87 W 3RD ST ROOF PERMIT ,Ly
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
+� ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ROOF-1460
Job Type: ROOF PERMIT
Description: REROOF 32 SQUARES 6/12 PITCH SHINGLES
Estimated Value: $9,321.00
Issue Date: 6/24/2016
Expiration Date: 12/21/2016
PROPERTY ADDRESS:
Address: 87 W 3RD ST
RE Number: 170829-0000
PROPERTY OWNER:
Name: PENDERGRASS, THOMAS W
Address: 87 W 3RD ST
GENERAL CONTRACTOR INFORMATION:
Name: ROGERO &WILLIAMS ROOFING CONTRACTORS INC
Address: 883 Lawhon Dr ST
Phone: 904-518-5463
FEES:
BUILDING PERMIT FEE $96.61
STATE DCA SURCHARGE $2.42
PLAN CHECK FEES $48.30
STATE DBPR SURCHARGE $2.42
Total Payments: $149.75
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 V
(�I _ I n 3223
,lob Address: ��a� rz��t�'P� 71Cc 1 C !�Ck Permit Dumber: --- — --
P-as-ariE b l 3 e- 0 ('filen-h- Gec.c�
Legal Description 1 5 C 2 D FT LLT to 13 L K ''jam Parcel#„� 00 -ago d
P"loor Area o a. t. Sq.Pt
Valuation of Work S 9 32 - � Proposed Work heated/cooled non-heated/cooled
.: lass of NVork(circle one): New Addition Alteration(-�� Move Demolition pool/spa window/door
Use of existing/proposed structure(s)((circle one): Commercial ial-�--)
If an existing structure,is a firesprinkler system installed?(Circle one): Yes No N /A
=iorida Product Approval # Ft 06 - 0 W(l aq r1(/Tr� PRC PrQ, Q F 17 ZC�
For multiple products use product approval form
Describe in detail thet pe of work to be performed: � (t� 1 5a a-re-s a
_c rtty C Information:n� f
Address: ret1�C 2 -- ------ --
sf
StatrL Zip 5 Z33 Phone D , '7 0 3. ------ -----—
:u:. or Fax# tOptional) ----------- --.—.
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Contractor Information: �'\ ~ ` co
mpany Name: 01�l i 5 Quali mg Agent 0 r�
_address: 0 City Zip 32750
Office Phone - !5 �q 413 Job Site/Contact Number 40 y -a g 77(7 d Fax#9nd , 2�U(o4
State Certification/Registration# P('C--k -3 03 S-7
.-trchitect Name& Phone #
_ineer's?Mame& Phone# - l5 sr; � :Yew FL 3IZ�')
_e Simple Title Holder Name and Address o �'�� 1 a+t.S`�t An _�nf_.�__9_c _ _—_
-i.. : d:ng Company Name and Address -
1L:age Lender Name and Address — ---
_4pplication 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
nuance oj"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
.;r:d void q*uyork is not commenced within six(6)months, or if construction or work is sus ended or abandoned for a period of six(6)months at any time after
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
r O YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
�riin
at l haixn
his plic ion and know the same to be true and correct. ,-111 provisions of laws and ordinances hoverning r!s
'work will be coeci ied rein or not. The granting ofa permit does not presume to Bile authority to violate: n.cancer the
.� ,)I ir. other kaw r u ting construction or the performance of construction.
iman;re of Owner Signature of Contractor
--- 196;
Onnt Name //1v 5 Print Name :f... r ....... ................................................
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S•,orn to and subscribed before me Swo nd subscribed before me
his Day of 20 l u this ?Day of t 20 �
� - ►AUt ROSHN�ASUTTA --
= tA�tt7"S RT 6ASSF —
!'uh1tL. .a •,� Notary Public `� Commission N FF 39155
s �= Commission A FF 39155 • •= My omm�siP EXpirpis
'• = My Commission Expires RO
qac != July 24, 2017 �?WPNdf; 0I :,
Doc # 2016137861, OR BK 17601 Page 1554, Number Pages: 1, Recorded
06/17/2016 at 10:55 AM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
---------
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LOT 6 BLK 79
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