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Permit 1303 Ocean Blvd (vault) I 1 JOBADDRFM I "bO'�) O f�)Iv d , TYPE WORK `~ PRoPERTY oWNER TE LEMONE -�; Li(o--a 9 � CONTRACTOR TELEMONE PER3RT NIIMRER DATE INSPECTONS.• FOOTBVG SLAB TIE AE" LLVM 1vAIllly G FRAMING(COVER IIP INSULATION FINAL BUILDING CERTMCATE OF OCCUPANCY ELEOWCAL PERIM `t INSPECTIONS ROUGE' FINAL M CffA2V 'COIL PERMIT# I2VSPEC77ONS ROUGff FINAL PLL?,IM"G PERMI3 INSPECTIONS ROU G FUNDER SLAB TOPOUT WATER/SEWER FINAL NOTES• CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FLORIDA 32233 J INSPECTION PHONE LINE 247-5826 Application Number . . . . . 04-00029029 Date 9/20/04 Property Address . . . . . . 1303 OCEAN BLVD Tenant nbr, name . . . . . . REPAIR & REROOF SHINGLES Application description . . . ROOF Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 5000 Owner Contractor ------- --- - -- ----------- ------------------------ PRIDGEON, DONALD ROMANO ROOFING SERVICES 1303 OCEAN BLVD. P.O. BOX 33037 ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (904) 246-2929 (904) 246-5649 ---------------------------------------------------------------------------- Permit . . . . . . ROOF PERMIT Additional desc . . Permit Fee . . . . 83 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 5000 Fee summary Charged Paid Credited Due --------- ------ ---------- ---------- ---------- ---------- Permit Fee Total 83 . 00 83 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 83 . 00 83 . 00 . 00 . 00 i PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. 4-- Bb4U1*6.QFF%JAL7-w-ft- CITY OF ATLANTIC BEACH ROOFING PERMIT APPLICATION �"tf'73J't)V Date: I �/ JobAddress: ' Owner of Property: P+�r kCtn Address: ( �j cYmn-\\j6 • Telephone: Contractor: 9p14An/n W ee f l n/g 5'e,?✓ie-eS State License Number: CC -C DSr�l b 3 Contractor's Address: 3,0 W 9 X-re& e-T &Z.a.✓7"ic 13 Z/ 3.2 9 3 Telephone: 9LI 1� - ,'l 4/G, S.� 4�q Fax: 90 4/ 9,2 Scope of Work: w Deck Slope: 3A Z Greater than 2:12 Less than 2:12 Valuation of worki*,•rp Product Name (Example:Timberline): .3D Manufacturer(Example: GAF): iq2j=5t2 (7 ASTM Designation(s): . _jlk( Required Inspections: Sheathing a final Signature of Owner: Date: Signature of Contractor: Date: AS TO OWNER: Sworn to and subscribed before me this �' day of 20 State of Flg§i4t Chi ftAyj(t� YOJE-McIAW, � MY COMMISSION#CC 976739 Notary's'Signature• EXPIRES:December 8,2004 'EOF`�° G' ❑ Personally known ❑ Produced identification Type of identification produced AS TO CONTRACTOR: Sworn to and subscribed before me this S f day of_/ , 20e. State of Florida,County of Duval _ Notary's Signature.2M o %GWRIAJ.CASTERLINE-Mc1AUW, MY COMMISSION#CC 976739 ❑ Personally known EXPIRES:December 8,2004 ❑ Produced identification Type of identification produced 800 Seminole Road Atlantic Beach,Florida 32233-5445 Telephone: (904)247-5800 Fax: (904)247-5845 •http://www.ci.atlantic-beach.fl.us Page 1 Revised 2121/03 Book_ 12042 Page 758 �(d5 MIN. RETURN p110NI# NOTICE OF COMMENCEMENT (PREPARE IN DUPLICATE) Permit No. Tax Folio No. State of County of To whom it may concern: The undersigned hereby informs you that Improvements will be made to certain real property, and in accordance with Section 713 of the Florida Statutes, the following Information is stated In this NOTICE OF COMMENCEMENT. Legal description of property being improved: 2 l - v C�� z z3 Address of property being improved: �e ' General description of improvements: Z4�2�Z'1�_ A Owner. Addresses Z z Owner's interest in site of the improvement Fee Simple Titleholder (if other than owner) Name Address Contractor_�e m4lyt) o�g Se/"I CAr Address 3 D -f'rl ee-T- /���.4N c 13 c ,4 �J/ 3 ;- ;Z,4 -? Phone No. 9'0 Spy Surety(if any) Address Amount of bond$ Phone No. Fax No. Name and address of any person making a loan for the construction of the improvements. Name Address Phone No. Fax No. Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other documents may be served: Name Address Phone No. Fax No. In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.06 (2) (b), Florida Statutes. (Fill in at Owner's option). Name Address Phone No. Fax No. Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLY' OWNER Signed: Date: Before me this day of 2 d0 c, in the iocli PI$04 97089 County of Duval, State of Florida, has personally appeared Book: 4 Page: 758 Filed S Recorded 00/16/2004 01:46:24 PM Notary Pubic at Large, State of Florida, C unty of Duval JIM FULLER CLERK CIRCUIT COURT My commission expires:--iLg �-.,�e 1 DUVAL COUNTY RECORDING $ 5.00 Personally Known or TRUST FUND i 1.00 COPY FEE $ 1.00 Produced Identificati *"Y°/''� GWRIAJ.CASTERLINE-MdA0j,. CERTIFY $ 1.50 MY COMMISSION#CC REC ADDITIONAL f 4.00 OF 10 EXPIRES:DemmberR,29CA Cc: CITY OF ATLANTIC BEACH D For rSL�f i jv,. L. Higgins BUILDING / ZONING DEPARTMENT oerr J i sf 800 Seminole Road a r� Atlantic Beach,Florida 32233 (904)247-5800 (904)247-5845 Fax PLAN REVIEW COMMENTS Permit Application # Q 1 - 2 9,0:19 Property Address: 1303 0 0�AN BIM Applicant: R0 M No R 0QFl NG GtR\ l G� S Project: RtPA ' gtR(UF 5o) N G L'5 This permit application has been: lIA Approved ❑ Reviewed and the following items need attention: 16 Please re-submit your application when these items have been completed. Reviewed By: Date: I IO N CITY OF ATLANTIC BEACH V� PERMIT CALCULATION SHEET JiM' Date �• 1 - 'o�-'� Address (X Permit fee based on dollar evaluation as indicated on permit application. Heated Square Footage @ $ per sq ft= $ Garage/Shed @ $ per sq ft= 5 Carport/ Porch @ $ per sq ft= $ Deck @ $ per sq ft= $ Patio @ $ per sq ft= $ TOTAL VALUATION: $ $ sbeo $35.00 1s1 $1000.00 $ $35.00 Total Valuation Remaining Value Per thousand or portion thereof: CONSTRUCTION TYPE: TOTAL BUILDING FEE $ SS ZONING: + '/Z Filing Fee $ FLOOD ZONE: ( ) Fireplaces @$35.00 $ IMPERVIOUS SURFACE: BUILDING PERMIT FEE $ WATER IMPACT FEE S SEWER LMTACT FEE S WATER METER/TAP $ CAPITAL EMPROVEMENT $ SEWER TAP S C ( )RADON HRS .0050 S SECTION H PAVING S CROSS CONNECTION $ ST ( ) SURCHARGE $ OTHER $ GRAND TOTAL DUE $ g� CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FLORIDA 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 04-00028245 Date 5/11/04 Property Address . . . . . . 1303 OCEAN BLVD Tenant nbr, name . . . . VINYL SHAKE SIDING Application description . . . SIDING Property Zoning TO BE UPDATED Application valuation . . . . 15000 Owner Contractor --------------------- --- ------ ------------------ PRIDGEN, DONALD THE DESIGN & BUILD GROUP, INC. 1303 OCEAN BLVD. 394 9TH ST . ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (9 04) 241-2228 ---------------- ------------------------------------------------------------ Permit . . . . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 105 . 00 Plan Check Fee 52 . 50 Issue Date . . . . Valuation . . . . 15000 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 105 . 00 105 . 00 . 00 . 00 Plan Check Total 52 . 50 52 . 50 . 00 . 00 Grand Total 157 . 50 157 . 50 . 00 . 00 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 REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. BUILDING WFICIAL Cc: CITY OF ATLANTIC BEACH JS BUILDING / ZONING DEPARTMENT s Hieeins S� 800 Seminole Road 1 Atlantic Beach,Florida 32233 v~ (904)247-5800 (904)247-5845 Fax PLAN REVIEW COMMENTS Permit Application # ON - d-S-)--4f S Property Address: 11303 ©ccafn Elly Applicant: Project: Vi This permit application has been: Approved "viewed and the following items need attention: C� Please re-submit your application when these items have been completed. Reviewed By:S Date: � /l"y 4 (+ k J .w CITY OF ATLANTIC BEACH SIDING PERMIT APPLICATION Date: Job Address: 1�U Owner of Property: ! ) Address: ?Q 0c-,4/ Telephone: ?&' C-Q Legal Description: Block Number: -Y Lot Number: r Zoning District: I yW,4Z-4y Siding Contractor: Contractor's Address: Telephone: .2-,q, ) 2-72--Z-R' 2-41—- I" 004's Describe proposed use and work.to be done: f����(A�-� Present use of land or building(s): _, /Z&/LV x0j—„P, Valuation of proposed construction: �t/=5�zzo Is approval of Homeowner's Association or other private entity required? Ale If yes, please submit with this application. Procedure: In order to expedite issuance of permits, please follow all steps and provide all information as appropriate. Incomplete applications may result in delay in issuance of permit. Step 1. Attach detailed information on product to be used. Step 2. Attach details concerning attachment of product,i.e.,fasteners,etc. I hereby certify that all information provided with this application is correct. Signature of Owner: �OL L �t 0--r + —P Date: 1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of the 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 federal,state or local rules,regulations,ordinances,or laws in any manner,including the governing of construction or the performance of construction of the property. I understand that the issuance of this permit is contingent upon the above information being true and co ect and that e the plans and supporting data have been or shall be provided as required. i �� v Signature of Contractor: Date: 800 Seminole Road .Atlantic Beach,Florida 32233-5445 Telephone: (904)247-5800 •Fax: (904)247-5845 •http://www.ei.atiantic-beach.fl.us Page 1 Revised 1/17/03 ` Address and contact information of person to receive all correspondence regarding this application(please print). Name: Mailing Address: Telephone: Fax: E-Mail: AS TO OWNER: Sworn to and subscribed before me this day of U .20 State of Florida,County of Duval .......... JENNIFER HLUETER Notary's Signature: lAk ;= MY COMMISSION#DD 121301 •. EXPIRES:May 27,2005 personally known F' Bonded Thru Notary Public Underwriters P„ Produced identification p Type of identification produced' `�L, f V� j- AS TO CONTRACTOR: Sworn to and subscribed before me this r +k day of '�' ,20Z. State of Florida,County of Duval Notary's Signature: r, r'P JENNIFER SCHLUETER [personally known MY COMMISSION#DD 121301 � produced identification 'e R Bonded h rruu Notary Public UnMay �riters Type of identification produced 800 Seminole Road •Atlantic Beach,Florida 32233-5445 Telephone: (904)247-5800 Fax: (904)247-5845 •http://www.ci.atiantic-beach.fl.us Page 2 Revised 1/17/03 5 MIN. RETURN Vc# 2004145722 ook: 01 PHONE# 1791 a e: 2oi Filed 6 Reco Prded NOTICE OF COMMENCEMENT 05/07/2004 01:22-03 PPI JIM FULLER A State of CLERK CIRCUIT COUkT f Z0 A uy. Tax Folio No. 1?11URL_C.4UNTY - N County of u 1/V L RECORDING � S•0© TRUST FUND !` 1.00 pl To Whom It May Concern: it The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT. 0+ N Legal description of property being improved: Address ofpro a being impr ved: / G 0 General description of improvements: f ✓ Owner: ! D Address: 13aC.L&IJ /c_ Z Owner's interest in site of the improvement: Fee Simple Titleholder(if other than owner): Name: Address: P( • Contractor; uox Address: 315 e�° Phone No: 4,L - Fax No: Surety(if any): Address: Amount of Bond S Phone No: Fax No: Name and address of any person making a loan for the construction of the improvements. Name: Address: Phone No: Fax No: Name of person within the State of Florida,other than himself;designated by owner upon whom notices or other documents may be served: Name: Address: Phone No: Fax No: In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.06(2xb),Florida Statues. (Fill in at Owner's option). Name: Address: Phone No: Fax No: Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLY _OWN Signed: � Date: � 7 � Before me this day of vA & the County of. val, State-of Florida,has perso allya p 4LS ed -I--- Not#Public aqmge,State of Florida,County of Duval. My commission expires: Personally Known: or Produced Identification: j-6 -D i JENNIFER SCHWETER %; »• MY COMMISSION#DD 121301 �= EXPIRES:May 27,2008 ' �a.,• Baged Thru Notary Public Underwiaerg FAX NQ, :904 519 1301 88J16/2AA3 97114 9042697961 Aug. 18 2003 08:42AM P1 MATTDALVCZ-TL-r Ct�WC J P'AGE p \010 PERFORMANCE SIDING APPROVE D �i f, Jr ATLANTIC BEACH 3UILDING OFFICE PLPN.0TSMourrx SHHAIE MAY 112004 _ 2001 Certification of SpecificationY: DESCRIPT19H Portsmouth Shake siding looks like wood shingles but does not require the maintenance,that is common to wood products. Portsmouth Shake siding is molded from natural cedar wood shingles. Portsmouth Shake siding is appropriate for use in new construction and remodeling. MATERIAL RgQ MEMENTS Portsmouth Shake siding is produced from a modified(ASTM D 792)outdoor polypropylene copolymer and also known as a reirforoed Thermoplastic polyolefin(TPO). The material has a solid color throughout and is UV stabilized. It meets or exceeds the following tests TABLr; 1 Tensile Modulus, ASTM D 638(psi) Flexural Modulus ASTM D 790(psi) 188 000 Flexural Strength, ASTM D 790 (psi) 4.B30 Notched izod ASTM D 526 2.0 f 4bs.lin Gardner 1 23 ass C ASTM D 5420 180 in-lbs. T . Sum Rete, ASTM 0 635 _ Horizontal Bum Classified 11.88 Mwminuto Optical Density of Smoke ASTM E 662 240.40 Average Corrected'Specific Optical Density FIRE SAFETY When polypropyierse matwW is exposed to considerable heat or flame the polypropylene will soften, melt or bum and may possibly expose the material underneath. Care needs to be taken when selecting underta»ymOnt materiels because many are made from organic materials that are combustible. Fire properties of undsdayment materials must be established prior to their installation. AN burning materials should be installed in accordance with local, state (provincial) and federal fire regulations and building codes. FROM :AMERICAN WHOLESALE FAX NO. :904 519 1301 Aug. 18 2003 08:43RM P2 Y 08/16/2003 07:14 9042607961 MATT$AUMEZSTER CRANE PAGE 03 jNI!TALLLATION Complete instructions are available. Please review prior to installation. vItARRANTY Crane Performance Siding supports Portsmouth Shake siding products with a Lifetime Limited Warranty that is transferable. WEATtIERiNG REQUIREMENTS Portsmouth Shake siding in continually tested for weatherability in both light and dark colors. Port9mouth Shake siding is manufactured from the highest quality outdoor material that is designed specifically for exterior applications. ADDITIONAL PRQDUCT CHARACTERISTICS Portsmouth Shake • 14" panels (double course)exposure by 48" exposure • 22 panels per 100 square feet of coverage D Material thickness = A 00 inch • Panel weight = 3.5 pounds • Molded cedar grain appearance from actual cedar • Color Is spectropho ametricelly controlled FROM :AMERICAN WHOLESALE FAX NO. :904 519 1301 May. 10 2004 11:39AM P2 CRANE PERFORMANCE SIDING PRODUCT SPECIFICATIONS PA1f1' 1 Gi•:NiCRAT, 1.01 Scope of Work Furnish all necessary labor,mate". and cquipmant,fer complete installation of Grano Pe rfo m:utec Siding Vinyl Siding and related work as shown ori d"wings or specified herein. 1.02 References Amorican Society fir Testing slid M.a tandard Specification for Rigid Poly Vinyl Chloride(PVQ Siding. i) 256 Test Methods for Impact Resistance of Plastic.and P.lectrical Imulating Material D 639 Tact Method for Tensile Properties of Plastics D 648 Test Method for Deflection Temperaturc ofPlaslics Under Flexural Load i) 696 Test Methnd for Coefficient of Tinea of Thcnwl Expansion of Plastic, D 1929 feat Mcthod for Ignition of Properties of Plastics T)2943 Test Method for Tensity of Smoke from the Auming or Tkeotnpostfito of Plastics D3679 Standard Specification for.Kigid Poly Vinyl Chloride(PVCJ Siding T)4226 Tett Methods for Impact Resistarxc of Rigid Poly Vinyl Chloride(FVC)Building Prodilcis 1.03 Submittals Submit samples of siding design.si'Ae and color for approval. 1.04 Quality Assurance Manutacturcr to certify that vinyl siding as supplied meets or exceeds the conditiums specified in section 2.02 Materials. Regulatory Compliance: t. National Building Code—R00k Research 0974 t 2. Starulard)3uildling(,cgdc. S13C:(.1(:otnpliance Report#2223 3. tlnifonm Building Code—", O F..valuation Report NF,R-3378 4. IItJU--NIU Minimum Property Standards S. Texas Depaameot of.Insuratrce--13011 1.05 IDelinry,Storm and tlaaoWng Deliver vinyl products is original pa kaging. Each box to be clearly marked with the siding style,color and identifying lot number. Prior to application,vinyl siding and accessories are to be stored in an am that is cleats,dry and out of direct sunlight Do not store in location where temperature may exceed 130 degrees F. Ratedle material in a manner to prevent damage. Do not allow siding cartons to crease. Warranty 1Jpon cmMle6nn provide a written Transferable,idedine Limited Warranty. PART 2 PRODUCTS MXnafactarer Material to be supplied by Crane Performance Siding,(;oluvibus,UH 43216. (900)3M-8472 ww•w.cranesitling.u7m Materials All(}ane Performance Siding,V'rnyi Siding,Soffit and Accessory Products ohalibe extruded Poly Vinyl Chloride(PVC)and shall conform u,all of the requirements established by ASPM Specifications 1)3679, developed in cooperation with the ivilusxy and ptthlished by the American Society for Testing and Materials. Vinyl Siding."I be VSI certified. PPOVE CITY OF ATLANTIC BEACH BUILDING OFFICE MAY 112004 (Y: FROM :AMERICAN WHOLESALE FAX NO. :904 519 1301 May. 10 2004 11:39AM P3 All Crate Pcrforinancc Sitting mcot:t or cxccetb the following properties' Impact Slrangth (v)74'P 2.12 ft.ib./in,of notch(ASTM T)256) 'Impact Strength rn?32'T 1.80 0.lb.tin.of notch(ASTM D 256) 'rcntilc Strength 7.331 psi(ASTM D 638) Modulus of Elasticity 4103308 psi(.'ASTM D 638) Goefitcieot of Linear Expansion 1•.17 x 10-5 in./in.F'(ASTM r)696) Warp <1/8 in.(ASTM 1)3679) Heat Shrinkage 0.01) (ASTM T)3679) Weatherability :No cracking,peeling,chipping or surface defects Surface Oistortion 14n distortion at 120'F(ASTM 1)3679) ImpactRewtancc 76.7 inAb.(ASTM D 4226) Fire Resistance Characteristics: Average Time of BurniiV °S sec.(ASTM D 63 5) Average Extent of Burning 9.4 mm(ASTM D 635) Plasma.Spread 21)(ASTM 1s 34) Smoke Density 390(ASTM E 84) Tg rition Properties Self Ignition did not occur. At 797'F mmple begati to smolder,fmd confined until consumed(ASTM D 192y) Siding Dinwasioam and Descriptions: SELECT APPUCAB.LE DPCCRTPI'ION Premium Pointe 360 .046 Average Thickncss,True Mi1Wcl Finish,'/-"panel projc ctioq w0ra thick.092" trill rollover nailing hem,(Select ProJlle)Double 4"Clapboard-Length 16'8", Width 8";Double 4-I h"Dutchltp Length 16'6",Width 9 Market Square .042"Average Thidwcss,Cedargain Finish,5/8" pawl projection,blegri-Lock locking system snaps panels securely together,(Select Pm/lle)D mble 4' Clapboard-Length 12'6",Width 8'-,Double 4-1/2"1)utchlap-Length 12'1", Width 9";T)ouble S'Clapboard-Length 12',Width 1(r. Carolina Sands .044"average Thickness,Natural Smooth Finish,5/8"panel projection.Select Proflie)6-1/2"Beaded--Length 12'4",Width 6-1/2". American Dream .040"Average'rhicknem,Woodgrain Firth*'r4"panel projection,Windbracer lock system„(Selec►Prof+le)Double 4"Clapboard--length 12'6",Width 8".. 13ouble 4"L'utchlap-Length 12'6",Width 8";Double 5"Clapboard-Length 12', Widtb l0":Double 5"Dutchlap • Length 12',Width 10. AD Value .038"Aventite'1'hicknem,Woodgrain Finish,''A"panel projection,(Select Prgftle) Double 4-1/3"Dutchlap--Length 12'1",Width 9":Triple 3-1/3"•-Length 12', Width 10". &"Clapboard .042"Average Thicknetis,Wo(xlw rt Finish,Length 12'6".Width 8". C(N..OR Siding color shall be at specified by architect. INTERLOCK Siding panels are made with post-form style lock with positive intalo ck. 13oth encu of the panel arc factory cut and notched for overlap. L FROM :AMERICAN WHOLESALE FAX NO. :904 519 1301 May. 10 2004 11:39M P4 'lhe vinyl siding and accessories shall he insUdled in accml;;uwo with tlu;boat practice,with all.joint memhers plumb and tragi. 3.1A Fier!Quality Control ARcr invtallatien of siding,check entire surface for obvious Daws or defects. Roplac c and repair any prohlcm'Areas. J.t1.4 (acsn-lJp After the vinyl siding has been applioxl,clean a9 na cwyary to rcawve all fuWcrptints and soiled areas. Upon completion of the siding application,the cntiro arca is to be cleaned,removing all scrap,packaging and unusedbuitding materials. FROM :AMER I CAN WHOLESALE FAX NO. :904 519 1301 May. 10 2004 11:40AM P5 WEEP HOI FS Small holes under the bottoin Mitt prevent vapor build-up acid allow accunuilated tttoisture to escape. SoiTrt T intension and Descriptions: CF_.UCT APPLICABLE DESCRIPTION Air Fla.% tit Natural Smooth Finish,W Depth,Length 12',Width 12".Center-vented (lanced)-ventilation,3.69 sq/ini%Wk roll-vvntcd-ventilation,11.07 sq/in/Ktl`1 and Nun-vetted. Premlew Pointe Soffit Natural Smooth Finish,%,"Depth,Length 12',Width 10",Concealed Vent- ventilation,2.2 9g1WY /t1 and Non-vcnted. Double S"SoMt Natural Smooth Finish,'f2"Depth,Lotngth 12'6',Width 10",Fully PerJinated- ventilxtioni;4,78mghn/sy/rt and Sofia 6"leaded SnfAt Matte Finish,Longlk 12'6",with 6"Concealed Vcnl-vcntilalion,1.2sglin/xVJ1 and Solid. 2.01 Accessories Accessories to he equal to di mension s and properties ac shown in the drawing and a%required for complete instaflatioxi. Accessories shall be produced from compound materials wiih comparable properties as the Siding. Schedule of Accessories I. Starter Strip:Metal 2. Starter Strip:Vinyl 3. Finish Trim 4. Dual Undemill Trim 5. Outside Corners:3 picec sysicin:including Cotner Cotinocwr,5"laneals with foam insert.Wide Architectural Corner Post,True Milled outside corner post,Woodgrain outaide corner past. G. Inside Comer Post 7. Architectural Fseen inig:5"W>exlow Lineals with faxen inxerts S. Architectural%sertiafs:3-112"Window Lincals with foam i iscrls 9. 2-1/2"Window/door Casing Channel 10. Gable Thin:5'Lincals 11. frieze Board:5'Ennals 12. Soffit Trim:F Charmel9 13. Soffit Trim:grown Molding 14. Miscellaneous Channels to suit.project comditims. l'AXt't i xxxctnioN 3.01 KISMIMdon Confirm that all critical dinx=ions arc as%pccificd in lbs drawings. Examine subslrite flaws and dol-cu. 3.02 Preparation Any substrate flaws or defect.%must be repaired before the vinyl siding is applied. Vinyl siding must be applied to walls that arc in plane and free front obstructions. 3.0.3 Installation Insall in accordance with the latest edition of the Vinyl Siding Installation"A How-To Guide"published by the Vinyl Siding Institute of the Plastica Industry. A CITY Off' ATLANTICBE 'A' 800 SET1,41NOLEPRO-AD ATLANTIC BEACH,i"i 3223 INSPECTION PHONE ONE LINE 247-5826 INSPECTION EMAIL REQUEST: B uildin-deptki,woab.us Application Number . . . . . 07-00000566 Date 4/26/07 Property Address . . . . . . 1303 OCEAN BLVD Application type description PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc re-pipe/ cold water only/9 fixtures ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ PRIDGEN, DONALD B & G PLUMBING 1303 OCEAN BLVD. 13997 BEACH BOULEVARD ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32224 (904) 223-3585 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . Permit Fee . . . . 98. 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 10/23/07 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 98 . 00 98. 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 98 . 00 98. 00 . 00 . 00 PERMIT.IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH PLUMBING PERMIT APPLICATION r J) J r wr*` Date: Property Address: UP,? dC-t +9 V �• - Owner: 'ti p A✓G= Telephone#: z q4 - Q Q ; `? Contractor: to V -AJC Co- Telephone m: Contractor Address: 2,23Z Cp0-e00VLAr2—::�' 'Fax#: - 2 ec) LV , In consideration of permit given for doing the work as described in the above statement,we hereby agree to perform said work in accordance with the attached plans and specifications which are a part hereof and in accordance with the City of Atlantic Beach ordinance and standards of good practice listed therein. Installation of plumbing and fixtures must be in accordance with the most recent edition of the Southern Standard Plumbing Code. Plumbing Type: If other construction is being done on this building or site, ❑ Ne list the building permit number: e-Pipe Number of Fixtures: Bath Tubs �_ Showers _ Closets Shower Pans Dishwashers _� Sinks Disposals Urinals Floor Drains Washing Machine 02 Lavatory Water Sewer �` Water Heaters Other Fees Permit Issuing Fee: $35.00 Total Fixtures: _9 X$7.00 + $35.00= ge QO 800 Seminole Road - Atlantic Beach, Florida 32233-5445 Phone: (904) 247-5800- Fax: (904) 247-5845- http://www.cl.atiantic-beach.fl.us PREPAZED 8/06/03, 8 :36 :35 INSPECTION TICKET PAGE 6 UITY OF ATLANTIC BEACH INSPECTOR: LARRY J HIGGINS DATE 8/06/03 ------------------------------------------------------------------------------------------------ ADDRESS . : 1303 OCEAN BLVD SUBDIV: TENANT, NBR: REPLACE EXISTING HVAC CONTRACTOR B & G SERVICES PHONE (904) 246-8971 OWNER PRIDGEN, DONALD PHONE PARCEL 171835-0000- - APPL NUMBER: 03-00026545 MECHANICAL ONLY ------------------------------------------------------------------------------------------------ PERMIT: MBCH 00 MECHANICAL PERMIT REQUESTED INSP D CRIPTION TYP/SQ COMPLETED RESULT SULTS/COMMENTS ----------------------- --------- --------------------------------------------------------------- 34 01 8/06/03 LJ ME FINAL TIME: 08:00 �q`y GARY 246 8971 -------------------------------------- COMMENTS AND NOTES -------------------------------------- PREPARED 8/06/03, 8:41:24 INSPECTION TICKET PAGE 1 CITY OF ATLANTIC BEACH INSPECTOR: LARRY J HIGGINS DATE 8/06/03 ------------------------------------------------------------------------------------------------ ADDRESS . : 1303 OCEAN BLVD SUBDIV: TENANT, NBR: RENEWAL OF PERMIT #23959 CONTRACTOR BROOKS & LIMBAUGH ELECTRIC PHONE (904) 241-9051 OWNER PRIDGEN, DONALD PHONE PARCEL 171835-0000- - r APPL NUMBER: 03-00026624 ELECTRIC ONLY ------------------------------------------------------------------------------------------------ PERMIT: ELEC 00 ELECTRICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS S ---------------------------------4------------------------------ -- -f- --- -------------------- 23 018/- �Q 06/03 LJ FINAL TIME: 17:00 -------------------------------------- COMMENTS AND NOTES -------------------------------------- CITY OF 4&4A& ate --- Office of Building Official REQUEST FOR INSPECTION /- Date 1,2-" —3 Permit No. D Time A.M. Received _ Job _ ess cality ! / ) Owner's I ^ / / Name Contractor `_� BUILDING CONCRETE ELECTRICAL PLUMBING MECHANICAL Framing ❑ Footing ❑ Rough Wiring ❑ Rough ❑ Air Cond.& ❑ Re Roofing ❑ Slab ❑ Temp Pole ❑ Top Out ❑ Heating Insulation ❑ Lintel ❑ Final ❑ Sewer ❑ Fire Place ❑ Pre Fab READY FOR INSPECTION Mon. Tues. Wed. Thurs. Friday A.M. Inspection Made RM. Inspector Final Inspection ❑ Certificate of Occupancy ❑ Date LANT�c 1)RIOP OF ADDITIONS or • " • D• NOT REMOVE JOB ADDRESS DATE THIS JOB HAS NOT BEEN COMPLETED The following additions or corrections shall be made before the job will be accepted $15M REINSPECT FEE It is unlawful for any Carpenter, Contractor, Builder or other persons, to cover or cause to be covered, any part of the work with flooring, lath, earth or other material, until the proper inspector has had ample time to approve the installation. After additions or corrections have been PLUMB made, call 247-5826, Building Depart- ment for an inspection. Field Inspectors ELEC are in the office from 8:00 a.m. to 5:00 BLDG p.m. Monday through Friday. fry CITY OF ATLANTIC BEACH J 800 SEMINOLE ROAD j s r ATLANTIC BEACH,FLORIDA 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 03-00026545 Date 7/22/03 Property Address . . . . . . 1303 OCEAN BLVD Tenant nbr, name . . . . . . REPLACE EXISTING HVAC Application description . . . MECHANICAL ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 Owner Contractor ------------------------ ------------------------ PRIDGEN, DONALD B & G SERVICES 1303 OCEAN BLVD. P. O. BOX 330032 ATLANTIC BEACH FL 32233 ATLANTIC BEACH, FL ATLANTIC BEACH FL 32233 (904) 246-8971 ---------------------------------------------------------------------------- Permit MECHANICAL PERMIT Additional desc . . Permit Fee . . . . 87 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 87. 00 87. 00 .00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 87 . 00 87 . 00 . 00 . 00 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 REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. BUILDING OFFICIAL a BUILDING AND ZONING INSPECTION DIVISION CITY OF ATLANTIC BEACH ATLANTIC BEACH, FLORIDA 32233 APPLICATION FOR MECHANICAL PERMIT IMPORTANT—Applicant to complete all items in sections I, II,III, and IV. I. Street Address: 1303 OCEAN BLVD. LOCATION OF Intersecting Streets:Between And BUILDING Sub-division H. INDENTIFICATION—To be completed by all applicants. In consideration of permit given for doing the work as described in the above statement we hereby agree to perform said work in accordance with the attached plans and specifications which are a part hereof and in accordance with the City of Atlantic Beach ordinances and standards of good practice fisted therein. Name of Mechanical Contractors Contractor(Print) B&C SERVICES Master GARY LOOS Name of Property Owner Signature of Owner Signature of Or Authorized Agent Architect or Engineer III. GENERAL INFORMATI 1 A. -Type of heating fuel: B. lX Electric IS OTHER CONSTRUCTION BEING DONE ON THIS 0 Gas: _LP _Natural _Central Utility BUILDING OR SITE? ❑ Oil Cl Other–Specify IF YES,GIVE NUMBER OF CONSTRUCTION PERMIT IV. MECHANICAL EQUIPMENT TO BE NATURE OF WORK INSTALLED 4I Residential or Commercial ❑ New Building (Provide complete list of components on back of this form) 2 Existing Building 0 Heat _Space _Recessed —Central _Floor I Replacement of existing system OA Air Conditioning: Room Central Cl New Installation o system 0 Duct System: Material Thickness Cl Extension or add-ono existing system Installed) Maximum capacity cfm Cl Other- Specify ❑ Refrigeration Q Cooling tower. Capacity gpm 0 _Fire sprinklers` Number of heads THIS SPACE FOR OFFIC.X.USE ONLY 0 Elevator: Manlift_Escalator (Number) (Received) 0 Gasoline pumps (Number) 0 Tanks (Number) Remarks 0 LPG containers (Number) 0 Unfired pressure vessel 0 Boilers permit Approved by Date Cl Other–Specify Permit Fee LIST ALL EQUIPMENT AIR CONDITIONING AND REFRIGERATION EQUIPMENT Number Units Description Model Number .Manufacturer Capacity Approving ons Agency 1 WATER TO AIR HP EM042 FHP 2 U L HEATING–FURNACES,BOILERS,FIREPLACES Number Units Description Model Number Manufacturer Capacity Approving (BTU) Agency TANKS How Many Nominal Capacity Type Liquid Name of Serial Approving And Dimensions Contained Manufacturer No. Agency CITY OF ATLANTIC BEACH DEPARTMENT OF BUILDING 800 Seminole Road-Atlantic Beach, FL 32233 -Tei: 247-5826- Fax: 247-5877 ELECTRICAL PERMIT PERMIT INFORMATION — __ _ LOCATION INFORMATION ---------- — Permit Number. 239-60-- Address: 1303 OCEAN BOULEVARD Permit Type: ELECTRICAL ATLANTIC BEACH, FLORIDA 32233 Class of Work: REPAIR j Township: 0 Range: 0 Book: Proposed, Use: Lot(s): Block: Section:0 Square Feet: I Subdivision: Est. Value: Parcel Number: Improv. Cost: O —_ - —_— WNER INFORMATION Date Issued: 4/01/2002 Name: DON PRIDGEN— J' Total Fees 25.00 Address: 1303 OCEAN BOULEVARD Amount Paid: 25.00 ATLANTIC BEACH, FLORIDA 32233 Date Paid: 4/26/2002 I Phone: (904)246-2929 _ Work Desc: ESS1001 PH3W240V SEURW ALUM REPLACE LINE SIDE BURNED SERVICE CABLE CONTRACTOR(S) _ APPLICATION FEES j BROOKS & LIMBAUGH ELECTRIC - 25.00 - N . ::. VN }y dy YS If ?iY" R-!` 1 al .y, rwuR+� ,� 0 ,,7 'y. � �. `,. 'L����Lt^N•i3k � '��$ "f�nJ���'sy NOTICE IF a L OtsTli}AT IrIAT. �3 �� -- ?R ECTION BUILDING MATER111 SPACE, AND I MUST BE CLEARED t . "FAILURE TO COM hNM # f L-AW THE PROPERTY OWNER1 ISSUED ACCORDING'TO APP n SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE I Optic: CYQU Types X Drarer: 1 r- Date: 41BM 61 Nioeipt ao: _ B E--AC,--H- -—A -- _ -=- 14 PAINTS-�111DIF 1. l2S.N ATLA-Nl'IC BEACH BU LDING D T. N14N1�2UN i --- __— ------- CK Cam 1516 SIN.N_,i --Y313-Of�-1s11—-- ihWl 1/19/II2 Tin: I4:b:r1 CITY OF ATLANTIC BEACH, FLORIDA E:= APPLICATION FOR ELECTRICAL. PERMIT TO THE CHIEF ELECTRICAL INSPECTOR: DATE:� � IMPORTANT NOTICE: IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WORK AS DESCRIBED IN TIIE FOLLOWING, WE HEREBY AGREE TO PERFORM SAID WORK IN ACCORDANCE WITH THE ATTACHED PLANS AND SPECIFICATIONS, WHICH ARE A PART HEREOF, AND IN ACCORDANCE WITH THE ELECTRICAL REGULATIONS, CODES AND CITY OF ATLANTIC BEACH ORDINANCES. gm& E ECTRICAL FIRM: J f MASTER E CTRICI N SIGNATURE JOURNEYMAN J�1 D prll� ` NAME _ � — ADDRESS: 63 RFD BOX BLDG.SIZE BETWEEN: RES. ( APT. I 1 comm. ( ) PUBLIC ( I INDUS. 4 1 NEW l ! OLD ( ) REW. ( ► ADDITION ( ) TRAILER l 1 TEMP. ( ► SIGNS 1 1 SO, FT. SERVICE: NEW 1 1 INCREASE ( ) REPAIR ( --I- FEE CONDUCTOR SIZE AMPS 00 COPPER ( ALUM. ' SWITCH OR BREAKER 10 AMPS ( Pit W 2''`) VOLT. _ RACEWAY EXIST.SERV.SIZE AMPS PH W VOLT RACEWAY FEEDERS NO. SIZE IND. SIZE NO. SIZE LIGHTING OUTLETS CONCEALED OPEN TOTAL RECEPTACLES CONCEALED OPEN TOTAL O JO AMPS. _- 71.100 AMP5. SWITCHES INCANDESCENT _— FLUORESCENT & M. V. FIXED 0.160 AMPS. OVER APPLIANCE9 +` _ _! BELL TRANSF. AIR H.P. RATING H.P. RATING CONDITIONING COMP. MOTOR OTHER MOTORS AMPS CEIL IIEAT: KW-HEAT 0.1 OVER MOTORS H.P. VOLTAGE PIIS NO, 1II.P. VOLTAGE PIIS MISCELLAC4EWS TRANSFORMERS: UNDER 600 V. OVER 600 V. NO. KVA N0. IKVA NO. NEON TRANSF. NO. VA. MA. MOTOR SIZE SWITCH FLASHER EACH SIGN FORWARDED TOTAL FEES C1 �NJ/ CITY OF ATLANTIC BEACH ! DEPARTMENT OF BUILDING 800 Seminole Road -Atlantic Beach, FL 32233-Tel: 247-5826- Fax: 247-5877 PLUMBING PERMIT PERMIT INFORAl1A'€iC3N _ LOCATION:IIVFORMMATION . _ Permit Number: 23069 Address: 1303 OCEAN BOULEVARD~� Permit Type: PLUMBING ATLANTIC BEACH, FLORIDA 32233 Class of Work: ALTERATION Township: 0 Range: 0 Book: Proposed Use: Lot(s): Block: Section:0 Square Feet: Subdivision: Est. Value: Parcel Number: Improv. Cost: 0 MEW INFORMATION Date Issued: 11/27/2001 Name: DON PRIDGEN Total Fees: 43.00 Address: 1303 OCEAN BOULEVARD Amount Paid: 43.00 ATLANTIC BEACH, FLORIDA 32233 Date Paid: 11/27/2001 C e: (904)246-2929 ! Work Desc: INSTALL PLUMBING CONTRACTORS CATION;FEES _ 43_ C. W. WOOD Na b. µ�T�yJp�"'�I� g .00 ! z , `kyr rte K � r RN ` ' ; •5 358'9• _ # 'zh s a. � �' ., �• _.. � .'vim t ��.�� . q ...m f P ! FINAL rm _ _ems g; "K" � FL "' y � r'`- .b 'tT.'.'•s` ,flz'�' .3x:: �' �`'2 _: � s i � ,s• yam"'E',•�. . ."' t. ."'fix',Sta - a� .-` �a " } - mays � f- 4�2' r ti _Svy; as -. ., NOTICE- INS ECTIONS �ES EO AT 4 IO JRS IOR TO SPECTION BUILDING MATERIAL, IB$15H ANS .� TWIS RK _ RIOT E CED IN PUBLIC SPACE,AND MUST BE RSO L�LEI :AWAY B CANT OR OR OWNER ov ' I .T FAILURE TO COMPLY WIT E-, ESULT IN THE PROPERTY OWNER PAYING )C TWO ISSUED ACCORDING TO APPROVED PIANS WHICH '-R OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. $43.88 14 ATLANTIC BEACH BUILDING DEPT. Dates 11/28/8! 81 Receipts 8815142 DECKS 27548 ' """19C1J-a-200 03:35P FR011: 247-5945 TO:97431730 P: 1/1 REACH APPLZOLTION I= PLiAl8=G POOCT JOB LOCATION: / 30,3 OWNER OF PROPERTY:!Jg U� 2& D "qe'Al TELEPHONE NO. o?�6� PLUMBING CONTRACTOR ,a_U) L)oab / A)"3 CONTRACTOR' S ADDRESS, /3�Ro/M A)'U STATE LICENSE NUMBER:�N; OS _—TELEPHONE: i SOW MANY OF THE FOLLOWING FIXTURES INSTALLED SINKS / SHOWERS LAVATORY WATER HEATERS BATH TUBS DISHWASHERS URINALS DISPOSALS aZ CLOSETS WASHING MACHINE FLOOR DRAINS SHOWER PANS SEWER WATER r KEPI PE OTHERq3 p TOTAL FIXTURES: 0 x $3.50 + $15.00 MINIMUM PERMIT FEE - $25.00 SIGNATURE OF OWNER: SIGNATURE OF CONTRACTOR: ---------- -------------.. ------------------------------------ INSTALLATION -yrs------.. --- --------------------..- INSTALLATION OF PLUMBING AND FIXTURES MUST BE IN ACCORDANCE WITH THE MOST RECENT EDITION OF THE SOUTHERN STANDARD PLUMBING CODE. CALL A. DAY AHEAD TO SCHEDULE INSPECTIONS - (904) 247-5826 SEWER CONNECTIONS MUST BE CALLED INTO PUBLIC WORKS FOR INSPECTION PRIOR TO COVERING UP - (904) 247-5833 6004 i" DEPARTMENT 4F BUIt.01NG CITY OF ATt.11�VTiC BEACH LOCATION INFORMATION ------ INFORMATION Addx�» x ; ANBC9LE130A'EFVARl Ca4t ,Nevab - ATLANTIC IGP ° . EACH FLORIDA ' Irs .: NEW' v'otl,op t netr. : W000 `RAN �.4t� Rl��sk m t`tNG z D '_ "`t��rLpz }arosod td t SNsLE FAPiL:Yubdvititn a . Eo'Lima ed V41VO SO,00 } I It+irrsv. c ti ''00 T ►t l s 3 $22.50 Arsov *22. 53 ROOF WITH NEW 2O-Y .AR6 EMINC�t� a ^ r #tTIN ....,+«. APPLICATION PS . : . .. ,.' S22, 5 N A "E 'TACT FSE O.`O ► Ade s; BLiL.EYARD Ft*E 4f It i ' V iii ►RM AS♦ $0,00,.. so. do R»taF�6►s !� O It *ATER T0lcio 4, Clio Am , ,? ': 1.1L R Ad*t� OL 322: t t~iRAtrit� C RN IRE B43. t+C cs 3 00 TYPE O ^INE;OVd 1" �"EI , ���a.�a � ESC, R Zii ACT FEE u� SCI. O � ss,ti f a 1 r 4 C e L NCTIC —ALL COWCMETE FORMS ANO FOOTIN MUST Ii+IB CTIEzO""BEFORE POURING PERMIT VOID BIX MONTHS AFTER DATE OF ISSUE BIJ#LDING MATERIAL.RUBBISH AND"DEBRIS FROM THIS WORK M UST NOTSE p).ACED IN PUBLIC MAT SPACE,AND DUST BE LEARED UIR AND HAULED AWAY By"E#'�HER'CONT.RACTOF OR OWNER. F � A11.ltR TQ Ct M. LY lllTH THE MECI��►NIOS' LIEN.1 AW CAVI RESULT IN `TNE P C) T11',C 1A/I g Ph►YlNG TW{CE Ft -OVE . v � rE: f tJED ACCO t3ING TO APPRiOVED.PLANS WHICH ARE PART OF THIS PERMIT ANt7 hl T fiC1 Rid EI:L I tv., t ATION+OFA OPLICABLE PROVISIONS OF LAW. �* . F r LAN TIC BEAC SUILDiNG DEPARTMENT CITY OF ATLANTIC BEACH PERMIT APPLICATION ROOFING owner(S) : Address: Phone: Lot # Block or Unit # Subdivision 0-- Contractor: -- 7. /, M-il Address: Phone: State License No. Describe work to be done: Materials to be used: OWNER: ' Date: Signature d0NTRACTOR:_