443 OSPREY KEY RERF22-0050 REROOF SHINGLE PERMIT PERMIT NUMBER
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CITY OF ATLANTIC BEACH RERF22-0050
800 SEMINOLE ROAD ISSUED:
ATLANTIC BEACH FL 32233 EXPIRES:
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other
governmental entities such as water management districts, state agencies, or federal agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
443 OSPREY KEY REROOF SHINGLE SHINGLE ROOF $8275.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172027 5086 SELVA LAKES
COMPANY: ADDRESS: CITY: STATE: ZIP:
AMERICAN ROOFING OF
JACKSONVILLE 2117 University Blvd. S JACKSONVILLE FL 32216
OWNER: ADDRESS: CITY: STATE: ZIP:
KERSEY RONALD L 443 OSPREY KEY ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $95.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$99.00
Issued Date: 1 of 2
L
0.;.4." , Building Permit Application Updated 10/9/18
; ,-. ,ci City of Atlantic Beach Building Department **ALL INFORMATION
��, v 800 Seminole Road, Atlantic Beach, FL 32233
HIGHLIGHTED IN GRAY
--J;i 91" IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 443 Osprey Key,Atlantic Beach,Florida 32233 Permit Number: RE RF-2 2- ~ 0°S C
Legal Description 41-55 17-2S-29E SELVA LAKES LOT 42 RE# 172027-5086
Valuation of Work(Replacement Cost)$8.275.00 Heated/Cooled SF 1372 Non-Heated/Cooled 1845
• Class of Work: •New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial •Residential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes •No
• Will tree(s) be removed in association with proposed project? EYes(must submit separate Tree Removal Permit) •No
Describe in detail the type of work to be performed:
Complete and total re-roof. 5/12 Pitch. 2 Story.
Florida Product Approval#FL16305 FL17322 for multiple products use product approval form
Property Owner Information
Name Cathy Kersey Address 443 Osprey Key
City Atlantic Beach State FL Zip 32233 Phone 904-528-7968
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company American Roofing of Jacksonville,LLC Qualifying Agent Dan Kinkel
Address 2117 University Boulevard South City Jacksonville State FL Zip 32216
Office Phone 904.385.4375 Job Site Contact Number 904.385.4374
State Certification/Registration# RC29027546 E-Mail admin@americanroofingJax.com
Architect Name&Phone# NIA
Engineer's Name&Phone# NSA
Workers Compensation Insurer Builders Mutual insurance#WCP105239304 OR Exempt 0 Expiration Date 5/3/2022
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 the laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS,FURNACES, BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and
there may be additional permits required from other governmental entities such as water management districts,state agencies,or
federal agencies.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
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 N'TICE OF CO► MENCEMENT,.
40.ignature of Owner or ,IP t) ��..��((�� (Signatur of Contractor)
Signed,an/d sworn to(or affirmed) •-fore e this �7day of Signed and sworn to or affirmed) befoie me this ' day of
P'l�l , 90X,by _1 414��� -/E- ' ; calA , + d• , by •1I. . . ...
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Si•n.ture of Notar ) (Signatur- of Notary)
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ii' EMIL' ULDING
Int Notary Public-State of Florida i►►� EMILEA SPAULDING
[ ] Personally Known OR •� 1� I Commission N HH 059009 • 'ersonally Known OR :f'�^ ..] Notary Public-State of Florida
'.7,7:.............. My Comm.Expires Nov 1,202 `•�y,k 1 Commission/HH 059001
P •roduced Identification
[jI]Produced Identification •Porde My Comm.Expires Nor 1,2024
bonded through National Notary Ass ,,e of Identification: ""'
Type of Identification: ssn.