1769 Seminole Rd 2013 drywall and elec CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00003083 Date 7/17/13
Property Address . . . . . . 1769 SEMINOLE RD
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 1800
----------------------------------------------------------------------------
Application desc
DRYWALL REPAIR
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
NARKIEWICZ, BRENT OWNER
1769 SEMINOLE ROAD
ATLANTIC BEACH FL 32233
--- Structure Information 000 000 DRYWALL REPAIR
Occupancy Type . . . . . . RESIDENTIAL
----------------------------------------------------------------------------
Permit . . . . . . ELECTRICAL PERMIT
Additional desc . .
Permit Fee . . . . 58 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 1/13/14
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE ELEC DCA SURCHARGE 2 . 00
STATE ELEC DBPR SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 58 . 00 58 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 8 . 00 8 . 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.
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
"tit
Application Number . . . . . 13-00003083 Date 7/17/13
Property Address . . . . . . 1769 SEMINOLE RD
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 1800
----------------------------------------------------------------------------
Application desc
DRYWALL REPAIR
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
NARKIEWICZ, BRENT OWNER
1769 SEMINOLE ROAD
ATLANTIC BEACH FL 32233
--- Structure Information 000 000 DRYWALL REPAIR
Occupancy Type . . . . . . RESIDENTIAL
----------------------------------------------------------------------------
Permit RESIDENTIAL ALT/OTHER
Additional desc . .
Permit Fee . . . . 60 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 1800
Expiration Date . . 1/13/14
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE ELEC DCA SURCHARGE 2 . 00
STATE ELEC DBPR SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 60 . 00 60 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 8 . 00 8 . 00 . 00 . 00
Grand Total 68 . 00 68 . 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: 26 f 70/ Permit Number:
Legal Description %()q Floor Are—a of Sq.Ft. Parcel 4 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 approva o
Describe in detail the type of work to be perfonned:
vv kot,/11
Property Owner Information:
T-) IL '2
Name: fs--&M Address:
city 4-��/�c Jt;>,qzz__ Stat —Zip Phone 3,S7—'2aP734P2
E-Mail or Pax#(Optional-
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 rn r rinow
Mortgage Lender Name and Address I I& L UU1 I
A a, he e ade b a a ermi'to do the work and installations as indicat or installation has commencedprior to the
11 be pe 0 ed to m�t the Stan a ds a 1 1r thisjurisdiction. This permit becomes null
0 t p r 0 1 1 s s f
t to r i Od rk u aWeriod ofsixp�)months at any time a ter
P'ic '0 's r by Md ha a k
p
i ance o a Per t an
s or c 't
ssu wi _ f rm h uct 0,
'o 'or mi t Iwo r
s 't com , w t s ), t
,d id k n ed hin (6 n n 'on
"cur f
or I 'trre e s
is c m c i 0 Ob ed E e a Pools, urnaces,Boilers,Heaters,
k ced. I understand that separate pe,.i s mu t
Tanks andAir 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.
Ihere certify that I have read and examined thisia h dknow the same to be true andcorrect. All provisions of laws and ordinances governing this
ecgication an
1�work will be co�nplied with whether ,le herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any otherfederal,state, or alsf,w regulating construction or the pe�formance ofconstruction.
Signature of Owner Signature of Contractor
PrintName Print Name .........................................................................................................................................
......................................................................
Before me Before me
this-14 y f this Day of
.20
SHIRLEY L I c
Notary Public My COMMISSION#DD 95776o
EXPIRES:February 14,2014 Revised 10.24.12
Bmded Thru Notmy ftlic UndmwThrs
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 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 V10LATION OF THIS EXEMPTTON. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO T14E BUILDING CODES AND ZONING REGULATTONS. 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.
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.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(l). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR, TELEPHONE THE
BUILDING DEPARTMENT(247-5826) IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
1 -7(�,� -3
ADDRESS PHONE NUMBER
PRI
DATE
S I G N_A�� �
Before me this /2 day of 2ot3in the county of
Duval,State of Florida,has personally ppeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of County of
0 P fly Known
Or:*
�r
.du d Identification- 7- 1
Notary Signature:
EY L GR M
MY COMMISSION#DD 9,57760
F,13LDG/0—Build�,Affid-it;REVISED: 4/16/2 09 EXPIRES:February 14,2014
Bonded Thru Notary r 111
m Notam
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach, Fl, 32233
Ph(904) 247-5826 Fax (904)247-5845
JOB ADDRESS: PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE
VALUE OF WORK$
NEW SERVICE F� Overhead F-1 Underground Underground up Pole
OResidential(Main) Service
110-100 amps 0 10 1-I 50amps El 151-200amps amps of Meters
01 Commercial(Main) Service
0 0-100 amps 0 101-1 50amps 0 151-200amps 0 amps OCT Service amps
Conductor Type- - Size
EMulti-Family(Main)Service
110-100 amps 0 101-1 50amps 1:1 151-200amps 0 amps of Unit Meters
0 Temporary Pole 0 amps
SERVICE UPGRADE []-amps 0 CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
0100amps 0150amps 0200amps El amps OCT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: __5- 0-30amps 3 1-1 00amps 10 1-200amps
Appliances: 0-30amps 3 1-1 00amps 10 1-200amps
A/C Circuits: 0-60amps 6 1-1 00amps
Heat Circuits: # circuits
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
U Swimming Pool 0 Sign 0 Smoke Detectors p
U _Qty 11 Transformers KVA 0 Motors h
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty_volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
0 Replace Burnt/Damaged Meter Can 0 Safety Inspection OPanel Change OOH to UG
EjOther:
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.
C:;' L -2 93-�jPy—
Property Owners Name vow4ieeocz Phone Number
Electrical Company Office Phone Fax
Co.Address: city State Zip
License Holder(Print): State Certification/Registration
Notarized Signature of License Holder
Before me this day of 20
Signature of Notary Public
CITY OF ATLANTIC BEACH.
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
Applicat ion Number . . . . . 13-00003083 Date 8/05/13
Property Address . . . . . . 1769 SEMINOLE RD
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 1800
-----------------------------------------------------------------------------
Applica .ion desc
DRYWALL REPAIR
--------------------------------------------------------------
Owner Contractor
------------------------
-------- ----------------
NARKIEWICZ, BRENT OWNER
1769 SE14INOLE ROAD
ATLANTIC BEACH FL 32233
--- Structure Information 000 000 DRYWALL REPAIR
Occupancy Type . . . . . . RESIDENTIAL
------------ ----------------------------------------------------------------
Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Sub Con:ractor . . STEEG PLUMBING Plan Check Fee . 00
Permit Fee . . . . 97 . 00 Valuation . . . . 0
Issue D3.te . . . .
Expiration Date . . 2/01/14 ------
------------------------------------------------------------- --------
Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 97 . 00 97 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 101 . 00 101 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
L U-1 CATION
�Or�'G PERMIT APP
-Tic BEACH
CITY OF ATLAIN
8 00 Seminole p -FL 32233
._d A�dan�,ic Beach.
Ph(904) 247-5826 Fax(904) 247-5845
JOB ADDRESS: 0. PEL.tr----------
N—bW OR UqSTALLATION: Project Value S ory
0 rf Ty-pE OF FL-vuFE
DITE OF DaURE — septic Tank&Fit
Bedatilb Shower
Clothes Washer Shower Pala
Dishwasher slop Sink
Drinking Fountain Three Conipa-
_Ltnent Sink
Floor Drauk Toilet
Floor Sink Urinal
-s
Hose Bibs Vacuum Breakel
Kitchen S i ik Water Connected Appliances
Laundry T.-ay Watter Heater
Lavattory WeLar Treatimg SYstem
Oth er F ixt ire s
RE-PIPE: 0 T-V Typf OF FaTURE OTY
TY-PE OF) DJVRE Septic Tank&Pit
Bathtub Shower
Clothes Washer Shower Pan
Dishwasher Slop Sink
Dfinking ountam Three Compa—rtment Sink
Floor Dra n Toilet
Floor Sili Urinal
Hose Bib; vacuum Breakers
Kitchen ink Water Connected APPlianc`es
Laundry aY water Heater
Lavatory WeLer Treating System
other Fixtures
MISCELLANE DUS: gajions(Requires 3 sets O�Plaj
[j Back Flow Preventer 0 G—Lease interOWLor(Trap)
r-- Sewe�r Replacelntnt
SDrjnjder :3ysteM_Number of Heads 0 Well inspectlon,
Lawn be submitted to tEe Building DepartMent for f"'
SJRWD Well COMPletiOn Form. Completea form to
E� Other 5(that I have
I hereby cert�.
nth penod or work is Suspended or abancloned.for six MM �omplied with whether sPeci5
mmm" mence within a six rno k will be c ru
permit becomes void if-xork does not com, of laws and ordinances govermng this wo the perfamance of const C"o'
'�O`s ,cn,=,1do,or
application aud know the same to be true and correct- All Prov' er state or iocal law regnlaliO
07-,lot.,The permit does lot give authorltv to YiOl3te the provisions of any Oth Phone Number
Name
'Pro-Derty Owners Z�
I OfEce I �one V4��,V_
Plumbing Comp�any te
_Ad, Sta
City �(f 0-3
1 10 Z4A -----------
Address: State CertifLcatiorjRegstration
License Holder 0�rW*
___�d�ayof
20
L4s�ub e ef or e e t h i�s
'License H61der
T�,Gfarize!i Sig�rjatgere oj' da7
Sworn smilbe bef0.e1--Getb1s--- y of
Signature of NotarY P-c,blic