1275 JASMINE ST - ROOF , ' CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
\� INSPECTION PHONE LINE 247-5814
\J1319''
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ROOF-1866
Job Type: ROOF PERMIT
Description: complete tear off and re-roof - tree fell on house - NOC from 16-
WIND-1469 to cover this permit also
Estimated Value: $6,500.00
Issue Date: 8/17/2016
Expiration Date: 2/13/2017
PROPERTY ADDRESS:
Address: 1275 JASMINE ST
RE Number: 171050-0100
PROPERTY OWNER:
Name: LLOYD, JAMES & LIZABETH, *
Address: 1275 JASMINE ST
GENERAL CONTRACTOR INFORMATION:
Name: AMERICAN ROOFING OF JACKSONVILLE
Address: 1720 Wildwood Creek LN
Phone: 904-385-4375 _
FEES:
BUILDING PERMIT FEE $82.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $86.50
I'I:R)IIT IS APPROVED ONLY IN ACCORDANCE WrrH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
' j ' X69
BUILDING PERMIT APPLICATION /C W I
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office(904)247-5826 Fax (904)247-5845
Job Address: 1275 Jasmine St. Atlantic Beach. FL 32233 Permit Number: 10— V--OO F- L $(0 ::,
18-34 38-2S-29E 0.120 SEC H ATLANTIC BEACH LOT 5 BLK 223
Legal Description Parcel#171050-0000
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ 6,500 Proposed Work heated/cooled 1460 non-heated/cooled 2016
Nos f Orn Vb-WI-Ntr.- Iq.bCi 1b Col) { k .:S p-1-(Mt} Ca&to
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
Florida Product Approval# Atlas Shingles FL16503 Atlas Underlayment, FL16226
For multiple products use product approval form
IlDescribe in detail the type of work to be performed: Complete tear off and Re-Roof
Property Owner Information:
Name: James Llyod Address: 1275 Jasmine St
City Atlantic Beach State dip 32233 Phone
E-Mail or Fax#(Optional)
Contractor Information:
Company Name:American Roofing of Jacksonville Qualifying Agent: Daniel P. Kinkel
Address: 1015 Atlantic Blvd, #352 City Atlantic Beach State FL zip32233
Office Phone 904-385-4375 Job Site/Contact Number 904.226.1205 Fax# 904.853.5318
State Certification/Registration# RC29027546
0 Architect Name& Phone# NA
Engineer's Name&Phone# NA
Fee Simple Title Holder Name and Address NA
Bonding Company Name and Address NA
Mortgage Lender Name and Address NA
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 pe ormed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void f work is not commenced within six(6f months,or if construction or work is suspended or abandoned for a period of six(6)months at any nine 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 cert fy that 1 have read and examined thisplication and know the same to be true and correct. All provisions of laws and ordinances governi 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 c' c he
provisions of any other federal,state,o local law regulating construction or the performance of construction.
f , 7
Signature of Owner / , Al"_ii/ Signature of Contras r -
--- 1 4/k/
Print Name _Stows 1 (J > Print Name hit! / )
Sworn to and subscribed before me S • to and s • c Led befo e me
this i(04 Day of Q,l,�o,t�.S-{- ,20 Ib th Day of 2, 20 s
t o 1 I ��;1
WNbta" / �L Notary 'u. is
' ,,`�,p *,, CHRISTY RIGNEY ./l�� '—I
NotaryPublic-State of Florida ,iiTONIGINDLE' .26.10
5, • , a. MY COMMISSION t FF 924951
• = My Comm.Expires May 31,2018 i_
;M,• 1�. �4R 7^ 1 l' l 9 � .,. 4..r. EXPIRES:October 6,2019
' •+, Commission # FF 122423 ` 4 lt,, Bonded ThruNoaryPutGcUnder iters
•ae'°s Bonded Through National Notary Assn. ` 3 1 1
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