1022 MAIN ST - ROOF -S r\J`1 r
r-1 ': `st, CITY OF ATLANTIC BEACH
.4.. -°." .J 800 SEMINOLE ROAD
si
: �:5 ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
'\131>r
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ROOF-1952
Job Type: ROOF PERMIT
Description: RE-ROOF
Estimated Value: $1 ,475.00
Issue Date: 8/29/2016
Expiration Date: 2/25/2017
PROPERTY ADDRESS:
Address: 1022 MAIN ST
RE Number: 170996-0000
PROPERTY OWNER:
Name: MASTERS, RALPH
Address: 1022 MAIN ST
GENERAL CONTRACTOR INFORMATION:
Name: ROMANO BROTHERS ROOFING, INC
, CCC1328893
Address: 1188 N 12TH ST QA DANIEL JOSEPH ROMANO
Phone: - -
FEES:
BUILDING PERMIT FEE $57.38
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $61 38
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: ) LA• inn n 54. 1 I '' I Permit Number:
Legal Description -C' i1Floor ealot 4 S .Ft.k 10_1Parcel# n l3gq( „ -CC
Valuation of Work S I LJ ) Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration •epair(MN a-demolition pool/spa window/door
Use of existing/proposed structure(s)(ic_ircle one):. Commercial (( Residential
If an existing structure,is a fire s�pnnkler system installed? (Circle one): Ye o N/A
Florida Product Approval# 1 q5 G.3
For multiple products use product approva'i'orm r
Describe in detail the type of work to be perfo . v /1 t— •
Prone Owner Information:
I IL-A et )•t{-..e- s ddress: )L S4-
Name: ��^
Ci i S Zi a Phone �I-D- - 1,...1 %).,
S4-
City
E-Mail or Fax • p •tional) I ..imium--
Contra tor Informa•on: ':Companl
��11 . Qual}'�'i�g Agen • 1 _ ��ta �V�.c O�`-
Address: N;�•t:•- City f�T State Zip'y�s�
Address: ((
Office Phone_ 1 • 1 Job Site/Contact Number
Fax#
State Certification/Registration# ' C i5_(l_ l 3 a 9,y,9 >
Architect Name&Phone
Engineer's Name&Phone#
Fee Simple Title Holder Name and(Address
Bonding Company Name and Addiless
Mortgage Lender Name and Addrelss
to the
construction in thisjurisdiction. This permit becomes the Application is hereby made to obtain a pe>imit to do the work and installations as indicated 1 certify that no work or installation has commencedpriorafter
ll
issuancenvoid ofwpermit and twork win die pe oonth,to meet one ucionstandards oworllk
laws regulatingo d si Furnaces,Boilers,time
after and void if work is not commenced within six(6 months,ori construction or work is_suspended Plnt�tt� gfi�s a oPools,d of six(6)months at any bine
work is commenced. I understand that separate permits must be secured for Electric
al• Tanks and Air Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING FINANCINGWICE FOR
IMPROVEMENTS
CONSULT
TO YOUR PR��IFERT IF YOU INTEND TO OBTAIN
YOUR LENDER O AN ATTORNEY BEFORE RECORDING YO'UR NOTICE OF
COMMEN E
this
I
o l vs and
to dnces or a ninncel the
t pe of work that
be have
w ith examined
this
l eeiaedlh tin ornot. .The he grae ntin8 of a permit e to be true and does not preesumt provisions vs and ordinances governing
type ofpp
provisions of any other federal,state,or local taw regulating construction or the performance of construction.
Signature of Owner .J�/ V
l I S -e- . - Print Name .ta.. Biu ► • do.
Print Name _ q __-! o o ++
/ M 23co—IR -- 9 g��,. i . . •d subs��bed before ne •20 1
Sworn to and subscribe befo-e nue is - Day of `V
thi 4 Day of s .20 , P.
I _Ada. , -
•t• -P•• 10 ' 4'' AMBER L HICKS
;:=o J. AMBER L HICKS tr° A evised 01.26.10
m • MY COMMISSION#FF023216 •1 MY COMMISSION#FF033216
`',rE of -Jr` EXPIRES July 2 'Al `• o? EXFIFES July 2,2017
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(407)398-0153 Floridallotar (V 'e..' 307)398-0153 FloridaN 'aryService.com