1850 Mayport Rd ROOF 2013 CITY OF ATLANTIC BEACH
s J 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00003364 Date 9/05/13
Property Address . . . . . . 1850 MAYPORT RD
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 500
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Application desc
EVE METAL, FASCIA, ROOF REPAIR
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Owner Contractor
------------------------
----------- ______
OSSI KLOTZ LLC ROMANO BROTHERS ROOFING, INC
P O BOX Z LLC 601 OLEANDER COURT
ATLANTIC BEACH FL 32233 NEPTUNE BEACH FL 32266
(904) 246-5649
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Permit . . . . . . ROOF PERMIT
Additional desc . • Plan Check Fee . 00
Permit Fee . . . . 55 . 00 500
Issue Date Valuation
Expiration Date . . 3/04/14
- - - --- - -- - ---------
- - - - - - ----- --
2 . 00
Other Fees STATE DCA SURCHARGE
STATE DBPR SURCHARGE 2 . 00
_ -------______ ---
Fee summary Charged
Paid Credited ----Due---
. 00
_ _ ----------
----- ----------
- . 00
Permit Fee Total 55 . 00 55 : 00 00 . 00
Plan Check Total • 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00
Grand Total
59 . 00 59 . 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: �)lJ �gV-2 Permit Number:
Legal Description Parcel#
1 Floor Area o q. t. q. t
Valuation of Work • Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Reair Move Demolition pool/spa window/door
Use of existing/proposed structures)(circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A
Florida Product Approval#
For multiple products use product approval form /
Describe in detail the type of work to be performed:
Property Owners Information: 1
Name: i Address: ���'�\ I'i
City t C t State_LZip :ig:3L3`3 Phone C L. ' OLI 7 3 I 30
E-Mail or Fax#(Optional) k
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent:
Address: C' 't v n City .c State_1 Zip
Office Phone-'j 0 i1 A 1, Job Site/Contact Number (.-.,---* -3 Fax#
State Certification/Registration# f Z. '�
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 fork is not commenced within six(ti)months, or if construction or work is suspended or abandoned for a period of six(6)months at any time after
work is commenced. I 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 here b 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 this
type 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 law regulating construction or the performance of construction.
Signature of Owner Signature of Contractor _
g V
Print Name r Print Name ` rL.'�: Ds^'►�--s-..........................................................
1�. ................... . .+�.............................................................................. .....:..............�............
Before me _ Before me C ? (zi
this 1, 1 Day o 20 this 1 yL D4
�;►a"�'''• JOSEPH DUDE ROb1AN0 SR.
�••'����Y"��4a, JOSEPH JUDE ROMANO SR. �', = 2ss Public•State of Florida
Not Pu 1C s. y 1C. a Notary 1 ,,� o`E My Comm.Expires Mar 7.2017
I My Comm.Expiry Mar 7,Y017 '•;�F�f� ;.• Commission#EE 881666
drA'' Commission#EE 881688 / ""'"
•bones`M�.