464 SARGO RD - ROOF II h
6� - ''= ,s, CITY OF ATLANTIC BEACH
-i- J 800 SEMINOLE ROAD
J� a
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
0!110,
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ROOF-1955
Job Type: ROOF PERMIT
0 Description: replace low-sloped roofing with modified bitumen roofing
(GTA)
Estimated Value: $2,400.00
Issue Date: 9/8/2016
Expiration Date: 3/7/2017
PROPERTY ADDRESS:
Address: 464 SARGO RD
RE Number: 171541-0000
PROPERTY OWNER:
Name: REYNOLDS, MATTHEW B
Address: 3534 SHINNECOCK LN
GENERAL CONTRACTOR INFORMATION:
Name: KEN WELLMAN COMPANY INC
Kenneth R. Wellman, CCC1327999
Address: 2941 EDISON AVE QA KENNETH RICHARD WELLMAN
Phone: - -
FEES:
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
BUILDING PERMIT FEE $62.00
PLAN CHECK FEES $31.00
Total Payments: $97.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
01..vj;yr, City of Atlantic Beach APPLICATION NUMBER
jsa Building Department (To be assigned by the Building Department.)
•v 7 800 Seminole Road Iio-f-oof-1RSS
.v, _r. Atlantic Beach, Florida 32233-5445 ` l
Phone(904)247-5826 • Fax(904)247-5845
-' /�
wow?. E-mail: building-dept@coab.us Date routed: 041-1 a""l l i b
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: t(0L SO-jS D 94 Department review required Yes No
uildina 7
Applicant: IcQ,r1 W tAleut-(1 Co• 7,-Ac . Planning &Zoning
Tree Administrator
Project: 1144,(•Q. \.Ow—SLOQQA WI to AA Public Works
17��i w _ Public Utilities
'Y Public Safety
Fire Services
Review fee $ Dept Signature
Review or Receipt
Other Agency Review or Permit Required of Permit Verified By Date
11 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:
APPLICATION STATUS
Ili
Reviewing Department First Review: 14proved. ['Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING 3d 6
Reviewed by: Date:
TREE ADMIN. Second Review: ['Approved as revised. ❑Denie .
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
JS 2''',',', BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH OFFICE COPY
800 Seminole Road,Atlantic Beach FL 32233
"-::40;119'' Office: (904)247-5826 • Fax: (904)247-5845
Job Address: 7-61 /'-) i..0 Permit Number: lb— V-Oo F. - MSS-
Legal Description 31-R. S g `LS - 2.18- /V P1 ,aye(A h5 RE#17( t 1II- DO 06
0o d^', t-71r
Valuation of Work(Replacement Cost)$ �� �� Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
ii-P U..' sry a LA ,,,,y1, �A46.)• 1.rd r/�P,,,,,,' 4 v3. C6-Tt4)
Florida Product Approval# rk•('ti t �i_.2.573-eV., Kir 1-" 11-1'' f-" for multiple products use product approval form
Property Owner Information -4 ss '`t`5k �L 12 t>
3' �-
Name: /144446,J / eeynio Ic'f Address: 55-3Y Sit; 4c- 6 1,t^t
City ((,-Ce.i Cu7e'e Or. ^'�l StateJ/4 Zip 32i? Phone gay - tp,i- 56?,4
E-Mail
Owner or Agent (If Agent,Power of Attorney or Agency Letter Required)
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.
Contractor Information:,
Y�
P
Name of Company: i itiefii+at' Co. Zt^' - Qualifying Agent: k4 nom a. ,,✓ G'.
Address: )4'1/ fol,sr,) 4\t-t. _ City J4c4Osomt ivr State Zip _ 3'LZS`f
Office Phone Ccjeti) 55 3 It' i Job Site/Contact Number
State Certification/Registration# Z -,.Z 7-545 E-Mail 6„.c,Yll7-i,,..k i eve comas/- ► '
ei-
Architect Name & Phone#
Engineer's Name & Phone#
Worker's Compensation47 _
et • nsurer ease mp oyees xpiration sate
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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(61 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. -/
Signature of Property caner: / e l►(i Signature of Contractor: _-_�i L.//
Befog pie p_ /_
this�((O'Day of . /r: �� Before me this a tf/ Da of , 4�/,.!..
„,.,�,. � ,. a
Nota Public: D ri•, Y::i;l? Iri parr Notary Public: IMUZIEIMA irrr. •— -
ry :4� y •a. . a e o s ,a A � ., r RY JANF an"•.r 4
.4.:01� r I.
Commission it FF 991508 �,, 1: •q�p"h' ��
I herebycerti that I t i . '' ' dielfes ttayhitc2626 'nd know the same to m`�J ec. All p,rq,v.iggz at and
ordinanes governing > • ,'El. whether specified her it?s t:; i ,- grsrktiggigr�ize{{n s not
presume to give authority to in. a e .r i n e to r. '!sons o any other federal, state, or local l aiv regu a !ig con tructiOn r the
performance of construction.
Rev. 3/14/16