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-'