373 6TH ST - ROOF IIP" `-', CITY OF ATLANTIC BEACH
SJ 800 SEMINOLE ROAD
J 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-1964
Job Type: ROOF PERMIT
Description: RE -ROOF, MODIFIED AND NEW SKYLIGHT
Estimated Value: $2,300.00
Issue Date: 9/8/2016
Expiration Date: 3/7/2017
PROPERTY ADDRESS:
Address: 373 6TH ST
RE Number: 169904-0000
PROPERTY OWNER:
Name: LINDLEY TOLERT DESIGNS
Address: 465 BEACH AVE
GENERAL CONTRACTOR INFORMATION:
Name: EMPIRE ROOFING SALES & SERVICE
, CCC1326007
Address: 2806 -1 GI GIBSON RD QA PEDRO R NUNEZ
Phone: - -
FEES:
PLAN CHECK FEES $30.75
BUILDING PERMIT FEE $61.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $96.25
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
-0,JAIJ;, City of Atlantic Beach APPLICATION NUMBER
r• 1 Building Department_ _ __ o be assi,ned bythe BuildingDepartment)
3;n" `� 800 Seminole Road— I CORO - I ,
,� i�r Atlantic Beach, Florida 32233-5445
0 ( -
Phone(904)247-5826 • Fax(904)247-5845 Q
o,t19r E-mail: building-dept@coab.us Date routed: •Z- /
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 373 (0-°‘-- S4 - Department review required Ye No
uildmg
Applicant: Cin(\(J ( R_E R 00 F- 1 a0 CS g &Zoning
Tree Administrator
Project: Rz. Public Works
S (� Public Utilities
k-�-(--(G HT Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
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
IReviewing Department First Review: roved. ❑Denied.
(Circle one.) Comments:
BUILDINt
PLANNING &ZONING Reviewed by: / / l Date: M/70"
TREE ADMIN.
Second Review: ['Approved as revised. ['Denied.
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
BUILDING PERMIT APPLICATION
r OFFICE COPY
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904)247-5845 1 ( _R 00F -I 9(04-
Job Address: 373 6÷' ,�'f" q, t. 6ttrj1, Fl • Permit Number:
Legal Description 5-6q '-/6 -tA S - atmht.Il` 30A-Parcel#
Floor Area of Sq. t. ,;z Sq.Ft
Valuation of Work$ 0'`1300 Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration 'epai Move Demolition pool/spa window/door
Use of existing/proposed structures)(circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed?(Circle one): Yes • N/A
Florida Product Approval# r 5 19 •' , Fl ac33 , t )3 MI s- -q , 6 SIeylith V
For multiple products use prod 'uct approva orm
in detail the type of work to be performed: Re-ra f cI ei 4- o ti Rav' of- Heys e.. f e ,/rn.>
ro}4ed wood and rtpiac.e Slhyb yAt1.
Property Owner Information:
Name: QremdanBarASS Address: 373 d'''' 54-
City q,i 15 s4 State riZip lay Phone Bjg - Ygy'rf
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS: Pedro
Company Name: ,re, Qualifying Agent: +'edro /vunreL
Address: 2856-j (As� gd C• , ' ' State P9. Zip 3./Ao 7
Office Phone1-007 Job Site/Contact Numb r _• -CJ ; Fax# 3q 1-187 7
State Certification/Registration# CC-L..132007
Architect Name&Phone#
Engineer's Name&Phone# ifYI t k,p .
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address r
Application is hereby made to obtain a permit to do the work and installations as indicated. I cert 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 aiperiod 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, oilers,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 herebycert that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type ofworkspecifiedwill be complied with whether herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federa state, or ,calla• reguu ting construction or the performance of construction.
Signature of Owner ,
� Li‘ Signature of Contractor ,fral.,4r /21-77-de
Print Name r
►l..et1dG .&.rrk,S. Print Name A1-Orl`p Ni//✓C,'7j
Before n3 Beforr
this Day of ,.. ,204 this.1 y • ��,..,�_; 0 l�
�, �o`"a�, r r COOK
�R
/ .COOK j e �- :` _: •''' . - ' - eo ,
414 sq,.r' ,� moi/ z
Notary 'U IC 20';--=. st; Notary Public•State of Florida Nota ' b is ,�r, �' 'Y omm.Expires Feb 21,2018
i-'_• ` 474,1: =MyComm.Expires Feb 21,2018 rh �� �/
�D L _ � "'.',�FO�oa,,� Commission # FF 0863
' r : p Bonded�uq�N�;��NZ
;����poc Commission# FF 086334
'4�°���`` Bonded Through Natiaial Notary Assn. L Q / I.