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221 Seminole Rd 2013 Minor interior repairs drywall etc CITY OF ATLANTIC BEACH j 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 13-00002708 Date 5/22/13 Property Address . . . . . . 221 SEMINOLE RD Application type description RESIDENTIAL ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 15000 ---------------------------------------------------------------------------- Application desc INTER REMODEL FRAME DOOR FOR WHEELCHR/DRYWALL ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ THOMPSON,WALTER OWNER 221 SEMINOLE RD ATLANTIC BEACH FL 32233 --- Structure Information 000 000 DOOR FRAME AND DRYWALL Occupancy Type . . . . . . RESIDENTIAL ---------------------------------------------------------------------------- Permit . . . . . . RESIDENTIAL ALT/OTHER Additional desc . . Permit Fee . . . . 125 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 15000 Expiration Date . . 11/18/13 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 125 . 00 125 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 129 . 00 129 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. MAY-22-2013 11:10 FROM:CLERK OF COURTS 904 270 1512 TO:92475845 P:1•'1 I NOMI CE of COMMENCEMENT (PREPARC IN DUPLICATE) Permit No.^ — Tax Folio No. State of County of To whom It may conceal: Tho undersigned hsrahy Informs you that improoveme0%will be made t>d certain real yfropeM,Good in accardance with 3factton 713 oftne Florida Statut %the f01lOWIng infgnm MIn IS 3ftetiod In thle NlOMCE OF �] Ggal aleeicCtlpf pf prppefty tmin frit ved:,^ � / r ` moo►^- rx!Do no I) S Alfdress of Property being Improved: Q 1 . net descrt don of i rovaments: oc/� 'f~ t r 41r, of ` r' Own �Iisr'a atldress interest in Oita of the improvement Fee Slmple Titleholder(If other than ownw) y,/ptc - Name Aadrafra I Contractor— Address Phone No- Fax No. Surety Of any) 94 Adomes_fIl/ Amount of bond S i phone No. Fax No. i Name and address of rson making a loan for the corrshucWn of the improvements. Name - Address Phoria No. Fax No. -- Mame of person within the State of Florida,other than r vtelf,designated by owner upon whom notices or other documents may be a Name— Address Phone No. - -- -•Fax No- _ -- In addition to himself,owner doslgnatef!Rita follovAng person to rawtvo a oapy of the Li Tinea Nufto as provided ir! Section 713.06(2)(b),Florida Statutes,(Fill In at Ownes's option). Nome - - Addiess Phone No, Fax No. Eviration date of Notics of Commeno went(the expiration date fa one(1)year from fits date of recording unless a different date is specified): THIS SPACIE FOR RECORDER'S USE ONLY t7K R Bipne .„may DATE /2 2,-17 sefore roe!RI PF In the (befnty srtt)wel,S[et2 of Fronde,hes personally npp7mpd Doc#2013129870,OR BK 16379 Page 2115, h�a dY ififae�stf!ftareettatld 5dfirma that a&stetartsla orand deetareUorr;heroic, Numocr Pages:1 arota, acouram Rneorded 05/22/2013 at 11:43 AM, P,olinie Fussell CLERK CIRCUIT COURT DIJVAL COUNITY RECORDING$10.00 Mona MyL�o PerduEXPRES;�" ' "�"r arb BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: 90,11 S-etall rtoke Permit Number: Legal Descriptioni Parcel# co oor Area o q. t. q t Valuation of Work$ �0 roposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition Iteration Move Demolition pool/spa window/door Use of existing/proposed structure(s) (circle one): Commercial t If an existing structure,is a fire sprinkler system installed? (Circle one): es o N/A Florida Product Approval # For multiple products use product approva orm Describe in detail the type of work to be performed: i h t A111,0 1 w o`k � ('Do S 1"al Awe r� b ue-I Roc- e � Property Owner Infor ation. DPfnr"0e— yeah Name: eC Address: Ct�►1chO�es City M cart tL c. L Sta ZipPhone — Co 0— E-Mail or Fax#(Optional) Contractor Information: Company Name: Nell Qualifying A.06 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 a d 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 or abandoned for a period of sixP6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools, urnaces,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 hereb certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type.VIwork will be complied with whether speci ted 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. �;�---------------------Signature of Owner Signature of Contractor A44 ..... . .... Print Name - ........................................................Print Name1 � sa ................................................................ . .... BefoBefore me this ay of 20 [�J this Day of 20 . v„ . w EP No fie ;- so Notary Public x'iRES >enruary 1a 2014 Revised 10.24.12 o onnpnru Norary Public Underwriters V2, CITY OF ATLANTIC BEACH OWNER / 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 REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. II. 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. ADDRESS PHON UM ER r PRINT NAME ^ SI NATURE /w/ DATE V of Before me this � day of 20L�in the county of Duval,State of Florida,has personally aenccurate herin by himself/herself and affirms that all statements and declarations are true . NotaryPublic at Large,State of��,County ofri rsonally Known Produced Identificati 'I AM farigan. >ltur . ES: ebru 14,2014 Tv 3Ef�` npti Thru Nttta P n . :BLDG/0wncrliuilclCc9f�&d81 C,� CITY OF ATLANTIC BEACH is1 r J 800 SEMINOLE ROAD � S) J - a ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 13-00002708 Date 7/29/13 Property Address . . . . . . 221 SEMINOLE RD Application type description RESIDENTIAL ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 15000 ---------------------------------------------------------------------------- Application desc INTER REMODEL FRAME DOOR FOR WHEELCHR/DRYWALL ---------------------------------------------------------------------------- Owner Contractor - ------------------------ ----------------------- THOMPSON,WALTER OWNER 221 SEMINOLE RD ATLANTIC BEACH FL 32233 --- Structure Information 000 000 DOOR FRAME AND DRYWALL Occupancy Type . . . . . . RESIDENTIAL ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . Sub Contractor . . JAMES JOLLY PLUMBING Permit Fee . . . . 90 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 1/25/14 -------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00 STATE PLBG DBPR SURCHARGE 2 . 00 -------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 90 . 00 90 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 94 . 00 94 . 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: 4;2PERMIT# 13 O NEW OR REPLACEMENT INSTALLATION: Project Value$ TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY Bathtub Septic Tank&Pit Clothes Washer Shower Z 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 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 ** SJR WD 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.l hereby certify that I have read this application and know the same to be true and correct. All ovisions of laws and ordinances governing this work will be complied with whether specified or not. The permit does not give authority,toi late the pr ovi 'ons of any other state or local law regulation construction or the performance of construction. �-ATProperty Owners Name ✓ Phone Number i Plumbing Company J 1z Office Phone c)3 Fax Cit State qL Zi �U Co. Address: 0 S _ Y p License Holder(Print): State ert' tcation/Registration#0 0 c7O Notarized Signature of License Holder sHIRLEYL subs ribed befor s d of 20 S'. 4V COMMISSION 957760 rad; 3ondedT�hruNrixpl otaryPuDUnae � f Notary Publ> Pf„h CITY OF ATLANTIC BEACiJI.�•- J 800 SEMINOLE ROjkD .3 r� ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 13-00002708 Date 1/08/14 Property Address . . . . . . 221 SEMINOLE RD Application type description RESIDENTIAL ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 15000 -- ------------------------------------------------------------------------- Application desc INTER REMODEL FRAME DOOR FOR WHEELCHR/DRYWALL --------------------------------------- Owner Contractor - ------------------------ ----------------------- THOMPSON,WALTER OWNER 221 SEMINOLE RD ATLANTIC BEACH FL 32233 --- Structure Information 000 000 DOOR FRAME AND DRYWALL Occupancy Type . . . . . . RESIDENTIAL -- ------------------------------------------------------------------------- Permit . . . . . . ELECTRICAL PERMIT Additional desc . . Sub Contractor . . FIRST CHOICE ELECTRIC INC 00 Permit Fee . . . . 63 . 60 Plan Check Fee Issue Date . . . . Valuation . . . . 0 Expiration Date 7/07/14 Other Fees STATE ELEC DCA SURCHARGE 2 . 0 STATE ELEC DBPR SURCHARGE 2 . 00 Fee summary Charged Paid Credited Due ---------- Permit Fee Total 63 . 60 63 . 60 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 67 . 60 67 . 60 . 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 2 Ph(904) 247-5826 F (904) 247-5845 .TOB ADDRESS: PERMIT# JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE VALUE OF WORK$ NEW SERVICE ❑ Overhead ❑ Underground ❑T Underground up Pole []Residential(Main) Service ❑0-100 amps ❑101-150amps ❑151-200amps a amps #of Meters ❑Commercial(Main) Service [10-100 amps El101-150amps El151-200amps amps ❑CT Service amps Conductor Type Size ❑Multi-Family(Main)Service ❑0-100 amps ❑101-150amps ❑151-200amps 11-amps # of Unit Meters ❑Temporary Pole ❑ amps SERVICE UPGRADE ❑ amps ❑ CT Service amps NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.) ❑100 amps ❑150amps ❑200amps []______amps ❑CT Service amps ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC. Outlets/Switches: __Ld'�, 0-30amps 31-100amps 101-200amps Appliances: 0-30amps I 31-100amps 101-200amps A/C Circuits: 0-60amps 61-100amps Heat Circuits: # circuits Number of Lighting Outlets, Including Fixtures: OTHER ELECTRICAL PROJECTS ❑Swimming Pool ❑ Sign []Smoke Detectors_Qty []Transformers KVA ❑Motors hp FIRE ALARM SYSTEM (Requires 3 sets of plans) VALUE OF WORK$ Qty volts/amps REPAIRS/MISCELLANEOUS ❑Replace Burnt/Damage d Meter Can ❑Safety Inspection ❑Panel Change DOH to UG ❑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 ff Phone Number , Electrical Company � 1 2-�� c.P r, Office Phone 7 y 1'3'3 1 _Fax Co.Address: "7 1 c City t A r P j� State-L Zip z--i � License Holder(Print): State Certification/Registration# �`� �� xc,o icense Holder 20 Not 1�+�..P s -.�_ ' SMALEyL GRAHAM efore me this day of 1Y COMMISS10 �Q, c'�P1F�.c•cAh NNDD957760 Rf1th� i3ond ThruNotaryPublryUnda,*,, Signature of Notary bllc