Permit Door/Drywall 401 Skate 2011 CITY OF ATLANTIC BEACH
s 800 SEMINOLE ROAD
"=� = ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 11-00002824 Date 10/27/11
Property Address . . . . . . 401 SKATE RD
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
sheet rock and 1 exterior door
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Owner Contractor
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CUMMINGS FAE LAVERN ET AL SUMMIT ROOFING AND CONST (BLDG)
RITTER HELEN M 1652 EMERSON STREET
401 SKATE RD JACKSONVILLE FL 32207
ATLANTIC BEACH FL 32233 (904) 725-4050
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Permit RESIDENTIAL ALT/OTHER
Additional desc . .
Permit Fee . . . . 60 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 1800
Expiration Date . . 4/24/12
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 60 . 00 60 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 64 . 00 64 . 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: S KA'fL �'' / #� ��- Permit Number:
Legal Description 1-OOT 12- i !Slo -
t-k t S "I A - pA-"� Z
S 'AParcel# t—7 1 S 3 0000
Eloor Area o q. t. q. t
Valuation of Work$ moo. _Proposed Work heated/cooled asp non-heated/cooled
Class of Work(circle one): New Addition Alteration C:_ei;d* Move
-- Demolition pooUspa window/door
Use of existing/proposed structure(s) (circle one): Commercial Rle- etltial
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes N/A
Florida Product Approval # (:�- `kQ Oq- I
For multiple products use product approval form
Describe in detail the type of work to be performed: 5 H- e r 9-o c,fe i9ez,,i,r- 0-i G ra4 r P-e c -.,
/k-r.!17 I- E-KTnz{.F�,A- Pz%>_-
Property Owner Information:
Name:Fi4c t-AVV*-#-JE Address: 4c,1 SkA-rC Xb,
City A-?'C i-AJ1 Z C_ State_Zip 3223 Phone -z-v"7- S Y tfI
E-Mail or Fax# (Optional)
Contractor Information:
Company Name: 'T- G &r c&j-i sf-J cri a-.,J
L6Qualifying Agent: F-OLIAt ! Z(1—O
Address:- 165z, Cw,c- S tJ `-r City State_fEL- Zip 3 Zz o'7
Office Phone Job Site/Contact Number 174--725-Lf 05c3 Fax#
State Certification/Registration# SRC- 13302-44
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,
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.
1 hereby certify that I have read and examined this a lication and know the same to be true and correct. All provisions of laws and ordinances governing this
type o1 work will be complied with whether speci ted 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 Inv regulating construction or the performance of construction.
Signature of Owner � A441 Signature of Contractor �-�--�
Print Name........L.......Gvw ..f. l ........................... Print Name �le-t y1-tj CN A c-A
SwornWnd subscribed before me Swornta and subscribed before me
this��`Day of DC706 E/2 20)/ this 2Day of 0C-rQ6e7)2- 20
t ary Public State of FloridaINI u
I liil�q�
Notary Public �, o My Commisciori D071 1559 dt bTht;a A Renfroe
oF F�6 Expires 1pt 8/2011
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loy,;ommission DD711559�oExpire.10/28/2011 R Vlsed 01.26.10
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STOP W
CITY OF ATLANTIC BEAC
BUILDING AND ZONING DEPART
NOTICE
his building has been inspected and: /1
� V�
General Construction ❑ Mechanical
❑ Concrete and Masonry ❑ Electrical
Plumbing ❑ Gas Piping
IS OT ACCEPTED
CORRECT AS NOTED BELOW, BEFORE ANY FURTHER WORK
I fl TA 1/0 �io V\ Rep 0i K-� O-e
DO NOT REMOVE THIS NOTICE
Inspector,.. _ Date• !O'a
Failure to respond to this Notice within l0 days *rill esult in this violation being forwarded
r
to the
CODE ENFORCEMENT' BOARD.
The posting of this Placard by its contents shall serve as due notice.