1101 Cornell Ln roof permitCITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
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:
17 -ROOF -2934
Job Type:
ROOF PERMIT
Description:
re -roof 10124-R15 & FL15216.1
Estimated Value:
$2,500.00
Issue Date:
1/5/2017
Expiration Date:
7/4/2017
PROPERTY ADDRESS:
Address:
1101 CORNELL LN
RE Number:
177387-4005
PROPERTY OWNER:
Name:
TACKETT, MARLENE
Address:
1101 CORNELL LINE
GENERAL CONTRACTOR INFORMATION:
Name:
RELIANT ROOFING INC RYAN SHOUPPE
Cameron Ryan Shouppe, CCC133061S
Address:
528 Millhouse Lane Orange PARK
Phone: - -
FEES:
BUILDING PERMIT FEE $62.50
STATE DBPR SURCHARGE $2.00
STATE DCA SURCHARGE $2.00
Total Payments: $66.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Desch, FL 32233
Office(904)247-5826 Fast(904)247-5845
Job Address: {'IyI QXyU,0 IIv, - Permit Number. «_tf-O0E—3Ci3LI
55-011 1-1- 25 - 2Afo. in
Legal Description r K Il I 1,e,+ 1 P real# t7_13$, -4Wao
Floor Area of Sq.Ft. , I �1 h SgTt
Valuation of Works Z5(b.LQ ProposedWork Ill
heated/cooled ," non-heated/cooled l 2 _
Class of Work (circle one): New Addition All eor, m[wn Repair Move Demolition pool/spa window/dour
Use afexinmg/propmedatroctme(e)(Nrcle one): Commercial Residential lj_I
Han existing structure, is a fire sprinkler system installed" (Circle one): Vee i9 N /A
Florida Product Approval # Y L b 2,a{— R lS 7� FL 16 -1 (D . wtala+'t0- paw^ For multiple products use product appy 1 1 royal form JMI✓up4s (� 11 11
Describe in detail the type of work to be performed:�4 1ZSlii� _ �K 1 f1h:t5 4 �D s5Q
c
M(Af-avAL Tac
wJI-ii
Name:
City, rix -L ijtxarn
Stam
E -Mail or Fax # (Optional)
Cmm Information:
axtor
Company Name: oa"^a°<^u. m
Address: anssssmsm
Office no. mtffirmm
Job Site
Architect Name & Pboae #
Engineer's Name & Phone #
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Leader Name and Address
mrsn-ma
tse�rrA/y/yy +N seer Eia,e.meamE es°ni�eprxenc /laffctiariw, mer ehe.w,em Nn„e°ad �cz#r�e.wa. /ia„�:Wdo,drsaaa,x°�smi as
s1 wYWMri�1,uide-1aco1�lmr rety,yl°(inRcnrnuCn�w�tav�ff °•°a�,I�m ir,0etmP•"°,"`re x�.e aaene ibm wdmr e. tri.
L14 7�1
Si,natum of Owner Signature of Casonsemr
Print
I{,h•(� ^ I Print m
Name Caeron Shouppe
Name IRI -1 ----- ----
S;opDey of Afore me
n
NmV Public '
V Jennifer Kraut
NOTARY PUBLIC
STATE OF FLORIDA
Comm# FF9515B4
E14 Expires
1/19/2020
SwoI and sub d before me
this Day of
NoU Public
Revised 01.26.10
NOTARY PUBLIC
STATE OF FLORIDA
C,,,*FF9515B4
E t41 Expires 11192020
Doc 9 2017002191, OR EK 17832 Page 2119, Number Pages: 1, Recorded
01/04/2017 at 02:36 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVA COUNTY
RECORDING $10.00
��. NOTICE OF COMMENCEMENT
lnneaua w ooxrutEl
Feral No. Tea Fdia No.
slab d 1�4 County m D V
To whom H awry uneem:
no uMeralgned healthy Informs You Mat Improvarwlts will W awatle to net. last PnoFoM. and In
accordance with Section 713 of the Florida Senate. the fallowing Inform.Ilon Is soled In Inca NOTICE OF
COMMENCEMENT.
Lepra atins, Non mpropedY uinp Irnpray.I ]-
(txv�e..l l 1 low 1
Nil Lim
Peereasm Y0e1M m01oved' I
W&.01 L Z
CNlenl a.aapion mYnprownwnb: 1`'C� Y�7c�T"
wne, Mtw4.nF�TAcKe
Addle UI avu.11 Ly1 (a.vltic t3fac12 E - 32233
Fee Stype TBenoben
Camrseta Rdwx Roofing, Iz.
ypitioey 822. AIA Highway Suit, 310 Pales Vgar. Borah FL 320112
PMtu No. sa'sn"I'a" Fax No. 904477-7972
Adduw /awlaUllmevlaB
Pbw No. Fee No.
None sm ada,.aa of aro IMfon mrge •ion NFlhe unMNdlon mb.IawplowHM
Pnone No Fu No.
Nsrc of pseon wNUn the Bab of FbW~ them Mn N. dsggnalgd RY ownsragon wnan nNlwamodw
dongnBdc may oe carved:
Address_
Phare, No
Fax
in Mention 0 annuall, own., aesynWF the fofl pperson b neaeivaa copy of the Liarofa NMies as povaed in
SeaBon 713 N (2) (h), Flood. Satellites. (Fill in .1 Ow d Oplpn).
Plans No. Fax No.
Expo.don dela of NoOce of Damlen9Hnent (ft exaltation data he 9,1. (1) deal Ram be dab ml.00,are unless a
ditmnt date Is spedfwd)'
THIS BPACEFOR RECDRDER'S USEONLY OYIf1ER
r°pi0e. a Rt d� a ti]�im� D"a t: nee
J.ww Num
Expima 1119=20