90 FORRESTAL CIR - ROOF ' ,-. 1_,.!-\1/7,----:--N.,'j ,
�S, CITY OF ATLANTIC BEACH
r;' _'.. ; 800 SEMINOLE ROAD
j = — J ATLANTIC BEACH, FL 32233
\ \ INSPECTION PHONE LINE 247-5814
\0.21911"
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-2477
Job Type: ROOF PERMIT
Description: RE ROOF TOURCH DOWN
Estimated Value: $4,400.00
Issue Date: 10/19/2015
Expiration Date: 4/16/2016
PROPERTY ADDRESS:
Address: 90 FORRESTAL CIR
RE Number: 171751-0000
PROPERTY OWNER:
Name: MABRY TRUST ET AL, PETER
Address: 407 S OCEANWALK DR 407 S OCEANWALK DR
GENERAL CONTRACTOR INFORMATION:
Name: THE MASSENGILL CO
Address: 23705 ARRIGO BLVE QA TONY LYNN MASSENGILL
Phone: - -
FEES:
BUILDING PERMIT FEE $72.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $76.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND 'HIE FLORIDA
BUILDING CODES.
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.�l77/— 0°0 a
State of t 1 e f'1 p t� County of U rev.L_
To whom It may concern:
The undersigned hereby Informs you that improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF
COMMENCEMENT. J� J�
Legal description of property being improved: 2o s( /7••23.. z 9& 4114ni&
tam-Gtr Villa 0 61 , R 0 II'0(({s ix_/ G"2 S a
ri-t-t,.ti(-<< 1, A48 3 ZZ3
Address property ring improvy9: q 6✓re,$ig C /-C ' S
`C NP74C f L 3a 3
General description of improvements: /Zoo•F ,'Q & r/re ff',NC-CAA-CA,i!-
Owner / 00 R
�j
Address 3. r A. j / K. d v. I Q iC --L A5-`b
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
��rr)y-�.,J Contractor ` fila Sse ) i (, C,�
Address Qt IX)1 U‘.0\9 Z• f\. 1,1\ Fek,>d
Phone No. .5b Z.• 2 2 / Fax No. 2 t V�Q � �
�, s �q�o
Surety(if any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any per on k' g a loan for the construction of the improvements.
Name ��'
Address
Phone No. Fax No.
Name of person within the State of Florida, th than himself,designated by owner upon whom notices or other
documents may be served:
Name
Address
/4.--
Phone No. Fax No.
In addition to himself,owner designat s the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06(2)(b),Florida S to es.(Fill in at Owner's option).
Name
Address
Phone No. 666 Fax No.
Expiration date of Notice of Comme cement(the exp'ation date is o e(1)year from date of recording unless a
different date is specified): Aft rend g &•IL /1"'"- Zr
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signed: L
444 DATE '0J i 3-if
Before me this ay of bc: O b x-13 In the
County g`[41,1 at§J�o([F oriel has personally appeared
hims fi sland afffrms�hatl statements and dectara herein by
Doc#2015240323,OR BK 17340 Page 1345, are true and accurate �� LYNET7E ANN BECOTTE
Number Pages:1 * * MY COMMISSION i FF 169258
Recorded 10/19/2015 at 02:54 PM, EXPIRES:06tO118f 19,2018
Ronnie Fussell CLERK CIRCUIT COURT DUVAL � A nr' I . .<-t u'+,p���t+°` 8ond�dThruBudpgNodryS�Moet
COUNTY L{,(([,
RECORDING$10.00 Notary blic at Large.State of ocountyof 1).(1 t/GLL
My commission expires:
Personally Known (J or
Produced Identification
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 J `�00 —Z477
Job Address: �,Qbhq' G,Q S . Permit Number:
Legal Description o - $" . - S -.2 .... - „ Ct. ((q ,,t Parcel# 17/ •00a
o• oor Area o 'q. t. t
Valuation of Work$ (1 C vv. Proposed Work heated/coo ed / as f- non-heated/cooled
Class of Work(circle one): ew Addition Alteration Repair Move„Denialtf l pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval #fi L 2-S-33- a (
For multiple products use product approva o rm
Describe in detail the type of work to be performed: le£ 1c, 04- 1 C.N. /c A eJb.N'e-
C eltk t K hip / b14 rst0Ni) Cet ir•41 4.41 Ana /44.4e/it--
Property Owner Information:
Name: ARC 416 y;4t $ Address: 933 s �- e- 5 r e— z-6
City State zip ;12.62_ Phone
E-Mail or Fax#(Optional) ((��
Contractor Information: CONTRACTOR EMAIL ADDRESS: - ht- NlC.sserlg;1f co£t 6-mq%�i.
Company Name:�j�Q f>�(1r�i 1( C Qualifying Agent p(\y MgbS e, `(
Address: q4(O"'1 1,_.■ 1�►c —\..,r% City r-es Ack nc i rtos State F L. Zip-3Z cy
Office Phone SO 2-'L-'Q 1 Job Site/Contact Number '$b Z,Z404,1 Fax# 2 -Z S"- grt 10
State Certification/Registration# �c.C_\'S Z, Sck rl
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 cert(j 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 if work is not commenced within six(6)months,or if construction or work is suspended or abandoned for aperiod ofsix(6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools, urnaces,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.
l hereby 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 of work 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
2rovisions of arty other federal,state, or local law regulating construction or the performance of construction.
>ignature of Owner Ati Qce4%atm M.0 Signature of Contra r ,V1K0
'rint Name S�pC`� Print Name !!d L /1261 SCw� 1
sefor� y Before Wyd.. — — / — ——iis of ! ,p. .I1:.K
j iS �f / X1SSA J.COOK
t..c-State o Florida
�!i` _ ►'i+{ xpires Feb 21,24 ,_ _ `�1Ea ,m eb 21,2018
"otary P 1 sic c , �ir`>Bo� Cr+mtnission S x8633 Notal P�:� .,;±,��ti�o-
+F o ,,o?.'� 8tld dough Natia>si Naar,Assn.. '%°;;,`,�'•/,nded through National Notary Assn.
'•au„a`
• - --- - --ReVIS(1711726.10
b' • \s CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
\J ATLANTIC BEACH, FL 32233
(904)247-5800
THE 5TH EDITION OF
THE FLORIDA BUILDING CODE
TAKES EFFECT
JUNE 30, 2015
ALL BUILDING PERMITS, APPLIED FOR, ON OR
AFTER JUNE 30, WILL BE REVIEWED AND
INSPECTED UNDER THE FBC, 5TH EDITION.
BUILDING PERMITS APPLIED FOR BEFORE JUNE
30, WILL BE REVIEWED AND INSPECTED UNDER
THE CURRENT 2010 FBC.
DO NOT WRITE BELOW- OFFICE USE ONLY
Applicable Codes: 2010 FLORIDA BUILDING CODE
Review Result (circle one):
Approved Disapproved Approved w/ Conditions
Review Initials/Date:
Development Size
Habitable Space Non-Habitable
Impervious area
Miscellaneous Information
Occupancy Group
Type of Construction
Number of Stories
Zoning District
Max. Occupancy Load
Fire Sprinklers Required
Flood Zone
Conditions/Comments:
Florida Building Code Online Page 1 of Z
FLORIDA PfiPAnTM6M /YI OF
Business & Professional Regulation krt ill
rpspe HOME. ABOUTOBPRI 08PROIVISIUMS CONTACTDBPR,
bolo Department; BCIS Home Log In User Registration Hot Topics Submit Surcharge Stets&Facts Publications FBC Staff BCIS Site Map Links Search
Busines k,
Professional Pubic User Approval
USER:regulation
u,r,e:Morey
r,„.,!3,,, Product Aooroval Menu>Product or AoolKation Search>Aoollcation List>Application Detail
tofPlelt ;{ ; •; FL# FL2533-R13
Application Type Revision
Code Version 2014
Application Status Approved
Comments
Archived
Product Manufacturer CertainTeed Corporation-Roofing
Address/Phone/Email 18 Moores Road
Malvern,PA 19355
(610)651-5847®
mark.d.harner@saint-gobain.com
Authorized Signature Mark Harner
mark.d.harner @saint-gobain.com
Technical Representative Mark D.Harner
Address/Phone/Email 18 Moores Road
Malvern,PA 19355
(610)651-5847`0
Mark.D.Harner @saint-gobain.com
Quality Assurance Representative
Address/Phone/Email
Category Roofing
Subcategory Modified Bitumen Roof System
Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed
Florida Professional Engineer
Evaluation Report-Hardcopy Received
Florida Engineer or Architect Name who developed Robert Nieminen
the Evaluation Report
Florida'License PE-59166
Quality Assurance Entity UL LLC
Quality Assurance Contract Expiration Date 07/03/2017
Validated By John W. Knezevich,PE
Validation Checklist- Hardcopy Received
Certificate of Independence FL2533 R13 COI 2015 01 COI Nieminen.odf
Referenced Standard and Year(of Standard) Standard Year
ASTM D6162 2000
ASTM D6163 2000
ASTM D6164 2005
ASTM D6222 2008
ASTM D6509 2009
FM 4470 1992
FM 4474 2004
Equivalence of Product Standards
Certified By
11ttu://www.floridahniMina nra/nr/nr chi oOm,/r\n . .TT n Pr,irl • r
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