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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