1483 Laurel Way RERF23-0029 Re-Roof Shingle permit & App 0!..A.N REROOF SHINGLE PERMIT PERMIT NUMBER
RERF23-0029
yr CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 2/21/2023
"-art ATLANTIC BEACH. FL 32233 EXPIRES: 8/20/2023
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:
1483 LAUREL WAY REROOF SHINGLE Re-Roof Shingle $15050.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170704 0020 HIDDEN PARADISE
COMPANY: ADDRESS: CITY: STATE: ZIP:
EMPIRE ROOFING SALES & 2806 -1 GI GIBSON RD JACKSONVILLE FL 32207
SERVICE
OWNER: ADDRESS: CITY: STATE: ZIP:
Jeremy Doan 1483 Laurel Way Atlantic Beach FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT I'
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.
1 BUILDING ROOF IN-PROGRESS INSPECTION REQUIRED INFORMATIONAL
Notes:
IN-PROGRESS INSPECTIONS ARE REQUIRED FOR EXTERIOR SIDING,WINDOW,AND DOOR INSPECTIONS,AND SHOULD BE SCHEDULED FOR THE FIRST
DAY OF WORK.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $130.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2 00
Issued Date:2/21/2023 1 of 2
Js
i"''"' REROOF SHINGLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RERF23-0029
800 SEMINOLE ROAD
ISSUED: 2/21/2023
st ATLANTIC BEACH. FL 32233 EXPIRES: 8/20/2023
STATE DCA SURCHARGE I 455-0000-208-0600 I 0 $2.00
TOTAL:$134.00
Issued Date:2/21/2023 2 of 2
0• " Building Permit Application updored10/9,18
City of Atlantic Beach Building Department **AU.INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us b n IS REQUIRED.
Job Address: 1 `)O3 1_4 -fl tLJ!•yl /`1T1Gtiu1C✓ct�v� 312_�
VPermitNumber: V--t12 -0O2
Legal Description t5 c}- i J 1- 2$- Q 6 •I. /4;44•h Alm,/iSe. arc 3 RE# 1 70 704- 176,10
Valuation of Work(Replacement Cost)S ISI 050 °° Heated/Cooled SF c21 A- ) Non- Heated/Cooled 17 (P
• Class of Work: ' New LAddition Alteration _:Repair L1Move lDemo DPool LWindow/Door
• Use of existing/proposed structure(s): ❑Commercial �tesidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s)be removed in association with proposed protect? =Yes(must submit separate Tree Removal Permit) 5 O
Describe in detail the type of work to be performed:
PNe- 406c -- `4- l
Florida Product Approval ff FL-• /i 3 55-• a _ for multiple products use product approval form
Property Owner Information FL, 1S•?16 .QOG
x Name )EI?ri"i 130-.`") Address I 4-183 LA, r61 W Ay
city I\ '; L t3 C . State FL_ Zip 32.233 Phone Clod 330-
E-Mail
30-E-Mail 3 :Yo L e_
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information tt_
Name of Company iQG v___�Tt .jt'St-SJS 7P+c .Qualifying Agent
Address or-I ;bsorN, 1A • J City "rdf n✓t lle State Zip 32.24-7
Office Phone Q()L{^ 1-1 0 C Job Site Contact Number 40 t-t 35v- i Li 41 / Kof-a q-0 n
State Certification/Registration# CCC 1 3,A,(e 00-7 E-Mail FfeG-esiiftde[,ewtPi rotrFi ADA 'al(•('
Architect Name& Phone it
Engineer's Name& Phone tt
Workers Compensation Insurer .c.-01.5A k 1FZr.,surefs icsrd OR Exempt 0 Expiration Date 1— I—c2 4
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 OBTAI -FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RE DING YOUR NOTICE OF COMMENCEMENT. r'
Si nature of Owner or Agent) (Signature ature of Contractor)
B g ) (5 g
Signed and sworn to(or affirmed) h f',fnrrnr th i of Signed and sworn to(or affirmed) before me tthis LU of
1,3D• ,,30,33 . h + ems— rdolli .9_2023,by 4'e r0 4v �
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_q•i;i4•': MERCEDES MCLEOD ( tgnatureofN.ta
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_ '„1� Notary<_ P ublic-State of Florida
Commission N HH 323856
a r\` My Comm.Expires Nov 2,2026
[ i P sonally Known OR Bonded through National Notary Assn. 1 Personally Known OR oar p Notary Public State of Florida
I r duced identtftcatic,- i — _ _— �(f Produced identification ? ; EMILY TABER
Type of Identification: [i.(`vJ SCJ � �� y e of Identification: �:. •F- °f N oS-U uy 1024 mission HH 19560
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State of Fonda.County of Duva:
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OF C CE'vLE\T ARE CONS3E REO! ROPER PAYNL TS UNDER CHAPTER 713.PART L SECTION
_111,1.FLORIDA STATUTES,AND CAN RESULT t YOUR PAYING T' CE FOR U ROVEME TS TO YOUR
PROPERTY. A NOTICE OF COfvSENCEME T 'MUST BE RECORDED AND ?OS i ON THE :OB
BEFORE rrr FIRST I'SPECTlON. 7 YOU: LNT=ND TO OBTAIN F7!ANCLNG, CONSULT WT: YOUR
LENDER OR A`: ATTORNEY BEFORE COMMENCNC WORK OR R=►COtRDTNO YOUR N T CE OF
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therein ar - t best of my-ictow;t,'+_'s_e and belief
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0;AR PUBl iC SIGNATURE-STA-c OF F_O'er-a,
(Aka.Nola*.Scz.loose
1J."'''•., MERCEDES MCLEOD
`�'- Notary Public-State of Florida ,
. (`i Commission#HH 323856
ov My Comm.Expires Nov 2,2026
,...Bonded through National Notary Assn. I