309 MAGNOLIA ST - ROOF 1!) CITY OF ATLANTIC BEACH
ISS
800 SEMINOLE ROAD
_- 41, s-) 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-1690
Job Type: ROOF PERMIT
Description: RE- ROOF - NEW ADDITION AND EXISTING ROOF
Estimated Value: $11,000.00
Issue Date: 9/8/2016
Expiration Date: 3/7/2017 -PROPERTY ADDRESS:
Address: 309 MAGNOLIA ST
RE Number: 170450-0000 — _
PROPERTY OWNER:
Name: SCHAFFER, CLARK & MARGARET S, *
Address: 309 MAGNOLIA ST
GENERAL CONTRACTOR INFORMATION:
Name: JUSTIN LARSEN CONSTRUCTION INC
, CBC1259833
Address: PO BOX 1942 LIC # BELOW 4 GERALD GOLLOBIT
Phone: 904-327-4311
FEES:
BUILDING PERMIT FEE $105.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $109.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORID:k
BUILDING CODES.
100:0
,-s,.....1-‘17'.?;-.. BUILDING PERMIT APPLICATION
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, c, CITY OF ATLANTIC BEACH
\ 800 Seminole Road,Atlantic Beach FL 32233
•-•=t2.01119%.- Office: (904)247-5826 • Fax: (904)247-5845 1 G - '\o o F -(C09 d
Job Address: 3oa POOVAiA5k • At L 'J 33 Permit Number:
tar 30 co
Legal Description t19--f liP-75' 4-? 5',4LTA k Sc_ c RE#
Valuation of Work(Replacement Cost) $ (4 UM Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair o Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residenti
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No CP
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of o Tree Removal
Describe in detail the type of work to be performed: e. oo
Florida Product Approval#1-1. WI VI.f 1 S0 64.3 for multiple products use product approval form
/
Property Owner Information c�,, L
Name: S Y Afle_4 Address: 3004 �� V '\G. cam,�`�
City /4�rl,,(/l`(L fPra
tM StatertZip 3033 Phone aob-6q6-05q3
E-Mail k'S0.k4.101 'tie(pt,ktOO.co.,--,
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:
Name of Company uS#u- Z.,AtSFb-) aauNtliCilwir.r.eQualifying Agent: J Sf a5
ti tiM -1-*-)
Address: (1'(oa 14•... fe.Lc5 51, City rvl,pill ku4G State Zip p1.
Office Phone petp2?-1/4 3/1 Job Site/Contact Number Moet') 32$--Lt 3lf
State Certification/ egistration # 'CCL. t SIq- E-MailgLC Littcleh.) coac.) 7,4A--ao•C-0 r-
Architect Name & Phone #
Engineer's Name &Phone #
Worker's Compensation EK..�,,...f t
Exempt / Insurer / Lease Employees / Expiration Date
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.
phis permit becomes null and void if work is not commenced within six(6)months, or if construction or work is sus•ended or aba, .ned for a
period of six(6)months at any time after work is commenced. I understand that separate permits must be secured f. 1 ,trical W' Plumbing,
Signs, Wells,Pools, Furnaces,Boilers, ters, nks and Air Conditioners,etc.
Signature of Property Owner: Signature of Contractor: `ilk
ailf
Before me
this t. +k Day of v) 12 01 L Before me this & 0 of VI
J
Notary Public: ' Notary Public:S>P c 51.Ao ZOlfklit
46 11 ,,II/Ir14/// , /
I hereby cert that I have read and examined t - applied if.'` lr theISRll!WcPB REhi-znd c rrect. .; '. ' 'o SLATOFF
A,' iiket team FIoAAa c gra ,.s )IAYt�I 9 FF93602
ordinances governing this type o work will be complied� l �,
presume to give authority to violate or cancel the provisioi6 �. %�rWy Atifunatxpitegodovi2keuiel pi,reg. • ,. •c
, Str;,boor 09.2019
performance of construction. 0 •.',;� ;�•�: Commission•FF 174929 440 •p
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