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82 W 11th St - Roof CITY OF ATLANTIC BEACH BUILDING AND ZONING 800 SEMINOLE ROAD ATLANTIC BEACH FLORIDA 32233 INSPECTION PHONE LINE 904-247-5826 Application Number 02-00024776 Date 9/12/02 Property Address 82 W 11TH ST Application description Property Zoning . . . ". . . O B ATED Application valua ' n . . . 2i0.Q Owner -Contractor ARMSTRONG,' KIRK CROSBY ROOFING 82 WEST 11TH STREET 11222 PINE STREET, ATLANTIC BEACH FL32233 JACKSONVILLE FL 32258 (904) 745-8106. (904) 655-6156 Permit . . . BUILDING PERMIT Additional desc Permit Fee . . . - 25 . 00 Plan Check Fee . . 12 .50 Issue.Date . Valuation -. . 2100 Fee summary Charged �-'" 'Paid Credited '; e Permit Fee Total 25 . 00 25. 00 , . 00 . 00 Plan. Check Total 12 . 50 12 . 50 . 00 .00 Grand Total 37 . 50 37 .50 . 00 ''-� . 00 :.,5.. '',,,,,,,,, ,„,,,,,,o ("4" r) 1 c Ar44' BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER. "FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS"ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOC TION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. BUILDING OFFICIAL CITY OF ATLANTIC BEACH PERMIT CALCULATION SHEET \ cm Address ZII I '` {`— V• i� GM t, Date q • 1U • �L J Heated Square Footage @ 4LjekL"--- per sq ft = $ Garage/Shed $ ► dA per sq ft = $ I� s Carport/Porch —C-2324ee@ $ per sq ft = $ Deck $ per sq ft = $ Patio @ $ per sq ft = $ TOTAL VALUATION : $ D.A00 , e0,6 L5. $ ( K. dam Total Valuation 1st $ (,off., •90 l . $ lo. Remaining Value $S per thousand or portion thereof TOTAL BUILDING FEE $ 5 . + 1/2 Filing Fee $ I ?) ( ) Fireplaces @ $15 . 00 $. J c9 BUILDING PERMIT FEE $ 3 WATER IMPACT FEE $ SEWER IMPACT FEE $ WATER METER/TAP $ CAPITAL IMPROVEMENT. $ SEWER TAP $ ( ) RADON (HRS) . 0050 $ SECTION H PAVING ( ) $ HYDRAULIC SHARES $ CROSS CONNECTION $ ( ) SURCHARGE . 0050 $ OTHER $ eSLS�� GRAND TOTAL DUE $ ?; ?0 . ADDITIONAL PERMITS OR FEES : Mechanical ; Plumbing Electric/New Electric/Temp ; SwimmingPool Septic Tank ; Well ; Sign Finish Floor Elevation Survey ; Other CALCULATIONS and/or NOTES : o'- � L 1 OlAjl' 4 APPROVED s� CITY OF ATLANTIC BEACH SEP -�Pa BUILDING OFFICE City of Atlantic Beach SEP 10 2002 Building y 7tAltigitic Beach• 800 Seminole Road •Atlantic Beach, Florida 32233-5445 L‘. Phone: (904)247-5800 •FAX (904)247-5805 •http://www/Oyatlantic-beach.fl.us �• �' PERMIT APPLICATION FOR ROOFING � JOB LOCATION 02 L) V��4- ��`� OWNER OF PROPERTY Q�� j ()A IPHONE#6L'1 CONTRACTOR �vw K�• EA CONTRACTOR ADDRESS p j.16 i9, I .' ZIP X<.5 CONTRACTORS LICENSE NO. PHONE# Sj S-Q54. 0 R 5GY"dg-4(6, SCOPE OF WORK (,) Jr, u „ DIIJ Qj,I ,;„a, P [ j • ( I 11 t 'C l (L-:14„. . DECK SLOPE O , 1;7? GREATER THAN 2 : 12 y LESS THAN 2 : 12 ACTUAL VALUATION OF WORK $ ;• `; 'C.,C,, , . PRODUCT NAME& MATE r'�JJ�(�l � 1 k•`,.1%d'Ic �"`�, �"� G" 0" TO BE USED. 1,--,.;yr\�.�o, ( 0.�. I�.tE L ASTM DESIGNATION(S) I REQUIRED INSPECTIONS SHEATHING FINAL M 9 c I / O Nei LIBILITY INSURANCE POLICY SUPPLIED YES NO WORKERS COMP. POLICY SUPPLIED YES NO CONTRACTOR LICENSE SUPPLIED YES NO OCCUPATIONAL LICENSE SUPPLIED/ YES NO SIGNATURE OF OWNER SIGNATURE OF CONTRACTOR • e. "' NICUL LEIGH MOOHE • I/ SWORN TO& SUBS • :`''$E -itOlZ.. $f F da Y OF �/ 200 y cI'omm.expires ug '4-r..�•' Comm.No.CC 867747 ' AS TO OWNER NOTARY PUBLIC ° f N, � •h4. NICOLE LEIGH AMORE - AS TO CONTRACTOR .: Nota f 71T s( �r' 4. • y comm.expires Aug.30,2003 r''�� Comm.No.CC 867747 • Ac# 0 0 81 5 r STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATIONSEQ# 01070500833 CONST INDUSTRY LICENSING BOARD DATE I:Y Iid:1aU,4I:l1:l LICENSE NBR 07/05/2001 01900005 RC -0054616 The ROOFING CONTRACTOR { Named below HAS REGISTERED Under the provisions of Chapter 489 FS . Expiration date : AUG 31, 2003 (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) CROSBY, KENNETH BETRAM CROSBY ROOFING 11222 PINE ST JACKSONVILLE FL 32258-1666 JEB BUSH KIM BINKLEY-SEYER GOVERNOR DISPLAY AS REQUIRED BY LAW SECRETARY 2001 -2002 OCCUPATIONAL LICENSE TAX LYNWOOD ROBERTS OFFICE OF THE TAX COLLECTOR CITY OF JACKSONVILLE and/or COUNTY OF DUVAL, FLORIDA 231 EAST FORSYTH STREET ROOM 130, JACKSONVILLE, FL 32202 PHONE: (9041630-2080 FAX: 1904/630-1432 Note - A penalty is imposed for failure to keep this license exhibited conspicuously at your establishment or place of business. This license is furnished in pursuance of chapter 770-772 City ordinance codes. CROSBY ROOFING 05 KENNETH CROSBY PEDDLER OF SERVICE 11222 PINE ST JACKSONVILLE, FL 32258-1666 ACCOUNT NUMBER: 009251-0000-6 LOCATION ADDRESS: 11222 PINE S T 32258-1666 DESCRIPTION: CONTRACTOR, ALL TYPES County License Code: 770.307-001 County Tax: $11 .25 Municipal License Code: 772.309 Municipal Tax: $31 .25 Total Tax Paid: $42.50 a 1 VALID FROM OCTOBER 1 , 2001 TO SEPTEMBER 30, 2002 RCPT# : 001/30/9084/0270/08272001 DATE: 8/24/2001 AMT: $42.50 ATTENTION ***The Following Construction Contractors Require Additional Licensure*** . l ALARM POOL • ALUMINUM/VINYL RESiCEN I iAL • BUiLDiNG' ROOF NG ELECTRICAL SHEET MEtAL SOLAR- : • MECHANICAL PLUMBING IRRIGATION GENERAL • CARPENTRY WATER TREATMENT UNDERGROUNQ UTILITY HEATING AIR CONDITIONING • REFRIGERATION f This is an occupational license tax.only. It does not permit the licensee to violate any existing regulatory or zoning laws of the,County or City:- Nor does it exempt the licerisee from any other license or permit required by law. This is not a certification.of the licefisge's qualification. ;1 2001 -2002 OCCUPATIONAL LICENSE TAX LYNWOOD ROBERTS OFFICE OF THE TAX COLLECTOR CITY OF JACKSONVILLE and/or COUNTY OF DUVAL, FLORIDA 231 EAST FORSYTH STREET ROOM 130, JACKSONVILLE, FL 32202 PHONE: (904)630-2080 FAX: 19041630-1432 Note - A penalty is imposed for failure to keep this license exhibited conspicuously at your establishment or place of business. This license is furnished in pursuance of chapter 770-772 City ordinance codes. CROSBY, KENNETH BETRAM 05 CROSBY ROOFING - PEDDLER OF SERVICE 11222 PINE ST JACKSONVILLE, FL 32258-1666 ACCOUNT NUMBER: 047897-0000-8 LOCATION ADDRESS: 11222 FINE ST 32258-1666 DESCRIPTION: QUALIFYING AGENT, CONTRACTORS County License Code: 770.000-005 County Tax: N/A Municipal License Code: 772.325 Municipal Tax: $100.00 Total Tax Paid: $100.00 VALID FROM OCTOBER 1 , 2001 TO SEPTEMBER 30, 2002 • RCPT# : 001/30/9084/0269/08272001 DATE: 8/24/2001 AMT: $100.00 ATTENTION ***The Following Construction Contractors Require Additional Licensure*** ALARM POOL • ALUMINUM/VINYL I"�r•/'.■n rw ITI w � A■ ■�■ P'��w�A"'� rriCJiUCIv i IP'1L I�ViLuuv� rivvriivu ELECTRICAL SHEET METAL • SOLAR - MECHANICAL PLUMBING IRRIGATION ' GENERAL CARPENTRY WATER TREATMENT UNDERGROUND UTILITY HEATING AIR CONDITIONING REFRIGERATION • . This is an occupational license tax only. It does not permit the licensee to violate any existing regulatory or zoning laws of the County or City. . Nor does it exempt the licensee frq'm any other license or permit required :,y law. This is •ot a certification of the licensee'S qualification. • • ., • • 1 • _s_ • 'TAX COLLECTOR • 07-17-2002 STATE OF FLORIDA DEPARTMENT OF INSURANCE DIVISION OF WORKERS' COMPENSATION CERTIFICATE OF EXEMPTION FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation Law . EFFECTIVE 08/09/2002 EXPIRATION DATE 08/08/2004 PERSON CROSBY KENNETH B SSN 264-58-1074 FEIN 592978698 BUSINESS KENNETH B. CROSBY 11222 PINE STREET JACKSONVILLE FL 32258 NOTE: Pursuant to Chapter 440 . 1 0(1) ,(g) , 2 ,F . S . a sole proprietor , partner , or an officer of a corporation who elects exemption from the Florida Workers' Compensation Law may not recover benefits or compensation under Chapter 440 . PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF INSURANCE DIVISION OF WORKERS' COMPENSATION q 'A F CONSTRUCTION INDUSTRY �„ L CWORKERS'ECOMPENSATION LAW OF EXEMPTION FROM FLORIDA D NOTE: Pursuant to chapter 440.10)1),Ig1,2, F.S., EFFECTIVE: 08/0912002 a sole proprietor, partner, or officer of an corporation EXPIRATION: 0810812004 H who elects exemption from the Florida Workers' Compensation PERSON: CROSBY KENNETH R Law may not recover benefits or compensation under Chapter 440. SSN: 264-58-1074 E FEIN: 592978698 BUSINESS: KENNETH B. CROSBY 11222 PINE STREET JACKSONVILLE FL 32258 CUT HERE * Carry bottom portion on the job , keep upper portion for your records . Contractor Certificate I � w 1,7a CROSBY KENNETH B. This is to certify that is the qualifying agent for CROSBY ROOFING and had met all the requirements of law and this Board and is certified as a ROOFING CONTRACTOR contractor (expires September 30,2003) I No DC-40 Date David M. Pierson • Issued:10/1/01 CHAIRMAN CONTRACTOR CERTIFICATE This is to certify CITY OF JACKSONVILLE, FLORIDA I that the following CONSTRUCTION TRADES contractor has met . . . QUALIFYING BOARD all the requirements of law and this Board and therefore this • Type: ROOFING CONTRACTOR contractor certificate is renewed as follows: ,�,ll„ •%` No.: DC-40 0./A: CROSBY KENNETH B. C '•. C)d Date issued: 10/1/01 Name: CROSBY ROOFING Q� License year: 2001/2003 Address:11222 PINE STREET --• - • <t JACKSONVILLE , FL 32258-1666`J4Cks N\1\°.' u •I� Expiration Date September 30, 2003