2197 S FAIRWAY VILLAS LN - ROOF . A \T� CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
j s-, ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
'I'./ -riiir- i
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-2838
Job Type: ROOF PERMIT
Description: REROOF
Estimated Value: $6,323.00
Issue Date: 12/8/2015
Expiration Date: 6/5/2016
PROPERTY ADDRESS:
Address: 2197 S FAIRWAY VILLAS LN
RE Number: 169398-1066
PROPERTY OWNER:
Name: WALKER, OLIVER A
Address: 2454 TOWNSQUARE DR
GENERAL CONTRACTOR INFORMATION:
Name: BENTON INTEGRITY ROOFING & WINDOWS
Address: 5570 FLORIDA MINING BLVD S Ste S STE 310
Phone: 904-262-7663
FEES:
BUILDING PERMIT FEE $81.62
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $85.62
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
• CITY OF ATLANTIC BEACH
• 800 Seminole Road, Atlantic Beach, FL 32233
Office(904) 247-5826 Fax (904) 247-5845
• /� FL 3aa Z 3
Joo�Address: o21 C(l .. IC- t Cam\ �II,,I,l, L A#.&-� �XPermit 'umber:
egal ieesscri sin 6--°�G r V i S ' 3 } Parcel# g't OCo Co
P t "loot'Area o Sq.Ft. /Z /_ Sq.Ft
Valuation of Work$(0 3 3, Proposed Work heated/cooled /�J ?Y� non-heated/cooled
Class of Work(circle one): 40) Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial d
Resiential
If an existing structure,is a fire sprinkler system installed? (Circle one) Residential
o N/A
Florida Product Approval# FL- NS&
For multiple products use product approval form T � 37 s)44 ?"-- .—/
Describe in detail the type of work tb be performed: . . ` lr �1 ._ ��L'• • -lac ri• \ t '.
01% '' — L • 1 • to !' -I.A.f ' _ _ A 2...j,I / V
Property • veer Information:y - _ m_
Name:�t�i5i#ink vtalAV' Address: CJ" i A-t ., ^�/1!t� ` c
City.jot dc.€:Oi'v 911%e _State Zip 3 Phone 0`ib�C 531 a
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Benton Integrity Roofing Systems Qualifying Agent: John Albritton
Address: 5570 Florida Mining Blvd.. #310 City Jacksonville State FL Zip 32257
Office Phone 904 262-7663 Job Site/Contact Number_904 260-1372_Fax#__9.04.260-1355
State Certification/Registration# CCC 1 329868
Architect Name& Phone 4
Engineer's Name&Phone ft
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 certh that no work or installation has commenced prior to the
issuance ofa permit and that all work will be pe ormed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void tf work is not commenced within six(6j 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 ElectricalpWork,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.
I 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
provisions ofany other federal,state.or local law regul tutg construction or the performance ofconstruction.
''//
Signature of Owner "..� _ '__,% Signature of Contract +�` "& Pa
Print Name C SJ7E �. Print Name . � ittAWD`J
Sworn to and subset-.•ed before me
,--,-- Sworn to and subscr'bed befit- me ,,�
this,, ,.. bay of- 20/-S this/4rDay o . ,24N, — —
A 1 & d / .N.., KRYSTAi.K SALM t �/ �" KRYSTAL K SALM
Notary ', 'lie }�ti 1�tConMnbebn FF 91ft403 Notary�'u•lic , t�- 'o any u - e e of
Commission•FF 91f
� - a My Comm.Expires Sep 15.2019 �''r ".��.1' ire e 1
'''T���ii Y�` Bo.rd,0 ttwau tl( �Ate'a ''''aa i t Bonded 1f row$National Not
Doc # 2015278097, OR BK 17390 Page 1125, Number Pages: 1, Recorded
12/08/2015 at 08:02 AM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
. NOTICE OF COMMENCEMENT
Stata't,f F I Q j. _.. lax f•ca... . i ...NA.3qa..-.1.0104
County csr.... .Ul.
To Miran It May4Coneern:
'De tinilensigrted hereby inform you that iinp.tover entc will be made to eviasn real property,and in n trrthgx:t: with Swim 713 of
the Florida Statute:4 th following,in'''tirmatior:is antmel in thK NOTICE OF COMMENCEMENT. !
Legal Del xiptintt of ptopert;�being improved. :...3 —22• Q3-.2$-Z.. g»_Pal rway\.11Q 'i Lot
Aiiiiress ol'property being improved: 21,417/ $ r12110jliay...Vi.1.lasS.._ . Af.t n \c .fi cock, FL 3.2zo 4144
ae?acti:l description of improvements: Re-Roof ...:El isttn3 zuudins•
max :.G. .nt....Walker ' sWire,...Ir.. 1deaisrill. 3
t?w t.g intweg in site of the improvement;_ _i rae
1'etr Siut3tk'l'it€tholder of other than uw r;`. _ _.__.__......»_. . ..
lvatttc: .. .».. _ _ ...._..._ �._.._
Cortirstitof: ....s. r-lpll.llItgl tI.get3.ctil 5.!fhl F.I F
A.ddmas: $570 Florida Mini tiivdL Ste 0 IO lam" gs. e,,FL 3411 » __
Telephone No .....art 2.i3 .:.'c.0 ........_. ..................._ Fax No 4(4 7,60-1;q ._,
Story(Want
Rddrsta»: Amount of Hood$
Telephone No: Fax No;
Name and addressor any person making a k>aaa for the ctm n. Lion of the improvements
Name.
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Pliant No. t'aY Ne.
Name of pftoou wilhini the Slate isf lorkiL tither than hii oielf,&alguated by owner upon whom oinii.`cm or other dOcttrtteatt tuay he
served: Name:
sltllulttis: ... .
Telephone No:
in addition to himself, owner tiesionatnv the following, person to motive a copy or the i it'd s Nottoe as provided it its Section
?i ,tioC2•1(h),Florida atatt:ee. (Fill in at Owner's(spoon)
Address:
Telepixioe No:
Expiration date of Notice of Ci ouneticernetat(die expiration date is one(1).war:u frtmt the date of recd dattg nolo%a dilIbrent date is
THIS SPACE FOR R3 Ct)Rt*R'S USE ONLY OWNER f,; /
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,�.\ &foie me this 4 l a,.gr ;qty of (in she is cximi,.of Duval,Woe
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