2251 FAIRWAY VILLAS LN N - ROOF 1::;:i;111V
• J;
, CITY OF ATLANTIC BEACH
: Sl
• 800 SEMINOLE ROAD
_
\J ;r 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-1792
Job Type: ROOF PERMIT
Description: NOC REQUIRED - remove & re-install new shingles &
underlayment
Estimated Value: $4,879.00
Issue Date: 8/8/2016
Expiration Date: 2/4/2017
PROPERTY ADDRESS:
Address: 2251 N FAIRWAY VILLAS LN
RE Number: 169398-1084
PROPERTY OWNER:
Name: CARRUBA. PHILIP
Address: 2251 N FAIRWAY VILLAS LN
GENERAL CONTRACTOR INFORMATION:
Name: RON RUSSELL ROOFING INC
Address: 4419 HUDNALL RD QA RONALD WAYNE RUSSELL
Phone: - -
FEES:
BUILDING PERMIT FEE $74.40
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $78.40
PERMIT IS APPROVED ONLY' IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax(904) 247-5845
Job Address: 2ZS Iilet( -y U;II4s In r✓ Permit Number: lb— - 00Fr ( ca.
Legal Description -2.2- o%s-ZS-.ZI b Pod v:114,6 Lo+ .J2 Parcel#
Floor Area of Sq.Ft.
Valuation of Work$ `j Y1 9. O Proposed Work heated/cooled /0 6 Z _ non-heated/cooled_//$ _
Class of Work(circle one): New Addition Alteration Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial 'eside •
If an existing structure,is a fire sprinkler system installed?(Circle one): `es o N/A
Florida Product Approval # /0/Z`f• / o
For multiple products use product approva orm
Describe in detail the type of work to be performed: A—,2.0-c=r`^ eskl
6111Kltrs d- tA.vulevioliA.tIA* ) a—Rc iKS'z►\\( S\a,v.3‘+5 4- v,Amkt v-Lt.?"4A–
Property Owner Information:
Name:fii*e+ 404.0eee 1'i) L4c.wi t 4Soit GL 4- Address: 2 23 ve iC lQkn 5)d
City Po.,ft' Vecd.-et State Fe- Zip 3zv kt Phone 4,4/4/– P9 5 3
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Qualifying Agent: 26,1.41 i ssc k
Address:`1`'I%ct .r).vt&At P--4. City J c1/4,y State f C_ Zip 3 Z Z—'1
Office Phone -T `'l- //0"1 Job Site/Contact Number 600– icT tf 3 Fax#
State Certification/Registration# CC C %3 2714 S'�4
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. 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 a period 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 1 have read and examined this application 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.
i
Contractor i - .' e
Signature of Owner
, print e w a.l ek .R*a.s s c Lt
Print Name A erY (T v
Sworn to and subscribed
Sworn to and subscribed before me
before me this Z Day of
this Z Day of ADab{- ,
#4‘4,3(4.6i- , 201b 20 'C ' '
c
7 .. L Notary Public AI 4
No • $,P 1 iC Ryan Rennidc Eyrick
Revised 01.26.10 `.. INOTARY PUBLIC
0 STATE OF FLORIDA
044Y_'1='Commit FF945229
Ryan Rend&Eyrick "-
r NOTARY PUBLIC Expires 12/20/2019
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y STATE OF FLORIDA
. " Comm#FF945229
' Expires 12/20/2019
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