ce Phone t 2 '� e l `• • d Fax 91 Q �0�� Co. Address: glii 2- () . City k t $'id tate Zip 322-V° License Holder (Print): A KI IO L•D 0 • W N TC_____ State Certification/Registration # ecCo S2,9 Notarized Signature of License Holder ` ` Sworn and subscribed before me this �_ day of ,litt•ty • 20 (2. ' . 4siti , Zaintnift950 Wd . Signature of Notary Public X.— . 21(\4146-'