410 S Oceanwalk Dr 2014 Bath remodel CITY OF ATLANTIC BEACH
IJ 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00001385 Date 8/25/14
Property Address . . . . . . 410 S OCEANWALK DR
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 300
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Application desc
bathroom remodel/durarock
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Owner Contractor
-
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PODZAMSKY, SUSAN BURNS OWNER
410 OCEANWALK DRIVE S .
ATLANTIC BEACH FL 32233
--- Structure Information 000 000 BATH REMODEL
Occupancy Type . . . . . . RESIDENTIAL
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Permit . . . . . . RESIDENTIAL ALT/OTHER
Additional desc . . . 00
Permit Fee . . . . 60 . 00 Plan Check Fee
Issue Date . . . . Valuation . . . . 300
Expiration Date . . 2/21/15
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Other Fees STATE DCA 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 4 . 00 4 . 00 . 00 . 00
Grand Total 64 . 00 64 . 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: 0 r-e PAJ a f k f,'1-_xr-, -,—:
Permit Number:
fT
Legal Description J �ft if I / Parcel #
Floor Area of Sq.Ft. Sq*
t
Valuation of Work S 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 approval form
Describe in detail the type of work to be p rformed:
Property Owner Information:
Name: Address:
City Sta ip Phone
E-Ma or Fax# (Optional) 247
Contractor Information: CONTRACTO EMAIL ADD S:
Company Name: A if 4 1 k Ne u ' ng Agent:
Address: State
Office Phone Job Site/Contact N er 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 and 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 tf work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six�6)months at any time after
work is commenced. 1 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 here b certify that 1 have read and examined this a plication and the same to be true and correct. All provisions of laws and ordinances governing this
type q Iwork will be complied w'h whether specified herein o . The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other feder st r to regulatin o truction or the performance of construction.
Signature of Owner _/ ,[ Signature of Contractor
Print Name N Q.LA ,►� � Print Name ..............................................................................
.. . .......................��....................... .
Befor Before me
this Day 2 - this Day of •20
to Florida
Notary ublic hirley ra am Notary Public
My Commission FF 086990
.,, Expires 0211412018 Revised 01.26.10
wu�Mr'�ti
CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
V
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.
ACKNOWLEDGEMENT;V.
STA EMEENTAND (
THAT I COMPLY WITH AHEREBY LL DISCLOSURE THAT I HAVE READ THE ABOVE
L THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
ADDRES /► �j P / �j , /, ONE NUM R
PRINT N` ,
r
SIGNATURE DATE
Before me this day of 20L in the county of
Duval,State of Florida,has personally app red herrn by him If/herself and affirms that
all statements and declarations are true an ccurate.
Notary Public at Large,State of ,County of
Personally Known
❑Produced(dent' ion- Jsr n4 Notary Pubtic State of Florida
u
Shirley L Graham
my commission FF 056990
Notary Signa or Expires 02/14!2018
F/BLDG/Owner-Builder AM&vit; VISE /16/2009