1220 SEMINOLE RD - REPAIR CAR PORT ,s,
' t. ';, ,_,s,
CITY OF ATLANTIC BEACH
— ' -".• .9 800 SEMINOLE ROAD
j " ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-RAAR-2870
Job Type: RESIDENTIAL ALTERATION
Description: TREE REPAIR - CAR PORT, ROOF AND TRUSSES
Estimated Value: $6,500.00
Issue Date: 12/10/2015
Expiration Date: 6/7/2016
PROPERTY ADDRESS:
Address: 1220 SEMINOLE RD
RE Number: 171936-0000
PROPERTY OWNER:
Name: ELF, ROBERT D TRUST
Address: 1220 SEMINOLE RD
GENERAL CONTRACTOR INFORMATION:
Name: BLASINGAME BUILDING SVC., INC.
Address: 14286 -19 BE BEACH BLVD APT 365 QA WILLIAM GRAY
BLASINGAME,III
Phone: - -
PERMIT INFORMATION:
FEES:
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
BUILDING PERMIT FEE $82.50
Total Payments: $86.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
131. 11..1)11{(■ Yl'.KMI l Al'PLICA I ION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233 nn / j
Office(904) 247-5826 Fax (904) 247-5845 15 R i`n∎C� -iS 7 U
Job Address: /2 a.0 .Semi rNo1 e /:zo. Permit Number:
awn' Lor 81K
Legal Description ,Z7- 6 /6-.2-5--.24( SECvq inARTNA x 2 3Pareel# / 71 93 6, o0 0
of floor Area of Sq.l-t. Sq.I.t
Valuation of Work $ 6 ro a Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration ep • Move Demolition poolispa window/door
Use of existing/proposed structure(s)(circle one) Commercial
If an existing structure,is a fire sprinkler system installed? (Circle on N IA
Florida Product Approval 1# 1ort5 6.3 HuRRrcei Are Tie
For multiple products use product approval form
Describe in detail the type of work to be performed --_gt/°fl.Zie .II 4 A),vni 6( jo CA R Pof2T /eOO •
Property Owner Information:
Name- ei,e/'o/V ELF- Address: /2 2-0 ,<649I/voLE O.
CItv iAT ,4A/TY� e6fai Staten Zip, 1-21.?Phone 35.2--2$ - 9EO C _-_
E-Mail or Fax u(Optional)
Contractor Information:
Company Name:"Af G44itE S1-® i;SEXY KluaIifying Agent:1✓;J/"o-ot 4, d/et.SiK�a-
Address: /J.286 -/7____ _.i LYD City P_,kSoNvZU( State/L Z_ip7.2 1
Office Phone 6-2i'9-' 777—Job Cite/Contact Number ¢- .- Fax#
State C ertitication/Registration ft__. • y 4 et Z7 ------_.
Architect Name& Phone ii i
Engineer's Name& Phone# 4
Fee Simple Title [folder Name and t ddress 4 -
Bonding Company Name and Address—. • /i9 _
Mortgage Lender Name and Address f
Application is hereby made to obtain a permit to do the work and installations at indicated. 1 certify that no work or installation has commenced prior to the
issuance of a permit and that all work will he performed to meet the standards of al!laws regulating construction to this jurisdiction. This permit becomes null
and void if work is not commenced within six(6)months.or if construction or work is susp ended or abandoned for a period of six(6)months at any time after
work is commenced 1 understand that separate permits mast he secured for Electrical-Work,Plumbing,Signs, Wells, Pools, Furnaces, Boilers, Healers,
Tanks and Air C'onhtioners,arc
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 1 have read and examined this apphcaoon and know the same to he true and correct. All provisions of laws and ordinances governing this
type of work will he complied with whether specified hereto; or not The granting of a permit does not presume to give authority to violate or cancel the
provisions alarm other federal. stare.or local law regulating construction or the performance ofctnsmtction.
/ _ •
Signature of Owner . ids' Signature of Contractor ../✓
Print Name .IPOi .4-if Print Name 441/iam (G . AY/as:.�a y.,•_-�
Swo f to and subscribed before me Swcio subsc ' ' before me t
this .r Day of De(it1n�.- ,201 S- this r . of MIRA* 20 AO
Notary PUitl,c u•eP110I 5 i If• IGINDLE8PER�
J f"s 1086E41GF) ••!1Y'Y '' My�OMMISSIONtFFt124951
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Blasingame Building Services, Inc.
16:29PM December 09, 2015
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16:29PM December 09, 2015
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