351 4th St (vault) (2) City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Build' Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City web-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: �,51 Z""�' S7-tti_C
7 pql�i�ent review required Yes 0
Applicant: k)IV�JOP Planning &Zoning
Tree Administrator
Project: D I Ao�;,AX.Ar5 Public Works
Public Utilities
Public Safety
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco I
Other:
APPLICATION STATUS
Reviewing Department First Review: EEApproved. FIDenied.
(Circle one.) Comments:
(E��
PLANNING &ZONING Reviewed by: 12-7 Date:- 2'_
TREE ADMIN. Second Review: []Approved as revised. F-1knied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. E]Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
W" INSPECTION PHONE LINE 247-5826
Application Number . . . . . 04-00029218 Date 12/07/04
Property Address . . . . . . 351 4TH ST
Tenant nbr, name . . . . . . REPL SHINGLES FLATROOF
Application description . . . ROOF
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 7400
Owner Contractor
--------- - ----- ----- ---- ---- -- --- ---------------
PICKETT, CHARLES AND VALARIE CHILDERS ROOFING & SHEET METAL
351 4TH STREET 10416-196 NEW BERLIN RD STE2
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32226
(904) 246-7086 (904) 696-8550
---------- ------------------------------------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . . REROOF
Permit Fee . . . . 105 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 7400
Fee summary Charged Paid Credited Due
-------------- --- ---------- ---------- ---------- ----------
Permit Fee Total 105 . 00 105 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 105 . 00 105 . 00 . 00 . 00
PERMIT IS APPROVED ONLy IN ACCORDANCE wITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND TIIE FLORIDA
BUILDING CODES.
CO t4K
BUILbMG OFFICIAL
V CITY OF ATLANTIC BEACH
ROOFING PERMIT APPLICATION
Date: L(
Job Address:
Owner of Property:
Address: ;4 Q25A4j, Telephone: =(pq ,at_�6 -I.DS("I
Contractor: at,wair!�Zo�1-1, eL4nmtok State License Number: 6!Z— tl_'o LjA_j tj 7_
Contractor's Address: i0l41(e
Telephone: Cl 0-4—(0 9�0 13 Fax: q 0 Lf —(09(,p
Scope of Work: R�ep(AA_ga_ VNW___A_) ir)�jgavaV4-1;���.,qj
e,v\
(-eS
Deck Slope: Lilt i Z_ Greater than 2:12 Less than 2:12
Valuation of work: -T Li 00 co
Product Name(Example: Timberline):
Manufacturer(Example: GAF): T�L<o Aiddu4)!!��
ASTMDesignation(s): An�TM b4,�:jZ2-- 1-h yoz,,g SJOV A!5rtA
_,p6T_ L
Required Inspections: Sheathing and Final
Signature of Owner�_�_--7�!A Date:
Signature of Contractor: > Date: 0 Z-1 -0!/
AS TO OWNER:
Sworn to and subscribed before me this day of
Sta r. a jqU&j9Qpal of
X-)HNS Notary's Signa e:
e Id
of Flo' a
-Notary Pubiic-State of Florida
S
-11VIVCommissix-ExpiresSepl,2007 al,kn
Personally kn wn
Commission#DD243097
PF.F al otary 5 Produced identification
Bonded By National Notary Assn. Type of identification produced
AS TO CONTRACTOR:
Sworn to and subscribed before me this day of
State of Florida,County.,of Duval
REGINA L.JOHNS Notary's Signature:,�
y P 11,
State of Fkwkja
Notary Public
WycommwonExpiresSep],2007 Personally known
Commission#DD243097 Produced identification
BoncIed8VNak=INofWAssn. 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 I Revised 2/21/03
CITY OF ATLANTIC BEACH
PERMIT CALCULATION SHEET
Date
Address 4q
19 Permit fee based on dollar evaluation as indicated on permit application.
.Heated Square Footage @ per sqft= S
Garage /Shed @ per sq ft= S
Carport/Porch per sq ft= S
Deck @ S per sq ft= 5
Patio @ s per sq ft= S
TOTAL VALUATION: $
5 q()-o $35.00 ill S1000.00 $ $35.00
Total Valuation
S $
Remaining Value Per thousand or
portion thereof-
CONSTRUCTION TYPE: TOTAL BUILDING FEE S
ZONING: +1/2 Filing Fee ' $
FLOOD ZONE: Fireplaces @$35.00 S
IMPERVIOUS SURFACE:
BUILDING PERNUT FEE S 10t>1
WATER EMTACT FEE S
SEWER IMPACT FEE
WATER MMTER/TAP
CAPITAL EMPROVEMENT S
SEWER TAP
C ( )RADON BRS .0050
SECTION H PAVING S
CROSS CONNECTION $
ST ( ) SURCELARGE S
OTHER S
GRAND TOTAL DUE S
Cc:
CITY OF ATLANTIC BEACH D. Ford
�- Higgi�
-S. go—err
BUILDING ZONING DEPARTMENT
800 Seminole Road
Atlantic Beach,Florida 32233
(904)247-5800
. ..... (904)247-5845 Fax
PLAN REVIEW COMMENTS N0\1
Permit Application # 0 'q- 21M8
Property Address: 351 4T� STRff-T
Cli c
Applicant: , 9A SHVET- M'F TA
Project: Br-FLACE 31110&�FS AMP FLAT )�GOV
This permit application has been:
Approved
Reviewed and the following items need attention:
Please re-submit your application when these items have been completed.
Reviewed By: ux- Date: Of%k
7*bUCKTP
2-4 4 0 1 A 10102184
C55 —*flueftt:
DEPARTMENT OF BUILDING P-448 118 PA
CITY OF ATLANTIC BEACH.FLORIDA PERMIT NO.—
PERMIT TO BUILD
THIS PERMIT MUST BE POSTED ON JOB
Date 10-02-86 19—
Valuation$ $ 7.50
This permit not valid until above fee has been paid to City Treasurer,and is
subject to revocation for violation Of applicable provisions Of law.
ENNETT REX ALANIZ
This is to certify that
RC0048059
has permission to build RE—ROOF
Classification RESIDENTIAL Zone
Owned by SHEPART BERSA
Lot Block S/D�
House No. 351 4th STREET
According to approved plans which are part of this permit
NOTICE—ALL CONCRETE FORMS
AND FOOTINGS MUST BE IN-
SPECTED BEFORE POURING.
PERMIT VOID SIX MONTHS
-n AFTER DATE OF ISSUE
10 4 10 0 Building mater-W, rubbish and debris
z
I from this woik/must not be placed
"in publicApa . and must be cleared
u a;4 ed awa�y�either Con-
p n a
trac owner.
BiraAg Official.
FOR OFFICE PERMIT
DATE
USE ONLY NUMBER CONTRACTOR
PLUMBING
ELECTRICAL
SEWER
WATER
CITY OF ATLANTIC BEACH
APPLICATION FOR ROOFING PERMIT
BUILDING OWNER _P119NE
JOB ADDRESS-
LOT# BLOCK OR UNIT # SUBDIVISION
CONTRACTOR P I I ON
Y% ,�j c/3
ADDRESS
LICENSE NUMBER EXPIRATI%L_ja,,�sz
JOB VALUATION $
MATERIALS:
SIGNATURE OWNER
SIGNATURE CONTRACTOR
DATE