270 Belvedere St 2013 roof CITY OF ATLANTIC BEACH
1 j 800 SEMINOLE ROAD
"J =" ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002661 Date 5/14/13
Property Address . . . . . . 270 BELVEDERE ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 2350
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Application desc
REROOF
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Owner Contractor
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NELSON MICHAEL ANDREW RON RUSSELL ROOFING INC
270 BELVEDERE ST 4419 HUDNALL RD
ATLANTIC BEACH FL 322334109 JACKSONVILLE FL 32207
(904) 714-1907
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 65 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 2350
Expiration Date . . 11/10/13
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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 65 . 00 65 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 69 . 00 69 . 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: 210elye(�p,/�C4 Permit Number:
Legal Description0- ✓ r Sec � t R-5 Parcel#
Floor Area ot Sq.Ft. Sq.Ft
Valuation of Work$ 'L,350.oe 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
Resident" .lam
If an existing structure,is a fire sprinkler system installed? (Circle one): es � N/A
Florida Product Approval# Ib i Zq,16
For multiple products use product approval form
Describe in detail the type of work to be performed: N0.,l Otter. 5 h n t Rd0
Property Owner Information:
Name: mic 7 h e o Address:Z7() 13 L5k
City Stat _zip SZ2 23 Phone 0'/- 7-674"7
E-Mail or Fax#(Optional)
Contractor Information:
Company N,�me: i'! Qualifying Agent:
Address://IV/ , Ci S o X State Zip 32 Zb7
Office Phone�0V- /-f-/9o7 Job Site/Contact Number - 'AT Fax#
State Certification/Registration# CC /327 122y
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 th6 in nte work and installationn ors as indicated. 1 certify that no work or installation has commenced prior to the
issuance of a permit ancommence 'd that all work will be performed to meet the standards of all lawis ss rpegulating construction in thpis jurisdiction(. This permit becomes null
work isd o work is .ot I understand that sepaix rate permits must be sectr.ured for Eleetrieual Workl Plumbrngor �Signs,or aWellseri�P ols xFuinaees,Boilermonths at s,t Heaime l after
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.
I hereb certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing
type oj�work will be complied with whether s eci ied herein or not. The granting of a permit does not presume to give authority t violate or can the
provisions of any other federal,state, or local aw regulating construction or the performance of construction.
cam.
4wature of Owner Signature of Contractor
/J Print Name �pl� .1 ......!!J...... 1.1._SSC L
int Name
Sworn to and subscr' bef�L we o Sworn to and subscribe beforf ve e RIS 3
this Day of �,� this Day of PUBLIC
:TE OF FLORIDA TE OF FLORIDA
Notary Pub tc Expires 8/12/2014 n 11M#
Notary Pub is E)Vm&01e53;
Revised D4.16.10