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RECEIVED
CITY OF ATLANTIC BEACH
' BUILDING & ZONING
s. i,g11
CITY OF ATLANTIC BEAC MAR 1 12004
'Z,
ROOFING PERMIT APPLICATIION
"Dills) /
BY:
a
Job Address:
Owner of Property: 14h,1V es Tee
Address: e Zvg: 1,VN-c 1!),.", Telephone:
Contractor: e, .�j— t _<('./V�ta icense Number:
Contractor's Address: -3,0 fA 3 2-
Telephone: Fax: -Z-
Scope
Scope of Work: /'va J / /L / 6 C►i��'�(�
�(�r��► 1��1 I 1 2-9�f
Deck Slope: / _Greater than 2:12 Less than 2:12
Valuation of work: 9 1
Product Name(Example:Timberline)
Manufacturer(Example: GAF):
ASTM Designation(s):
Required Inspectio - S ng an inal
Signature of Owner: Date: Ile /b
Signature of Contractor: Date:
AS TO OWNER: o
Sworn to and subscribed before me this f day of /L�G�'2v/( ,20
State of Florida,County of Duval „ )w
Notary's Signature:
,GLORIA I.CASTERLINE-MCLAUGHLI'ti
❑ Personally known
t .y MY COMMISSION#CC 976739 Produced identification f 7/ q
(( '?oFn T EXPIRES:!tT&erg,z Type of identification produced PL� Z, aJIJ
1-gpp.3.fVOTARY FL Notary Service 8 Bont]inn � lI
AS TO CONTRACTOR:
Sworn to and subscribed before me this day of \/Z/Y ,20 -
State of Florida,County of Duval
Notary's Signature:
4?1�r° GLORIM.CASTERLINE-McLAUGHLIN'
MY COMMISSION#'CC 976739 Personally known
o0 EXPIRES:December 8,zow ❑ Produced identification
� T FLMAWServioeaeonoing Inc Type of identification produced
800 Seminole Road Atlantic Beach,Florida 32233-5445
Telephone: (904)247-5800 Fax: (904)247-5845 • http://www.Ci.2tl2ntic-beach.fl.us
Page 1 Revised 221/03
CITY OF ATLANTIC BEACH PERMIT .CALCULATION SHEET
Address_ k 571 S
Date � •Cq
Heated Sauare Footage ( ' per sq _ft = $
Garage/Shed L ���
_(�,� p e r sq ft = $
Carport/Porch �; @ $ per sq ft = $
Deck @ $ per sq ft = $
Patio @ $ per sq ft = S
TOTAL VALUATION: $
Total Valuation 1st $ Iity
E ; s ,qr�
Remaining Value $'j per thousand
or portion thereof f
TOTAL BUILDING FEE $ `7
+ 1/2 Filing Fee
( ) Fireplaces @ $15 :00 $
BUILDING PERMIT FEE $
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 $
GRAND TOTAL DUE $
ADDITIONAL PERMITS OR FEES : lyechanical Plumbing
Electric/New Electric/Temp ; SwimmingPool
Septic Tank Well ; Sign Finish Floor Elevation
Survey Other
CALCULATIONS and/or NOTES :
.5 ASN. RETURN
qH 0�E i NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
0 State of County of_
To whom it may concern:
0!
QI 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: v
co C
.9 Address of property being improved:
0
G4
General description of improvements:
Owner /Y/L e3 T z`4
Address Lr/,5-
Owner's interest in site of the improvement
Fee Simple Titleholder (if other than owner)
Name
Address
/ ! Contractor r Ale,
Address
Phone No. 2 s� �' Fax No. el
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-1 OWNE
Signed: te:
Before me this /L7) day of 27Xt2 in the
County of Duval, State of Florida, has personally appeared
Doc# 2004082355 Notary Public aarge, State of Florida, County of lDu
Book: 11684 My commission expires: _ rC► c26�!
Page: 546
Filed I Recorded Personally Known or
03/11/2004 0'x:43:11 PM �/
JIM FULLERULLER Produced Identification
CLERK CIRCUIT COURT
DUVAL COUNTY ��' GLORIAJ.CASTERLtNE-Mct
RECORDING f 5.00
TRUST FUND $ 1.00 i cy MY COMMISSION#CC 976739 y
COPY FEE $ 1•pp poa EXPIRES:December 8,zona t
CERTIFY f 1.00 »oaararnHr Ft NMS saMo,a e« : -
y , CITY OF ATLANTIC BEACH Cc.
js r.- fff I� BUILDING / ZONING DEPARTMENT Higgins
S. Doerr
800 Seminole Road
Atlantic Beach,Florida 32233
(904)247-5800
(904)247-5845 Fax
PLAN REVIEW COMMENTS
Permit Application # 0.4 - o2 7,8,34
Property Address: GS <SP_CV- i'YL( r�nc� _ r-
d
Applicant: R O rYAL n
Project: 1 -r-
This permit application has been:
EP-'--/Approved
El Reviewed and the following items need attention:
Please re-submit your application when these items have been completed.
Reviewed By: :3� t� Sj Date: t4_✓
fi
CITY OF ATLANTIC BEACH
r) 800 SEMINOLE ROAD
ATLANTIC BEACH, FLORIDA 32233
INSPECTION PHONE LINE 247-5826
Ins)"
Application Number . . . . . 04-00027884 Date 3/12/04
Property Address . . . . . . 1515 SELVA MARINA DR
Tenant nbr, name . . . . . . RE-ROOF
Application description . . . ROOF
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 9000
Owner Contractor
--------------------- --- ------------------------
LESTER, DR. R. S . ROMANO ROOFING SERVICES
1515 SELVA MARINA DR. P .O. BOX 33037
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 246-5649
-------- ---- ------------------------------- - --------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 113 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 9000
Fee summary Charged Paid Credited Due
----------------- ------ ---- ---------- ---------- ----------
Permit Fee Total 113 . 00 113 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 113 . 00 113 . 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.
,0, ( , 1.'k
BUILDING OFFICIAL
PSR-3844
9024
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
PERMIT INFORMATION
Li.-,�:ATION INFORMATION
Permit Number : 902 4 diess ,
1515 SELVA MARINA DRIVE
Permit Type ; RE-ROOF
Class Of W017k : NEW ATLANTIC
ATLANTIC BEACH , FLORIDA. 3-
Constr . Type: WOOD FRAME --------- LEGAL DESCRIPTION
Prcivosed rise : SINGLE FAMILY at ; S I ock � S e C t i ctn
Dwell-inas : 1 Code: 0 Township :
RNG* 0
RFtifPated Value: 51505 .00 ubdivision: SELVA MARINA
Improv. cost : ; 0 .00
T',tal Fees : $22 . 50
Amourit voaio .- S22 _50
!94
)I#M�`TWFORMATION ---- APPLICATION
Add: PERMIT
RPRINA Uf�i
WATER IMP ICT FEE
A T
z 7nA
ACH , FLOFID'A 1MPACT FEE
RADON GAS-H. R . S .
CQNTF.AQT0R , jNFORMATiON RADON CAB 5%
NiMe . r-ANIkL- R. GRASTON
CAPITAL IMPROVE.
FOXHUNT, TRAIL
SEWER TAP
TLLE, FL 32250 ("ROSS CONNECTION
Typo: `
,;EC H IMPACT FEE
CONST. SURCHARGE
NOTES:
NOTICE —ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE
CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER
BUILDING ENGA MATERIAL, RL
U'L I M T L'
CLEARED
EARED U P AND HAULED
C
T FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN
P OP T_
HE PROPERTY 1
THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS.
.__ __ :: I
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
ATLANTIC BEACH BUILDING DEPARTMENT
By:
CIT? OF ALANTIC BRACH
ROOFING PERMIT APPLICATION
Owner(s) : 57,,�
Address : >.SIS" SENA elh-p „J4 pR
Phone: X49-�'49y
Lot ; Block or Unit
Subdivision-
Contractor : J7cn/
Address • &4p z
City, State and Zip_ .Ti4c�.�y>L�E
Phone
State License #_9C- c>
Describe work to be performed: RfcJZvof FLA7
Valuation of Proposed Construction:__
Materials to be used: C.*/1S7A
Signature of Owner;
Signature of Contractor:
Liability Insurance Supplied
Workers Compensation Insurance Supplied
License Information
FOR OFFICE USE ONLY
Date--,.;w...,F'. --------19 .,....
' p�J
Permit # /13 T.l--...Fee$.. ... ......
CITY OF ATLANTIC BEACH Valuation $ �--- ..............................
FLORIDA House #.../. .5,.. �_.. ......
...........................................................................
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the
building or other structure described. This application is made in compliance and conformity with the Building Ordinance of
the City of Atlantic Beach, Florida, and all provisions of the Laws of the State of Florida, all ordinances of the City of Atlantic
Beach and all rules and regulations of the Building Department of the City of Atlantic Beach, shall be complied with, whether
herein specified or not.
The Contractor or Owner-Builder who has been issued a Building Permit is automatically responsible to ascertain that all sub-
contractors engaged by him are duly licensed in the City of Atlantic Beach, Florida. To prevent delay or embarrasment regard-
ing intermediate or final inspections it is suggested that a list of sub-contractors be submitted to this office so that licenses can
be verified. ""��
A
/ Drate. ------------------------•---,- 19/.----
Owne -+.I`-..L _ A_ ---------- Address ��� 1'� lob lephone No..A.VQ..•ay/
Architect-------------------- ------------------------------------------------------Address- --.---------------------------------...................Telephone No..-------------_----------
ContractorBuilder-- . . --------------------------- ------------------------Address------------------------------------------------------------Telephone No.---- -------------
Lot No.--------/ ---------------•---------------Block No-------- T_----------------Sub Division----
-----------------------------------OO----------------------Street--------------------------Side Between-- ---------------------------------------------and--------------------------------------..............Sts.
Valuation $---7.1.0_-----_------------For what purpose will building be used-----16:440000"---_.-Type of construction_-_-_-__..._....._..-__-.__...--------
Dimensions of Building-47X_Z_Z.�_p---Dimensions of Lot _T-O-x..I�. ........................ :Size of Footings _............_
.
Size of Piers__-__ _________________________Size of Sills---- -__ -__ _ .. .__ -__.Greatest Sill Span in ft-----�------..____._Type Roof....'' M
How will Building be Heated?-_ _------_---___-___-------------Will Building be on Solid or Filled Ground?___ -.
A
Size of Ceiling Joists_!.-X�____-_--__-__--.__-_-, Distance on Centers___-_��....___-_-I--------..__..., Greatest Span____..1A.-I__-----------------_---- "
Size of Floor Joists------------------------------------ , Distance on Centers- - -- ------ ...................... Greatest Span----------------- ........................ „
N 0
Size of Rafters----------- ------------------_-�------_-- - -- , Distance on Centers........ �L -------•------------- Greatest Span.------1.4----------_-_------------ »
This rectangle is to represent the lot.
Locate the building or buildings in the
right position. Give distance in feet from
all lot-lines and existing buildings.
REAR LOT LINE
Two copies of plans and specifications shall
be submitted with application.
Inspections required.
1. When steel is in place and ready to pour footing. W W
2. When steel is in place and ready to pour columns and/or lintel. Z /�G' Z
3. When steel is in place and ready to pour beam. '� a
4. When framing is completed. O,-a '�.•— s
5. When rough plumbing is completed,and ready to cover up.
6. When septic tank drain field or sewer is laid but before it is covered. q A
7. Electrical inspection by City of Jacksonville.
8. Final inspection.
Note: In case of any rejection,re-inspection MUST be called for after
corrections are made.
FRONT OF LOT
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 building
regulations of the City �o'f`Atla is B _
Signature of Builder.-7_...: Address-?4V1 _.. /i_._ �. -
Signature of Owner._-.`, . Address = ,..
fes• � � ,.�,�,
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Or
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MAP SHOWING SURVEY OF
1116v _
AS RECORDED IN PLAT BOOK_Z7 PAGE6;,K + _OF PUBLIC RECORDS OF DUVAL CO., FLA.
FOR_"A,6_ LP__-+—CTA�ILZ�L
I
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,Soa�va.Z^lilav. ,� �SEr //t••/KO,V
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NOT.f: •
.ZEl.. t5:41&V_f>-oR ,Va. '.Z.74 FLA •
PECf/ECK r0 FEf3.
9 /
97/ 7-a 6R/,V<;
5a�z✓EY a.�-To-Oso fE
,4550C 1,4 TE 5/ INC.
HEREBY CERTIFY THAT I HAVE SURVEYED THE LANDS AS SHOWN IN THE ABOVE CAPTION
AND THERE ARE NO ENCROACHMENTS.
9 �
SIGNED_ 53
SCALE: / i� -
REGISTERED SUR�EYOR O. 320 FLA.
w _ ORDER NO. -- -
FOR OFFICE USE ONLY
Date.-__-! 146
------ �&_1951,
Permit #_'//](.4__ ..Fee$----•--
-
TOWN OF ATLANTIC BEACH
Valuation $-_.__. - . -----------
----------
FLORIDA House #----- -- ----------------------------------
---------------;'�
........../J_—J lj� lf - -....Or
----
APPLICATION FOR BUILDING PERMIT
---------------------------------------------------------------------------
Application is hereby made for the -approval of the detailed statement of the plans and specifications herewith submitted for the
building or other structure described. This application is made in compliance and conformity with the Building Ordinance of
the Town of Atlantic Beach, Florida, and all provisions of the Laws of the State of Florida, all ordinances of the Town of Atlantic
Beach and all rules and regulations of the Building Department of the Town of Atlantic Beach, shall be complied with, whether
herein specified or not.
The Contractor or Owner-Builder who has been issued a Building Permit is automatically responsible to ascertain that all sub-
contractors engaged by him are duly licensed in the Town of Atlantic Beach, Florida. To prevent delay or embarrasment regard-
ing intermediate or final inspections it is suggested that a list of sub-contractors be submitted to this office so that licenses can
be verified. Date-------------- -------------Z-3------
------------Z-3---------------
Owner-------, t4o------_4--4,Yk,0------_4WA
>../Volit-Address-----92--54_ _;K_IUS 4 Telephone
� ' N-
Architect-----------------------------------------------------------------------------------------------Address-------------- -----------------------------------------Telephone No.----------------------
Contractor
o-------------_--------
Contractor Builder----------------------------5 e f457--------------------------Address---------------------S_A �---------------Telephone No.......S'4.ef-r
Lot No..---.r------J&------------------------...Block No----------3-----------------Sub Division-67F AIrAT-_?WIWA-------4o0V4tr,.0---Zone-----------------
------A44---------Street__.,J9v4SrjSide Between_i5E/l 1A424__r_---ARA--------and.-----------
Valuation &.00-------Forwhat purpose will building be used......OW_"_k* Type of construction----,Al+.S
Dimensions of Building----------------,/
Dimensions of � Size of Footings---------&-4-A-nip--------
Size of Piers---------------------------------Size of Sill's-------------------------------Greatest Sill Span in ft.-.---------__------_-Type Roof---J_16Z/.....46r---0
How will Building be Heated? Building be on Solid or Filled Ground?------------5-41-41--h---------
Size of Ceiling Joists-------------- --------- Distance on Centers----------- ---161. -0-----4 ___, Greatest Span-------------- ---------------- 11
Y6--- ci-o' ft
Size of Floor Joists------------------------------__-------.--, Distance on Centers--------- ----------------—------------- Greatest Span-------------------------------------------
Size
pan--------------------------------------------
Size of Rafters--------------------- 4{-------, Distance on Centers-------- --_--146' ___Q...Coo---, Greatest SpAn.. ,/---Of
2 ------
54roPoPo!of r-5 A7-
This rectangle is to represent the lot.
Locate the building or buildings in the
right position. Give distance in feet from
all lot-lines and existing buildings.
REAR LOT LINE
Two copies of plans and specifications shall
be submitted with application.
Inspections required.
1. When steel is in place and ready to pour footing.
2. When steel is in place and ready to pour columns and/or lintel. Z Z
3. When steel is inp lace and ready to pour beam. a a
4. When framing is completed.
5. When rough plumbing is completed,'and ready to cover up.
6. When septic tank drain field is laid but before it is covered.
7. Electrical inspection by City of Jacksonville.
8. Final inspection.
Note: In case of any rejection,re-inspection MUST be called for after
corrections are made.
FRONT OF LOT
�w In consideration of permit give I n 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 building
regulations of the Town of Atlantic Beach.
7= - $!�� :� --- ----
Signature of Builder-----------74. 4.ew .1 4
to---------- 0. ..... ----------------------- -------*---------
*kddress------------------------------- ------- ......
Signature of Owner--------------
Instructions to Builders and Contractors building or working it the
Town of Atlantic Beach
No work on any building shall be started without obtaining the
necessary permit.
2. No changes in the approved plan shall be made without the approval
of the building inspector.
3. Inspections: The following inspections shall be called for:
A. Foundation, when steel is in place.
B. Plumbing, rough.
C. Lintle, when steel is in place.
D. Framing, before any wall covering is placed.
E. Electrical, City of Jacksonville.
F. Septic tank or sewer, before covering.
Q. Plumbing, final.
H. Final, when all work is complete.
Any concrete poured or work covered without the necessary inspection
shall be removed or uncovered at the request of the Building Inspector.
4. After the final inspection and upon submission of a drawing showing
the size and location of completed building on lot to the Building
Inspector a Certificate of Occupancy shall be issued. No building
shall be occupied before said certificate is issued.
5. Plumbing permit does not cover sewer connection permit .
6. All contractors and sub-contractors shall have occupational license
issued by Town of Atlantic Beach before doing any work within the
Town Limits. Contractors shall furnish certificate of liability
insurance when obtaining license.
7. The penalty for violation of any provision of the Building Code or
of Ordinance ,x}186, shall upon conviction thereof be punished by fine
not exceeding $500.00 or imprisonment for not exceeding 90 days, or
by both such fine and imprisonment.
8. Copies of The Southern Standard Building Code and Ordinance #1186
are available at the Town Hall for reference.
9. When a sidewalk exists across front of building lot, said sidewalk
shall be placed in first class condition before final inspection
is requested.
I have read and been furnished a copy of the above instructions
in connection with Building Permit No. Y .
Date , Y6 J01
Signed
n' APPROVED
I�► SCR �,_Zo, -Architectural Control Commlth!
».:. '
.. ................... ...
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