Permit Remodel Hall Bath 1927 Beachside Ct 2012 t CITY OF ATLANTIC BEACH
t) 800 SEMINOLE ROAD
�� yx, ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000271
Property Address Date 3/26/12
1861 BEACHSIDE CT
Application type description RESIDENTIAL OTHER
Property Zoning TO BE UPDATED
Application valuation . . . 10000
Application desc
REMODEL HALL BATHROOM
Owner Contractor
WHITTINGTON WILLIAM R & NANCY OWNER
1861 BEACHSIDE CT
ATLANTIC BEACH FL 32233
- -- Structure Information 000 000 REMODEL HALL BATHROOM
Occupancy Type RESIDENTIAL
Permit ELECTRICAL PERMIT
Additional desc .
Sub Contractor . ISLAND ELECTRIC OF THE FIRST C
Permit Fee . . . 60.40 Plan Check Fee .00
Issue Date Valuation 0
Expiration Date . . 9/22/12
Other Fees STATE ELEC DCA SURCHARGE 2.00
STATE ELEC DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 60.40 60.40 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 64.40 64.40 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph (904) 247 -5826 Fax (904) 247 -5845
JOB ADDRESS: (& ) RA WI SI A E (.-r. PERMIT # / ` -00000 . - 2- 1 %
JEA INFORMATION REQUIRED ON ALL PERMITS '2i7 v AMPS 170
/ VOLTS / PHASE
VALUE OF WORK $ • g 0o . 4as'
NEW SERVICE ❑ Overhead n Underground nT Underground up Pole
❑Residential (Main) Service
110 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps # of Meters
❑ Commercial (Main) Service
❑0 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps ❑CT Service amps
Conductor Type Size
❑Multi- Family (Main) Service
00 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps # of Unit Meters
ETemporary Pole ❑ amps
SERVICE UPGRADE ❑ amps ❑ CT Service amps
NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.)
❑ 100 amps ❑ 150amps 0200amps ❑ amps E] CT Service amps
ADDITIONS, REMODELS REPAIRS, BUILD -OUTS, ACCESSORY STRUCTURES, ETC.
Outlets /Switches: /19 0- 30amps 31- 100amps 101- 200amps
Appliances: 0- 30amps 31- 100amps 101- 200amps
A/C Circuits: 0- 60amps 61- 100amps
Heat Circuits: # circuits @ k
Number of Lighting Outlets, Including Fixtures: 1'
OTHER ELECTRICAL PROJECTS
❑ Swimming Pool ❑ Sign ❑ Smoke Detectors Qty LI Transformers KVA ❑Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans & Fire Alarm Checklist)
Qty volts /amps VALUE OF WORK $
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can ❑ Safety Inspection 11 Panel Change ❑OH to UG
❑ Other: 8A Am et :l M o t(—
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 /► 4- Pi 15 , W) A L) u t✓ TON) Phone Number
Electrical Company 15 t A N E (....,E CT 2t G Office Phone 2 '(6' TO 3'S Fax z cI (' 341 i
Co. Address: L Z ff 5Th A') ■O - , JA)(. eal , City J . 8. State FL4 Zip 32257
License Holder (Print): ,,, kW N S J N a • gr State Certification/Registration # ISO I3'( 3A
Notarized Sign ,. - .___._� .____...-- ..._.__ _ .A. •.a,
.0 ... SHIRLEY L GRAN ' ' �
. :; MV COMMISSIO Q {�ss n subscribed be ere me this ' , day o A/ a '� C `? 20/2 -
sa . EXPIRES: Feb 4 1 ,
ov F °° Bonded Notary Thru tary Public derwriters
- - Underwriters
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_ _ _ _ __ _ _._ .__.:-. f Notary Publ.,, .._
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CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J . , .... ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
- OE 5
Application Number 12- 00000271 Date 3/12/12
Property Address 1861 BEACHSIDE CT
Application type description RESIDENTIAL OTHER
Property Zoning TO BE UPDATED
Application valuation . . . 10000
Application desc
REMODEL HALL BATHROOM
Owner Contractor
WHITTINGTON WILLIAM R & NANCY OWNER
1861 BEACHSIDE CT
ATLANTIC BEACH FL 32233
- -- Structure Information 000 000 REMODEL HALL BATHROOM
Occupancy Type RESIDENTIAL
Permit RESIDENTIAL ALT /OTHER
Additional desc . REMODEL HALL BATHROOM
Permit Fee . . . 100.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 10000
Expiration Date . 9/08/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 100.00 100.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 104.00 104.00 .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: /7 / -5c4MS/ be cotter "id L 32233 Permit Number: y�2�
Legal Description 12'/4 Oq "ZS"2/IE. I3 Parcel #
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ S'' /t k Proposed Work heated /cooled non- heated /cooled
Class of Work (circle one): New Addition Alteration Repair 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): Yes No N /A
Florida Product Approval #
For multiple products use product approval form �'
Describe in detail the type of work to be performed: - 'fie 514 °j - and c /.4Ce i k/ iE--eS
Property Owner Information:
lv7 let - ' ' (, / T
Name: i �e�Nt f "Y�lu/ A. �l/h �t i�M Address: ��Cffs /AEC
City A/p v Stated Zip 322;33 Phone (qH) 24
E -Mail or Fax # (Optional) RUT 1 7M/O. C6Y.r! 1 ray = 104- 331 - 1,379'
Contractor Information:
Company Name: Qualifying Agent:
Address: 1 City State Zip
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 I 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 pernzit becomes null
and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a period of six f6) months at any time after
work is conznzenced. I understand that separate permits must be secured for Electrical IFork, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters,
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 OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby certify that 1 have read and examined this and know the sane 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 - • eral. state, or local law regulating construction or the performance of construction.
Signature of 0 Signature of Contractor
Print Name Wil'I/i Cy l df f? /J€7 7V Print Name
Swor t. . subscr Sworn to and subscribed before me
thi Day of 20 / this Day of / , 20
./
Notary Public
DEBORAH AM Notary Public
=+A MV COMMISSION # EE 057349
E XPIRES: May 21, 2015
Eia�ded Notary Public Underwriters Revised 01.26.10
� Z4 1 ,c. w 3.1'x. O9is-2)
CITY OF ATLANTIC BEACH
®W NER / BUILDER AFFIDAVIT
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 REOUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
I1. 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 IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT (247 -5826) 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.
44/ BE,4cHS/hE CDWQT 1 46 R..32233 90 Z4z -D /TO
ADDRESS , PHONE NUMBER
441777. j -2,u
L V/ a//.2---
IGNATU - / DATE
Before me this / day of / , 20 in the county of
Duval, State of Florida, has personally appeared herin by himself / herself and affirms that
all statements and declarations Waccurate.
Notary Public at Large, State of , County of d f*: gtMCt; DE BORAH
❑ Personally Known ( f Z /� 22 '��� ft4YCQMM « bN EE
��� chi l Jo� L7 J 7 •� w - -0 t he EXPIRES: INe '0'7349
�.P� ca on- dedThrU 21 , 2015
, Pu ndenvritem
Notary Signature:
F:/BLDG /Owner- Builder Affadavit REVISED: 4/16/2009
NOTICE OF COMMENCEMENT
State of r�I I )s,4 Tax Folio No.
County of /)(.f VAL
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of
the Florida Statutes, the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: 42-14 O'9 - 2 S 2 E .13 B £ 4i -f1 s i)N E
Address of property being improved: /26 / /3 E;4C is /At CvU R'r; ,41 It 66 461 FL ,3233
General description of improvements: . 7% Ye S6 /ii4-- A4 A' r/,a4ee 4 -tee
rj Owner: G(/i7 /ie e Aielklel A. WhagAgfityi c Address: / f eEi9�S/bc CT; kiILLt.g1G A FL 322 ?3
wner's interest in site of the improvement: Fe St* >LE
Fee Simple Titleholder (if other than owner):
Name:
Contractor: (0 /e/i/c,Q li !/ILLh4nt e. f ,4Ak( A. Will rri Ai 47
Address: /,%( & P ! W S , , b e co U Q7" ' T G 5NTi c t%4 tf FL 22 3..
/ 1 3
Telephone No.: (704) 24Z- 0/76 Fax No: (9'4) 33T- g37q
Surety (if any)
Address: A...na,..t o f Rnnd t
Doc # 2012052938, OR BK 15876 Page 448,
Telephone No: Fax No: Number Pages: 1
Name and address of any person making a loan for the construction of the im Recorded 03/12/2012 at 11:31 AM,
JIM FULLER CLERK CIRCUIT COURT DUVAL
Name: COUNTY
RECORDING $10.00
Address:
Phone No: Fax No:
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other documents may be
served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b), Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement (the expiration date is one (1) year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER 1) Ati:,-- R. Lvi
() l+/L �
Signed: ' Date: 12 m. 2012-
Before me t 1't'* � day of /Vla. rc � in the County of Duval, State
Of Florida, has personally appeared rte,/: /I; o,,,,a £ i J I , : f F 7,43 t o ,n
r . Notary Publk Stab of Florida N otary Pu blic at Large, Stat o Flor County of Duval. �1
D a v i d Willett My commission expires: 3 H! 2 016
+J My Commission EE 175885 Personally Known: or
or Expires 03/04/2016
Produced Identification: D r", v e r s 1.. ce nsp Par S tw.te. o f. rio ri lcL,
!i
\(s v 1 CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
j ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
tOF3 S}V
Application Number 12- 00000271 Date 3/14/12
Property Address 1861 BEACHSIDE CT
Application type description RESIDENTIAL OTHER
Property Zoning TO BE UPDATED
Application valuation . . . 10000
Application desc
REMODEL HALL BATHROOM
Owner Contractor
WHITTINGTON WILLIAM R & NANCY OWNER
1861 BEACHSIDE CT
ATLANTIC BEACH FL 32233
- -- Structure Information 000 000 REMODEL HALL BATHROOM
Occupancy Type RESIDENTIAL
Permit PLUMBING PERMIT
Additional desc . RELOCATE AND REPIPE
Sub Contractor . TDG PLUMBING
Permit Fee . . . 153.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 9/10/12
Other Fees STATE PLBG DCA SURCHARGE 2.30
STATE PLBG DBPR SURCHARGE 2.30
Fee summary Charged Paid Credited Due
Permit Fee Total 153.00 153.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.60 4.60 .00 .00
Grand Total 157.60 157.60 .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: « to k ile eicl s; de err PERMIT # Z___
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
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 2 Septic Tank & Pit
Clothes Washer _ Shower
Dishwasher 1 Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 2 1
Hose Bibs _� Urinal \
Kitchen Sink 1 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 fmal inspection. **
❑ Other Q Q LocA4e. d 'Fi'h ..
t teJ ..N. i� AO'lit (1AA
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 L e J (4:1 +∎. f l v — `-✓ ■ Lk: 4 4 ••••• C /N Pt n cl Phone Number
Plumbing Company T C S k . • , • • . • ‘ • :vi 'rt. c O f f i c e Phone S ) 4 41 Fax3lo'1 - (4'S3'
Co. Address: LA 4 2 L Lo.i s D (t.. City TS State r L, Zip £312.2 c.
License Holder (Print) R-Pt.3 ► , Coq : n Q State ertification/Registration # F'FC -(42., x.2
Notari • fr.' a ,, :r7 . 7fr'l- -. er r-'� J
�x: '" MY COMMISSION # EE 057349 J
� • EXPIRES: May 21, 2015 OM and subscribed before me this day of )11/A—L-- 20 (
. Pl`„� Bon ded thru Notary Public Underwriters 1
-" . ignature of Notary Public Ci