410 S Oceanwalk Dr 2013 Durarock bath CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00003087 Date 7/26/13
Property Address . . . . . . 410 S OCEANWALK DR
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 250
----------------------------------------------------------------------------
Application desc
durarock for bath
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
PODZAMSKY, SUSAN BURNS ATLANTIC COAST PLUMBING CORP.
410 OCEANWALK DRIVE S . 3653 REGENT BLVD #305
ATLANTIC BEACH FL 322334573 JACKSONVILLE FL 32224
(904) 249-5381
--- Structure Information 000 000 BATHROOM REMODEL
Occupancy Type . . . . . . RESIDENTIAL
----------------------------------------------------------------------------
Permit . . . . . . PLUMBING PERMIT
Additional desc CHANGE OUT 3 FIXTURES
Sub Contractor ATLANTIC COAST PLUMBING CORP.
Permit Fee . . . . 76 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 1/22/14
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 76 . 00 76 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 80 . 00 80 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Jul 26 13 04: 47p Susan Parrish 904-246-3673 P. 1
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-594
1--n 4 39
JoB Awmss: Z-// "/'/ - 70 PERmrr
NEW OR4��INSTALLATION: Project Value S
TYPE oF FixTuRE TYPEOFFIXrURE Ql�y
Bathtub S4�ptic 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
Laundr
y Tray Water ConnWad Appliances
Lavatory Water Flealcr
Other Fixtures Water Treating System
RE-PIPE:
TYPE OF FIXTURE QTY TYPE OF F!XTURE Q1 y
Bathtub Scptic Tank&Pit
Clothes Washer Shower
Dishwasher ShowerPan —
Drinking Fountain Stop Sink —
Moor Drain Three Compartment Sink —
Floor-Sink Toilet —
Hose Bibs Urinal —
Kitchen Sink Vacuum Breakers —
Laun4ryTray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
0 Sewer Replacement C3 Back Flow Preventer 0 Grease Interceptor(Trap) gallons(F equires 3 scts of p1sifts)
o Lawn Sprinkler Sysu=-Number of Hcads -'� Well
**SJRWD Well Completion Form.Completeillo—nuto be submitted to t uilding Department f)r final inspection."
Cl Other
Purnit bccorncs void if work doce,not conuncricc within asix nionth periodor wQrk i,%,;i;,,;pvndcd orabandoncd forsix rnonths,I t creby certify that I have read
this application and know dicmme to he true aM correm All prov;qions of inw-,and ordinattwes goveming this work will be complied with whether 9peciricd
or not, The pc=it does not give Quthority,10 violate tile provisiow of any others= or local taw,regulation construction or the pe,fortnance orconstruction.
Property Owncrs Name A/-* PhonoNurnbei
"6 -3.2 7,,�" F
"y) ce Phone ax J,7 1��-
�4 Offi
Plumbing Compan, -
Co.Address: Ci., Sta��e 2�n/-Zip 37,392
s
Liccnsc Holder(Print): --;--S_taft.C--t'd/f';-ation/Registratic a#
Notarized Signature of License Holder - J 6.
200 10-W P11-t, Before me this -2 4 day of Lzb�'Iv.
DLALNE 0. ROCHE
My COMMISSION#FF009958
OVIRES:April 21,2017 ubl ic,
Signature of Notary P
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00003087 Date 7/18/13
Property Address . . . . . . 410 S OCEANWALK DR
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 250
----------------------------------------------------------------------------
Application desc
durarock for bath
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
PODZAMSKY, SUSAN BURNS OWNER
410 OCEANWALK DRIVE S .
ATLANTIC BEACH FL 322334573
--- Structure Information 000 000 BATHROOM REMODEL
Occupancy Type . . . . . . RESIDENTIAL
----------------------------------------------------------------------------
Permit RESIDENTIAL ALT/OTHER
Additional desc . .
Permit Fee . . . . 55 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 250
Expiration Date . . 1/14/14
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 55 . 00 55 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 59 . 00 S9 . 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: e�d_27 kl .4 tAl hr-' lermit Number:
Legal Description Floor Area of Sq.Ft. Parcel# Sq*Ft
Valuation of Work$ 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 app—r—o—val-ro—rm .
Describe in detail the type of work to be performed: oz., 6 Air '660 ZA
JAI, ZPA V61 1161
Property Owner Information:
Name: �VA K (1)1A In Ml C Addre s: Lk A nLrm)10(01� 6, 9 .
4 4 .- ,
6 t j -StateQ-4p Phone' ' - N-0 )n
city
E-Mail or Vax 4 (Optior�al
Contractor Information:
Company Name: Qualifying Agent:
Address: -city State Zip
Office Phone Job Sit ontact Number Fax
State Certification/Registration
Architect Name&Phone# z
Engineer's Name&Phone# I/
Fee Simple Title Holder Name and A/dress
Bonding Company Name and Ad,].Kss
M gage Lender Namean
ortgage Lender Name and Ad ess
i he, ad t ob or installation has commencedprior to the
' t't 0 1 t thisjurisdiction. This permit becomes null
- t % d h a a
-4 1,a 0 '
i PP , 0 a p t 1 i f sixj6)months at any time after
s""
oi
and d fok I not'o"""d aWer od o
lls Uj
'o,"', "'t e ,Pools, urnaces,Boilers,Heaters,
rk d d an
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 FINANCING9 CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I herelb certify that I have read and examined this. P 1 a w the same to be true and correct. Allprovisions of laws and ordinances governing this
ife .lic�erei;n!��ot 0 The granting of a permit does not presume to give authority to v-olate or cancel the
type.).work will be co�nplied with whether I
provisions of any otherfederal,state, or loca r ula;j<construction or the performance of construction.
Signature of Owner Signature of Contractor
PrintName Print Name ................... ...................................................................................................................
Befor e Before me
this 20 this Day . 20
OM 121
M COMMISS1 #
go-taiTPIR R Notary Public
Revised 10.24.12
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
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 BUTLDING 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 6R LEASE A BUILDING YOU 14AVE 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 ACCORDfNG TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILM TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL 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 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(l). 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.
P�&1-2wp_11K Ar xn�
PIQCNE NUMYER-
ADDRESS
PRINT ftA ME
' R
E
7h,?11 3
0 in the- nty
If/ a f.
rr.oeul nd
R
X Q
M
SIGNATURI() DATE
Before me this_day of 0�_ in the county of
Duval,State off�Florida,has personally appeared rin b�y h�i�mself/herself and affirms that
tr
cu
all statements and declarations are true and ccurate.
Notary Public at Large, �te,�f County of zqt,06�
VEl sonally Known
Produced Identift ion-
Notary S t
Vly C
_x OMMISSION 1)957760
TM Fe4% CM,2014
F/BLDG/ affirukllaer4ypa icUndcrwriters
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
-5814
INSPECTION PHONE LINE 247
Application Number . . . . . 14-00001432 Date 8/29/14
Property Address . . . . . . 410 S OCEANWALK DR
Application type description PLUMBING ONLY
Property Zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 0 --------------
--------------------------------------------------------------
Application desc
INSTALL 3 FIXTURES
-----------------------------------------------------
Owner Contractor
------------------------
------------------------ ATLANTIC COAST PLUMBING CORP.
PODZAMSKY, SUSAN BURNS 3653 REGENT BLVD #305
410 OCEANWALK DRIVE S . FL 32224
ATLANTIC BEACH FL 32233 JACKSONVILLE
(904) 249-5381
-- -------------------------------------------------------------------------
Permit PLUMBING PERMIT
Additional desc - - Plan Check Fee . 00
Permit Fee . . . . 76 . 00 Valuation . . . . 0
Issue Date . . . .
Expiration Date . . 2/2S/15 -----------------------
-------------------------------------------- --------
Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
---------- -----------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 76 . 00 76 . 00 . 00 . 00
Plan Check Total . 00 * 00 . 00 . 00
Other Fee Total 4 . 00 4 * 00 . 00 . 00
Grand Total 80 . 00 80 . 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),247-5945
Wo PERMIT#
JoB ADDRESS:
NEW OR PLA�CE�ME:N�T STALLATION: Project Value$
1Z QTY TYPE or Fhyrtw Qry
TYPE OF
Bathtub Septic Tank&Pit
Clothes Washcr Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
l-lose 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 Stop 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:
m Sewer Replacement C3 Back Flow Preventer ci GTease [nterceptor(Trap) gallons(Requires 3 sets of plans)
c3 Lawn Sprinkler Systern-Number of Heads [I Well
**SJR WD Well Completion Form. Completeallo—rm—to be submitted to ding Department fir finall inspection."
o Other
Permit bcconics voidifWOTk does not conimcncc within asix nionth period or work iv susperidcd or abandoned for six months.I licreby certify that I have read
this application and know die same to be true and correct, All provisions of laws and ordinances governing thiS work will be complied with whether 4pceiricd
or n(K. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the pe-rormance of construction.
Phone Number
Property Owners Name S61 I ,
pz'� �1 4 — 0 -7 ax �3
Plumbing Company f" L4 fficePhone
Stale
Co.Address: city J x 4-Z-
License Holder(Print); I --i —Stab-Xertifxation/Registr-atiolI#
<
Notarized Signature of License Holder
r1av Af kt 't 5 20
Before me thi's Z
Signature of Notary Public
'FJ
0
Zi 2--2----
le- I %
DLANE 0.ROCHE
MY co
MMISSION#FF009958
EXPIRF-S:April 21,2017