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1595 Beach Ave 2013 sewer/water pipe replmnt CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 Application Number 13-00002397 Date 3/29/13 Property Address . . . . . . 1595 BEACH AVE Application type description PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc REPLCE SML PIECE OF WATER AND SEWER LINE ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ BLACKARD WILLIAM R JR. OWNER 3531 HEDRICK ST JACKSONVILLE FL 322059406 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . Permit Fee . . . . 69 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0: Expiration Date . . 9/25/13 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00 STATE PLBG DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 69 . 00 69 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 73 . 00 73 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. 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 OWNER OF YOUR PROPERTY�TO ACT AS LAW. TBE EXEMPTION ALLOWS YOU,AS TTIE YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTI YOURSELF. yOUMAyBUMDORIMPROVEAONE-OR YOU MAY ALSO BUILD OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING- IMPROVE A COMMERCIAL BUILDING AT A COST OF$25�000-00 OR LESS. THE BUILDING ST 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 SUME THAT YOU BUILT AFTER THE CONSTRUCUON IS COMPLETE,THE IAW WILL PRE YOU MAY NOT IT FOR SALE OR LEASE. WHICH IS IN VIOLATION OF T`HIS EXEMPTION' HIRE AN UNLIC SED PERSON.AS YOUR CONTRACTO 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 STA E LAW AND.BY COUNTY.OR MUNICIP , LICENSING ORDINANC S. 11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. Ill. IRS V41THHOLDING;'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 UND_ERANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA.5 IATUTE No. 455-228(j). 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. PHONE NUMBER ADDRESS & P NT NA E 7/41 18tGOATU A20 n the county of Before me thi day of Duval,State of Florida,has personally appeared h.rin b� I herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of County of pyermally Known Ev-duced Identificatio SrrIRLE�!. GRAI-1k,'. Glojl,*,,��!C,�J(`,N--i)P 7. .�z EXPIRES:Fo�,;*U�,�,,,14 Notary Sign. dedlhri,Nota�ryPutd FIBLDG/0�w-Builder Affadavit; 4/16/2009 PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph(9 4) 247-5826 Fax (904)247-5845 PERmrr JOB ADDRESS: NEW OR REPLACEMENT INSTALLATION: Project Value QTY TYPE OF FIXTURE QTY TYPE OF FIXTURE 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 Water Connected Appliances Laundry Tray Water Heater Lavatory Water Treating System Other Fixtures RE-PIPE: TYPE OF FixTuRE QTY TYPE OF FIXTURE QTY Septic Tank&Pit Bathtub Shower Clothes Washer Shower Pan Dishwasher Slop Sink Drinking Fountain Three Compartment Sink Floor Drain Toilet Floor Sink Urinal Hose Bibs Vacuum Breakers Kitchen Sink Laundry Tray Water Connected Appliances Lavatory Water Hea"ter Other Fixtures Water Treating System MISCELLANEOUS: _t1i (Trap) gallons(Requires 3 sets of plans) o Sewer Replacement Ei Back Flow reventer o Grease Interceptor Ei Lawn Sprinkler System-Number of Heads ci Well SJRWD Well Completion Form. Complete&-forin to be submitted to tfie-Building Department for final inspection.� coi Other ence within a six month period or work is suspended or abandoned for six months.I certify that I have mad Permit becomes void if wodk­does not comm ances governing this work will be complied with whether specified this application and know the same to be true and correct. All provisions of laws and ordin nstruction or the performance of construction. give author to violate the provi on of any other state or to I law regulation co or not. The permit does not Property Owners Name Phone Number O� ff 1 Fax Plumbing Company office Phone Co. Address: city State_Zip License Holder(Print): State Certification/Re ation# Notarized Signature of License Holder Before me this day of 20 1_ Signature of Notary PPXubl* S TOP WORK CITY OF ATLANTIC BEACH BUILDING AND ZONING DEPARTMENT NT , e NOTICE This building has been inspected and: 0-V F� General Construction F� Mechanical Concrete and Masonry R Electrical Plumbing R Gas Piping IS NOT ACCEPTED CORRECT AS NOTED BELOW� BEFORE ANY FURTHER WORK Pa I r �o S�e A-/- i? Z-ot vA-T 19-e f-rv,,,, I DO NOT REMOVE TMS NOTICE Inspector: -12� Date: 3 Failure to respond to t is Notice within 10 days will result in this violation being forwarded to the CODE ENFORCEMENT BOARD. The posting of this Placard by its contents shall serve as due notice.