1660 Beach Ave RERF22-0097 Roofing Permit -.-5-'' 't � REROOF SHINGLE PERMIT PERMIT NUMBER
ifoolir,�p�a RERF22-0097
I, ,A_fil CITY OF ATLANTIC BEACH
'''',''7,; ,',7
800 SEMINOLE ROAD ISSUED:4/28/2022
4.441
ATLANTIC BEACH. FL 32233
EXPIRES: 10/25/2022
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: l PERMIT TYPE: IDESCRIPTION: i VALUE OF WORK:
1660 BEACH AVE 3 REROOF SHINGLE SHINGLE ROOF $11511.00.
TYPE OF REAL ESTATE . BUILDING USE
ZONING: 1 SUBDIVISION:
CONSTRUCTION: ', NUMBER: GROUP:
169576 0000 ; OCEAN GROVE UNIT 01
COMPANY: ADDRESS: ' CITY: STATE: ZIP:
J & M RESIDENTIAL 6020 PARKWAY DRIVE NORTH CUMMING GA . 30040
SERVICES, LLC.
OWNER: I ADDRESS: CITY: STATE: , ZIP:
HART MARY JANE 1660-3 BEACH AV 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.
----- ----- — -- --- FEES -------- --- ------ --
DESCRIPTION— ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $110.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$114.00
Issued Date:4/28/2022 1 of 2
yTYll
-y , Building Permit Application Updated10/9/18
1-, '"-
49)
31, City of Atlantic Beach Building Department i .**ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
•tf j
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
---- -- - — e-RP"2 Z-- c 7
Job Address::\\01000 �e,o�Gh 'A1(L, uh�-�3 ; Permit Number:
Le al Description; 5— �j 2, �-Z, 2 9 g .O1 - e0a, rave, L i.1i V RE#'I tog 5 to b __._-
Legal
CO g, i0 RECD OI q 8 y-7-I LX
Valuation of Work(Replacement Cost)$ ,n) eated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ' tepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ,esidential
• If an existing structure,is a fire sprinkler system installed?: DYes ❑No
• Will tree(s)be removed in association with proposed proiect? ❑Yes(must submit separate Tree Removal Permit) ]$No
Describe in detail the type of work to be performed: Sh%n91-0_, Q e^ 1Zoo ,
.gerNOV-e, .-e x` ;rte Sh\ryes aro\ CZCV‘au- w- peva 9r"\91
i8. L c ,,• -all/ -eitch
Florida Product Approval# L Id,/4` 9,12.B CL ball-'4.'4 for multiple products use product approval form
Property Owner Information
Name Q 'a-OSA- Address
110 1h1o0gf—XXc.4-1s-,- e_ unit_ _
city' o C, C.cch °state - L Zip 3ZZ 33 Phone 9Oy- 331- 6569
E-Mail , q:h avU,ha 0. 2 I:SCU,�'h•AAA
Owner or q ent(If ent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company s V r I • '_I e.. &A ., Qualifying Agent. I VfS'�'Q11 Q
II
Addresst(p0O IAN % r. . r ;City,CUM/Y/169 C State Gil- ' Zip 1/0
Office Phone.—110— 2-q 2- 0 i35'/ Job Site Contact Number
State Certification/Registration#,CCC1 3.319Sj E-Mail phi gQ.t(: g� ih @ `J Qnd' R Goy,
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer An ,vC.o4r 111'\-eS OR Exempt o Expiration Date'iY0130102 2
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 1OTILE (riiaddition�4j{�1ixirequirements of thi
. ...-. -, .. ..� y MTP -.. ... ._ -,
1•eemit, n
' - "1 710 additional"restnction's apiplicable '.inn iproperty' i.i is ( found(tuft public records ci i county,EiRg
here i additional,pearnits required;; governmental( 1 ;><p water.management districts;Ef
L� q ;0
ederal e1
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
R C•RDING YOUR NOTICE OF COMMENCEMENT. itn-n- l_,n-1
/, -(Signa, e of Owner or Agent) (Signature of Contractor) ,,�
S. ned and sworn t. or affi' ed),before me this- .ay of S' ned and sworn to • a fir -d)before me this L� day of
4(Z -,y _4,A• 0 am �� �� by fa an �'�L�l
/ (Si: • • •
,a�����,a JAYSON A BRIGHT �.t:mpl, SON ALBRIGHT
arpk., i ,;° k°��`Notary Public-State of Florida
�I *E Crary issionStere of 95473979a •�'x`>l'\•; Commission # GG 954739
•/°=_�', ■= Commission# GG >� FYI,
I ]Personally K •wn OR ,%a;{r;,t•' M Commission Expires [ I Personally KncLn OR ,,-'k. rbc My Commission Expires
'F F`C February'rye o ti\,,, y 7 ''nnN+ 04, 2024
'14-Produced Identificatior �r,,,��+ February 04, 2024 'VI-Produced Identification
Type of Identification: f ornoa` /Type of Identification: ty(-1\t)4 t-
D A.itrS \\Q AJ