374 8th St RERF22-0248 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
374 8TH STREET LLC 1750 BEACH AVE ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
5 STAR ROOFING SERVICES
LLC 6201 SPRING FOREST CIR JACKSONVILLE FL 32216
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
169942 0000 ATLANTIC BEACH
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
374 8TH ST REROOF SHINGLE SHINGLE ROOF $9000.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $100.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $104.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other
governmental entities such as water management districts, state agencies, or federal agencies.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 2Issued Date:
PERMIT NUMBER
RERF22-0248
ISSUED:
EXPIRES:
REROOF SHINGLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
RERF22-0248
(ex Building Permit Application Updoted 10/9/18
Gea .City of Atlantic Beach Building Department **ALL INFORMATION
ti 800 Seminole Road,Atlantic Beach,FL 32233 HIGHLIGHTED IN GRAY
Phone:(904)247-5826 Email:Building-Dept@coab.us IS REQUIRED.wee
Job Address:lothe Bene EiL SU09>nit Number:
AS et nen 169942 -G000
Non-Heated/Cooled
Legal Description ;;-
Valuation of Work(Replacement Cost)$q ,000-60 Heated/Cooled SF
e =Class of Work:?Finew DAddition DAlteration tepair OMove (Demo (Pool CWindow/Door
e Use of existing/proposed structure(s):ClCommercial Piresidential
¢?Ifan existing structure,is a fire sprinkler system Installed?:(Yes [No
2 ¢g es [m bmi
Describe in detall the type of w
|Re-o£1S 84 \ali2 pirein PL iQu-
Florida Product Approval #\OLL AW -By for multiple products use product approval form
OwnerInformation CChmler eeened ;praia a)
Name eH cee,PEC A address (0406 $4 he wh
City Am ZA State CC Zip 3351SPhone GOY ?S=T
E-Mail CPercn'G aol.com
Owner or Agent (IfAgent,Power of Attorney or Agency Letter Required)¢a-les ETO aoe
NameofCom CA AK N_Qualifying Agent S Vi
?Oa Zip
State Certification/Registration #
Architect Name &Phone #
Engineer's Name &Phone #
Workers Compensation Insurer OR Exempt a Expiration Date (
Application is hereby made to obtain a permit to do the work and installations as indicated.|certify that no work orinstallation 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.|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 othergovernmental 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 alt
applicable taws 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
RE "nn R NOTICE OF COMMENCEMENT.7Ae
{Signature of Owner orAgent)(Signature of Contractor)
{s +
u ned and sworn to (or affirmed)before me this day ofVvoa208,by.?
(Signature of Notary)
!Commissio#
GPRS?My Comm,Expires Jun 29,2024
Ayn OR BondedthroughNational NotaryAssn,
{]Produced ident P
Type of identification:
ersonally Known OR
{)Produced Identification
Type of identification:
othbY Brandy Dampier
¥2,NOTARY PUBLIC
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:
Cormm#GG975106
Expires 4/1/2024
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RERF22-0248