375 4th St roof permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J --" ATLANTIC BEACH,FL 32233
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INSPECTION PHONE LINE 247-5814
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ROOF-2342
Job Type: ROOF PERMIT
Description: re-roof with asphalt shingles
Estimated Value: $4,500.00
Issue Date: 10/18/2016
Expiration Date: 4/16/2017
PROPERTY ADDRESS:
Address: 375 4TH ST
RE Number: 169846-0110
PROPERTY OWNER:
Name: MARSHALL, DOUGLAS
Address: 375 4TH ST
GENERAL CONTRACTOR INFORMATION:
Name: LOCKE ROOFING LLC
Daniel Wayne Lodte,CCC1330628
Address: 24 E 4Th ST
Phone: 904-424-7618
FEES:
BUILDING PERMIT FEE $72.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $76.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMrr APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
ort vt` 11 //�I
Office:1(904)247-5826 • Fax:(904)247-5845 ,,nn
Job Address: ttT5 LJVV) 4 2T14rp h'c BRK Permit Number:
Legal Description 5u9 41`, x1E ! Ai4 -41.ti 1. eLn Loi•7s Bi
Valuation of Work(Replacement Cost)$ 4t SDO•o[J 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 esidentia
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No /A
• Submit a Tree Removal Permit Application if any trees,are to be removed or Affidavit of No Tree Removal
Describe is detail the type of work tobel performed: rr,
,oF bA i
rX 1-h p,�7yo11} SL„ar iPS
Florida Product Approval# Cj�p 1 ot- fn multiple pmduas ux product approval toren
Property Owner Information
Name: �+� .a4S MnE4l ii Addres.3% 4y� 5�
City R{\o,ni t �tgc\. State 06 Zinp las Phone
E-Mail
Owneror Agent urrtsma,rowmarnnomermnaearww wauae4r •@1-LN'kll
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: VTR Qualifying Agent: 4h1!'I �,. -mac�-4.
Address:lck�k A ms C, CityC.,jjC,( ,&j1e State Zip ,
Office Phone Grk•t-a.43— lza4c Job Site/Contact Number 904-c1a4- I
State Certification/Registration# CC.C.I�' i(p��t E-Mai15b�,n:ellu7.L..,r11,.n-.-�wa.ur of
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensationt
xempt nwrer /TcaeeEmP xprnnE-'�"—
Applimlion whereby made to obtain a permit to ds the work and insmllatiov as irdicalyd. !rertify that rro wod or inrlallalion Ass rommenced
p fo fAe iuuanre oja permit and drat ah work will be pew mxd m neer the rrardaMs ajaH Iowa regulating co/urrvcfion in rM1v jurisdiction.
9'hu permit becomes nu//and wid IJ'xark nor rommenced within rix(d)monrhr, or ijrorulrveHon or xnrk rs suepe ded o bandoned rot n
Pd o(sis(6 the al any time alter wrk is commenced. !understand tMl sepamre permits mart be sewrcdjor Elurrlcal Work, binR,
Sfgni Wells Poor+.Furnace;Hollers,Nesters,Tanks anQ Ab ConQlHoners, S Z
�•/�
BefojjS5,pp{1�eofProperty Owaer o`^•�W" Sigvature ofContractor: ��� �
his LtL`•Day of (r l/o Before me this I)ay of z
Notary Public: //`✓I4/irrl4- Notary Public: SS ie 3
in
1 hereby cera fivhat 1 haoe read arrd 1, .ned this application and know the same to be true and romcf. All prommas of laws and S`
ordi ill be complied with whether specified herein ar not The granting of a permu does not �: m
pre. `, r aulbd%anAL r c cel the provisions of any other(e eral,slate, or local law reg laking consfnrcfion ar fhc
AIY COM.ASSIONAFF 018392
E%PIPES'.May 14,2011
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