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Permit Bath Remodel 675 Selva Lakes Cir 2012 ,',S ' CITY OF ATLANTIC BEACH ) 0 800 SEMINOLE ROAD J ' s r '. -. ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 --Oil :, Application Number 12- 00000551 Date 5/08/12 Property Address 675 SELVA LAKES CIR Application type description RESIDENTIAL ALTERATION Property Zoning TO BE UPDATED Application valuation . . . 2200 Application desc bath remodel Owner Contractor GRANT, THOMAS OWNER 679 SELVA LAKES CIR ATLANTIC BEACH FL 32233 - -- Structure Information 000 000 BATH REMODEL Occupancy Type RESIDENTIAL Permit RESIDENTIAL ALT /OTHER Additional desc . Permit Fee . . . 65.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 2200 Expiration Date . 11/04/12 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. _ r CITY OF ATLANTIC BEACH 41 ► WNER / 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. 1T IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REOUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. 11. 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. V. 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. c � .es Ci(cic ADDRESS PHONE NUMBER T • 6w4 C ley.%vck t 'b N A11 V W 5J s / %z IGNATURE DAT Before me this V day of / / ) 20. 1h the county of Duval, State of Florida, has personally app red herin by himself / herself and affirms that all statements and declarations are true and accurate. Notary Public at Large, State of ft , County of 1./ ❑ Pers nsily Known 1 2g /_ / 6 roduced Identificatio ! �P (p F rr+wmrsr.-!..ae®sao. i) t 't 54iIRLEY L GRAHAM i ! z ndY SHI L R DD 957760 o t a Sign al. � /lt , . t_XPIRES February 14 2014 N •411401.111 r ` .•. ry Bonded Plot Notary Public Underwriters F: BLDG /O,mer- Builder Af REVIS' 0: 4/16/24 - - BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247 -5826 Fax (904) 247 -5845 Job Address: (2 /" 5 St I v' L a 14.es Crc le Permit Number: Legal Description Parcel # Floor Area of Sq.Ft. Sq.Ft Valuation of Work $ 2 2-cc" • ' d Proposed Work heated /cooled n heated /cooled Class of Work (circle one): New Addition Alteration ' epair 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: re e (mac i �S - I C. / et v te, te, t(6 c t t-N 0 „\ n,tc.$ Orr sk1wel/ • Property Owner Information: Name: T n0 mh5 CC r•,v,-i' Address: '3' 5 se tvh Lke . Cie clt City ArgNAVN 13c'cin StateFL- Zip 32233 Phone `104- 0l49— 'i359 E -Mail or Fax # (Optional) - Rilowv,51 P140 Or o,.0)ey • CO w% Contractor Information: Company Name: Qualifying Agent: Address: 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 permit becomes null and void if work is not commenced within six (6) months, or if construction or work is suspended a�ended or abandoned for period of six 6) months at any time after work is commenced. 1 understand that separate permits must be secured for Electrical Plumbing, Signs, Wells, Pools, F urnaces, Bo 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 I have read and examined thisplication 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 s.eci ted herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federa state, o al # regulating construction or the performance of construction. I A' Signature of Own Ci .... ` 4 Signature of Contractor Print Name li/ltv" 145 Gel vrY Print Name Sworn .:: • sub c .. m- Sworn to and subscribed before me this ; t, ,Pay of / A11 / L 1 this Day of , 20 _�diAR li .. SHIRLEY SHIRLEY L. GRAHAM Notary 'ub 1C '- " EXPIRES: February 14, 2014 Notary Public Ag T h" Bonded Thru Notary public Underwriters Revised 01.26.10 S!r f. `i ` CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD 3 ' ` �" ATLANTIC BEACH, FL 32233 ` ° INSPECTION PHONE LINE 247 -5814 JJ3 T Application Number 12- 00000548 Date 5/07/12 Property Address 675 SELVA LAKES CIR Application type description PLUMBING ONLY Property Zoning TO BE UPDATED Application valuation . . . 0 Application desc SHOWER PAN Owner Contractor CARBONE, ANTHONY T JR COOKS EAST COAST PLUMBING 679 SELVA LAKES CIR 4850 OUTRIGGER DR ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32225 (904) 642 -1134 Permit PLUMBING PERMIT Additional desc . Permit Fee . . . 62.00 Plan Check Fee . . .00 Issue Date Valuation . . . . 0 Expiration Date . . 11/03/12 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: 6 7 S ,S L U y � ( (4G S ' (' j ' PERMIT # NEW OR REPLACEMENT INSTALLATION: Project Value $ TYPE OF FIXTURE QTY TYPE OF FIXTURE Bathtub QTY Clothes Washer Septic Tank & Pit Dishwasher Shower Drinking Fountain Shower Pan Floor Drain Slop Sink Floor Sink Three Compartment Sink Hose Bibs Toilet Kitchen Sink Urinal Laundry Tray Vacuum Breakers Lavatory Water Connected Appliances Other Fixtures Water Heater Water Treating System RE -PIPE: TYPE OF FIXTURE QTY TYPE OF FIXTURE Bathtub QTY Clothes Washer Septic Tank & Pit Dishwasher Shower Drinking Fountain Shower Pan Floor Drain Slop Sink Floor Sink Three Compartment Sink Hose Bibs Toilet Kitchen Sink Urinal Laundry Tray Vacuum Breakers Lavatory Water Connected Appliances Other Fixtures Water Heater 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. 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 T (� , .. �t-� 6 r 0- cn Phone Number LI ( f Plumbing Company COG k ` s S �- C 0 !� S E pC-, Phone 7C k G 4,-)-1/1 y Fax Co. Address: 4 S 0 O C.-�- JZ 1 ` ° `j ' I� �` City �� - State p Zip S License Holder (Print): E0 C r%^ State Cert' tcation/Registration # C ► 11 L 3 0 6 Notarized Signature taif'tcaen e' SVIg a ar 1SU � . cr befo - da of t 20/2 - �f" r�u . i Nnt ltoar.L1n errrkers 1 - • e tary Pubh