115 S SARATOGA CIR - ROOF (2) ' ` K CITY OF ATLANTIC BEACH
"'- A j 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
!Olt 9
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-2702
Job Type: ROOF PERMIT
Description: roof for shed
Estimated Value: $2,410.00
Issue Date: 11/18/2015
Expiration Date: 5/16/2016
PROPERTY ADDRESS:
Address: 115 S SARATOGA CIR
RE Number: 171768-0000
PROPERTY OWNER:
Name: CLEMENT, LARRY E
Address: 551 CAMELIA TERRACE DR
GENERAL CONTRACTOR INFORMATION:
Name: DIBBLE ROOFING COMPANY
Address: 3518 MORROW ST QA JOHN R. DIBBLE
Phone: - -
FEES: --- - -BUILDING PERMIT FEE $62.05
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $66.05
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACII ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904)247-5845
Job Address: 115 i SW-k-faDiel I y� Permit Number:
Legal Description 31-�13 38- V i Iii [a Un ) Df Parcel#
Floor Area of Sq.1.1. 3 Sq.Ft
Valuation of Work$ l MD 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 Residential
If an existing structure, is a fire sl‘nnkler pystem installed? (Circle one): Yes No N/A
Florida Product Approval# .9"--Fa I
For multiple products use product approval form SA e ef'
Describe in detail the type of work to be performed: bef- CItv Trzy, ?)--fab qnito,,s
Property Owner Information:
Name: i _ '_U'.1 Address: sl ,llA l IO P_, 1 V`PP
City V E State LZip Phone q — (_per 5_71.-51q
E-Mail or Fax#(Optional)
Contractor Information:
Company ame: . �i ' r rZ � * Quali ing • gent:
Address: • I :11111� �i;1% _:a City f_.__ III U • State : Zi I 'Ng I
Office Phone •MISK P.e: Job Site/Contact Number —TN-- 83 s- Fax#
State Certification/Registration#
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. 1 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 if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six(6)months at any time after
work is commenced. 1 understand that separate permits must be secured for Electrical ;York,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 hereby certify that 1 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
provisions of any other federal,state, or local law regulating construction or the performance of construction.
Signature of Owner _4/f 6 /,■ 4 Signature of Contractor 71' /-
Print Name I , y Print Name „.
Sworn to and subscribed bef re me Sworn jo and subscribed before J1 e
this I g Day of IVOIh P ,2015 this 1 Day of subscribed 'I' .2016-
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otary P blic .•p� f Notary 'u`1 "�° "ti., MISTY NN JAM S
ry MISTY LYNN JAMES ry P x_
MY COMMISSION #FF093710 MY COMMISSION#Fj 7
e';• 'fi Asti` EXPIRES February l 18U 0 �'
?a mod*:' EXPIRES February 18.2018 w
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