Permit Roof 1 Ahern Life Gd St. 2011 LAN._ fJr4
4 . .,
' ,,, f ' SA CITY OF ATLANTIC BEACH
, 800 SEMINOLE ROAD
"" ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
-. 0i31 9f '
Application Number . . . . . 11- 00002441 Date 8/04/11
Property Address 1 LIFE GUARD AHERN ST
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 4750
Application desc
reroof
Owner Contractor
CITY OF ATLANTIC BEACH BOHEMIA CO, INC (ROOFING)
LIFE GUARD STATION 3950 ST ISABEL DR E
1 AHERN STREET JACKSONVILLE FL 32277
ATLANTIC BEACH FL 32233 (904) 859 -3539
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 75.00 Plan Check Fee .00
Issue Date . . Valuation . . 4750
Expiration Date . 1/31/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 75.00 75.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 79.00 79.00 .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: 1 AHERN STREET, ATLANTIC BEACH, FL 32233 Permit Number:
Legal Description LIFE GUARD STATION - NO LEGAL AVAILABL Parcel #
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ 4.750 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 # FL21 21
For multiple products use product approval form
Describe in detail the type of work to be performed: COMPLETE RE -ROOF, REPLACEMENT WITH
JOHNS MANVILLE 60 MIL TPO MEMBRANE
Property Owner Information:
Name: CITY OF ATLANTIC BEACH Address: 1 AHERN STREET
C ATLANTIC BEACH . FL State _Zip 32233 Phone 904- 247 -5813 MICHAEL GRIFFIN, PATTY DRAKE
E -Mail or Fax # (Optional) PDRAKE @COAB.US, MGRIFFIN@COAB.US
Contractor Information:
Company Name: BOHEMIA ROOFING CO., INC. IVANA HODULOVA
Address: 3950 ST ISABEL DR E Qualifying Agent:
Office Phone 904- 859 -3539 Number 9 JACKSONVILLE 2-2114 State FL Zip 32277
Job Site/ Contact Number 9oa -96z -2114 Fax # 904-353 -2700
State Certification /Registration 4 CCC1328464
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 / certify that no work or installation has commenced prior to the
issuance of a permit and That all work will he 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 fin. a_ period of six (6) months at any time after
work is commenced. I understand that separate permits nuts, he .secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters,
Tanks 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.
/ hereby certify that / have read and examined Ibis application and know the same to he tree and correct. All provisions of Yaws and r dinanc governing this
type of work will he complied with whether specified herein or not. the granting of a permit does not presume to give authori 0 vat Je or cancel the
provisions of any olher/ed al, state, or local law regulann instruction or the performance of construction.
Signature of Ownerf i - Signature of
g Contractor
am , Imre Aft.
Print Name 7 f afe"7/7 Print Name 'Hob u LD Vi- 'UN A'
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wYPi''•, SHIR '>l GRASKised 01 26.10
.r i ` *.: MY COMMIS • N # DD 957760
.•,: .•. EXPIRES: February 14, 2014
s 'F c f h •' Bonded Thor Notary Public Underwriters