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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