265 CAMELIA ST ROOF CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
!� ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
JFiI`>`
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-1165
Job Type: ROOF PERMIT
Description: FL 10674.1 R-4 REROOF
Estimated Value: $7,400.00
Issue Date: 5/15/2015
Expiration Date: 11/11/2015
PROPERTY ADDRESS:
Address: 265 CAMELIA ST
RE Number: 170866-0320
PROPERTY OWNER:
Name: MEAD, GAYL E
Address: 265 CAMELIA ST
GENERAL CONTRACTOR INFORMATION:
Name: HAMMER TIME ROOFING
Address: 627 AQUATIC DR ANTHONY BETANCOURT
Phone: - -
FEES:
BUILDING PERMIT FEE $87.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $91.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax(904)247-5845
Job Address: � � CoLmd lG _ Permit (0it Number: 5
Legal Description 3 '�� 44 61 ear # —7
oorea o q. t. Sq.Ft '
Valuation of Work$ Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Iter do Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)((circle one): Commercial Residential
If an existing structure,is a fir prin=system insj*lled? (Circle one): Yes No N/A
Florida Product Approval#
For multiple products use product approv orm 1
—g
Describe in detail the type of work to be performed: L —/�cd
Property Owner Information1: / y(
Name: ✓� C' Address: 6 Cc//9 S
City State f Zip DJDJ3 hone
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
�; rr
Company Name: Quali inggent: _ I� c ✓�CCr.c
Address- 13966 h cTy' . Ci � e r ot State
Office Phone Job Site/Contact Number �.P Fax# Zip
State Certification/Registration# k
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 f work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a eriod of six(6)months at any time after
is commenced. I understand that separate permits must be secured for Electrical'Work, Plumbing,Signs, Wells,Pools,Furnaces,Boilers,Healers,
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 this
type ofYwork will be complied with whether specs sed 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 I cal law regulating construction or the performance of construction.
9 — t
Signature of Owner / Signature of Contractor IY.Oncau.[�
Print Name t ..C..4......1�t ...................................... Print Name 1hp........ .
Befo eBefo 7
this 1J Day of 1 20(S— this �J�Day of �r wN 201-5
vP"•.'v''., JENNIFER WALKER
Notary PUa '',S`•:1{ 17 Notary Public =•c a' Y COMMISSION#FF 011480
,Q � '. ., �iers %''• d: EXPIRES:April 24,2017
M As"f'.N .fF 11y Bonded Thru!it P�' U 0
Bo Y n erwi tern