Permit Roof 116 Poinsettia 2011 1r
(:). I �� CITY OF ATLANTIC BEACH
': 800 SEMINOLE ROAD
r ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
Application Number 11- 00001731 Date 3/01/11
Property Address 116 POINSETTIA ST
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 2250
Application desc
reroof
Owner Contractor
COSGROVE BURGER ROOFING CO.
116 POINSETTIA STREET 134 -1 ERNEST STREET
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32204
(904) 355 -2756
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 65.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 2250
Expiration Date . 8/28/11
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 65.00 65.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 69.00 69.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: 116 POINSETTIA STREET, ATL. BCH Permit Number:
Legal Description 10-016 21- 2S -29E 0.057 SALTAIR SEC 3 Parcel # 170640 -0020
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ 2,250.00 Proposed Work heated /cooled non- heated/cooled
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool/spa window /door
Use of existing/proposed structure(s) (circle one): Commercial Residential
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval # FL 10124
For multiple products use product approval form
Describe in detail the type of work to be performed: REMOVE EXISTING ROOFING AND REPLACE WITH A
PEEL & STICK UNDERLAYMENT AND 30 -YEAR ARCHITECTURAL SHINGLES.
Property Owner Information:
Name: ELIZABETH COSGROVE Address: 22 GALE ROAD
City HAMPTON State NH _ Zip 03842 Phone (603) 502 -2216
E -Mail or Fax # (Optional) BETSY.COSGROVEOCOMCAST.NET
Contractor Information:
Company Name: BURGER ROOFING CO. Qualifying Agent: GARY BURGER
Address: 134 -1 ERNEST STREET City JACKSONVILLE State FL Zip 32204
Office Phone (904)355 -2756 Job Site/ Contact Number _ (904)237 -9664 Fax # (904) 358 -0733
State Certification/Registration # CCCO32514
Architect Name & Phone #
Engineer's Name & Phone # ,
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
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 laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a period of six (6) months at any time after
work is commenced. 1 understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters,
ranks and Air Conditioners, etc.
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 NOTICE OF
COMMENCEMENT.
1 hereby certify that I have read and examined this plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal, state, or local law regulating construction or the performance of construction.
�Q
Signature of Owner�(‘ i.,e S ignature of Contractor i i
Print Name .. ,' ad Z.,A j \ C.6 f? t Print Name i .. :. r/ tr
Sworn to and subsc ibed before me Sworn and subscribpOefore me
this -1 Day of , 20 \ thi ,,,'Day of R - /,' , 20)1
Notary Pu is ' peANNA M. ST. HILAIRE No . :tic R. MEREDITH
Notary Public - New Hampshire 7, 2 013 * t , y % * MY COMMISS # DD 900284
My Commission Expires September q 1) r EXPIRES: July 14, 2013 Revised 01 .26.10
r f2 FOF noe §' Bonded Thru Budget Notary Services