1892 BEACH AVE - TRUSS REPAIR S CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J11 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-2822
Job Type: RESIDENTIAL ALTERATION
Description: TRUSS REPAIR
Estimated Value: $1.000.00
Issue Date: 12/9/2015
Expiration Date: 6/6/2016
PROPERTY ADDRESS:
Address: 1892 BEACH AVE
RE Number: 169522-0000
PROPERTY OWNER:
Name: LOVE, WILLIAM
Address: 1892 BEACH AVE
GENERAL CONTRACTOR INFORMATION:
Name: ROGERO & WILLIAMS ROOFING CONTRACTORS INC
Address: 883 Lawhon Dr ST
Phone: - -
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $55.00
STATE DCA SURCHARGE $2.00
PLAN CHECK FEES $27.50
STATE DBPR SURCHARGE $2.00
Total Payments: $86.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACII ORDINANCES AND THE FLORIDA
BUILDING CODES.
.,0...e `ik City of Atlantic Beach
;• - 0 Building Department APPLICATION NUMBER
t" p 800 Seminole Road (To be assigned by the Building Department.)
- „z Atlantic Beach, Florida 32233-5445 15 - R R7_
Phone(904)247-5826 • Fax(904)247-5845 C.Z
v;� �� E-mail: building-dept@coab.us Date routed: /Z. 1//
City web site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: / ?i 44e 4 / De• - a ent review required Yes No
:uilding
Applicant: J Eoyad ttei yi - anning &Zoning
Tree Administrator
Project: /rA35 ley AIX Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified By Date
Florida Dept. of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLIC STATUS
Reviewing Department First Review: pproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by:T Date:l_OS C'75-2.
TREE ADMIN.
Second Review: QApproved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
• PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: []Approved as revised. nDenied.
Comments:
Reviewed by: Date:
Revised 07/27/10
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, L 32273 �+
Office (904) 247-5826 Fax (904) - 7-5:
Job Address: /192 8V0-1 f(�!i its raper: 330
Legal Description lit—Z5 —Z!E .OS 17 PT 6Ot1 COTS +!f 1# I S-ZZ— 0 !(''
Floor Area of Sq.F't. �}
Valuation of Work$ 1000. '° Proposed Work heated/cooled `���" % -j : ? •..�+ , FIJI
Class of Work(circle one): New Addition Alteration (`2epai Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial esidenti.
If an existing structure,is a fire sprinkler system installed?(Circle one): 'es /A
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: I' S ':,
100 /
330
Property Owner Information:
Name: /1//W/4 14 r�r4(/4 Address: , 4Z- l'2 CkI ' 'Oto
City kiu'sc)Y7(� ef,404f StateR Zip 32233 Phone 9/7- qqq — /1!
P
E-Mail or Fax#(Optional) A.4444--
Contractor Information:
Company Name: J. 2oigeep ConK4tVe.-Ton ,T c- Qualifying Agent: JfitivAty 09e4e0
Address: 2950 {-Fa r+1 y tvad #2.. City. lacl(SOnV1 lit State Flo, Zip 3225
O ff i c e Phone 04-S(S- ' 3 Job Site/Contact Number gOri '4q7 -97 21 Fax# '90/-‘,/ -2ttf9
State Certification/Registration# CBC 12514 1o3L4'
Architect Name& Phone# nVA
Engineer's Name& Phone# LOU P0/01(p.0
Fee Simple Title Holder Name and Address iJJA
Bonding Company Name and Address jJ/A
Mortgage Lender Name and Address N/A
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 if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for aperiod of six(6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work, 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 e amined thisplication and know the same to be true and correct. All provisions of laws and ordinances governing this
.type of work will be complied with hethe-specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
'provisions e of any other fe era!�st te,1,rlo 1 law regulating construction or the performance of construction.
11.4
Signature of Owner A Signature of Contractor
Print Name X -1-7QC f\ S0.V 0-51-.,1-. Print Name J I/ < ,QtS�yf�Ie°
Sworn to and subsc -bed befo me Sworn to and subsc 'bed befor• me
this '1 Day of e ce.A.b.c,— ,20 /S— • '7 Day of / a_ , 20/ c
Win
� y , ID DAI F BASSFiT JR
Nota Public 11—.. Commission 4 FF 218179 Notary P`:'1c
'� ;�iq ��_ Commission # FF 218179
My Commission Expires i� �y�'(,p g� F,�,y�■
; ����' April 07. 2019 V%l;oir�'`'� 7(GV7JMVIQ2,V.'TVes
,,,,,,,,,,,�`� April 0 7, 2019
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''R°'I:(.'_ 1892 6EACH AVENUE
Lou Pontigo and
.3
Associates , Inc . -
420 Osceola Avenue -
Jax. Beach.Florida 32250 '°B NO. SAVA-15-00712 SHT.NO
Ph.242-0908 Fax.241-9557 J C K- 1
FL:CAN 8344 SC:CAI 3579 I)AIF.
11.25.15