383 Plaza 2015 Roof CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
,j 7 ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
>N
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-377
Job Type: ROOF PERMIT
Description: REROOF FL 5211.3 R3
Estimated Value: $10,273.00
Issue Date: 2/20/2015
Expiration Date: 8/19/2015
PROPERTY ADDRESS:
Address: 383 Plaza
RE Number: 170020-0000
PROPERTY OWNER:
Name: OBRIEN, CHRIS R
Address: 383 PLAZA
GENERAL CONTRACTOR INFORMATION:
Name: PRIME ROOF CONTRACTING LLC
Address: 13792 HERONS LANDING WAY APT 9 QA MARK ANDREW
YOUNG
Phone: - -
FEES:
BUILDING PERMIT FEE $101.37
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $105.37
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: 383 Plaza Permit Number.
Legal Description 5-6916-2S-29E ATLANTIC BEACH Parcel#
Valuation of Work$10.273 Proposed Work heated/cooled 1694 non-heated/cooled313
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial esidenti
If an existing structure,is a fire sprinkler system installed?(Circle one): es No ®/
Florida Product Approval# FL5211.3 R3
For multiple products use pr act approva orm
Describe in detail the type of work to be performed:Duplex Re-roof
Property Owner Information•
Name:Chris O'Brien Address:383 Plaza
City Atlantic Beach State FL Zip 32233 Phone
E-Mail or Fax#(Optional)
Contractor Information:
Company Name:Prime Roof Contracting Qualifying Agent:
Address:372 Royal Palms Dr City Atlantic Beach State FL Zip 32233
Office Phone (soa)452-8w Job Site/Contact Number(9 04)625-1446 Fax#
State Certification/Registration# CCC1329505
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. thrs jurisdiction. This permit becomes mal!
and void if work s not commenced within six(6)months,or ijconstruction�r work is suspended or abandoned for a pend ojsix/6J months a1 any time after
work is commenced. I understand that separate permits must be secured or Eleetrica!!Nark,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,
Tanks and Air Conditioners,etc.
WARNING TO OWNER:YOUR F ktEMENT.
RE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOPAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY.IF YOU INTEND,TOBTAIN FINANCING,CONSULT WITH
YOUR LENDER OR AN ATTORNEY BRE RECORDING YOUR NOTICE OF
COMME
I herel, certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
type 7work 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 ofany other federal,slate,or
late,or local law regulating construction or the performance of construction.
Signature of Owner tL V '
Signature of Con r
Print Name C,f,y 1 S tZ - 01 isV IGti._ Print Name
Swo to and sub bed before me Sworn to and subscr a before me
thisi,pay oft b f uG; 1 20 15 this Day of 20
No I b+
Notary Public
Revised 01.26.10
01. D. Mavis :a-V'� �',; Andrew D. Davis
r = COMMISSION A FF160849 *= COMMISSION 0 FF160849
EXPIRES: Sept 17, 2018 EXPIRES Sept. 17, 2018
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