1103 Cornell Ln re-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 -2933
Job Type:
ROOF PERMIT
Desaiption:
re -roof 10124-R15 & FL15216.1
Estimated Value:
$2,500.00
Issue Date:
1/5/2017
Expiration Date:
7/4/2017
PROPERTY ADDRESS:
Address:
1103 CORNELL LN
RE Number:
177387-4010
PROPERTY OWNER:
Name:
KOMOROSKI, RENEE
Address:
1103 CORNELL LN
GENERAL CONTRACTOR INFORMATION:
Name:
RELIANT ROOFING INC RYAN SHOUPPE
Cameron Ryan Shouppe, CCC1330615
Address:
528 Millhouse Lane Orange PARK
rnmc: -
FEES:
BUILDING PERMIT FEE $62.50
STATE DBPR SURCHARGE $2.00
STATE DCA SURCHARGE $2.00
Total Payments: $66.50
PERMIT IS APPROVED ONLY M ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address:
14 - Q -Do F -a013 3
Legal Description CnirI •L LOt2 Parcel # 1 / I Dn 1 — L40IV
Floor Area of Sq.Ft. Sq.Ft
Valuationof Work521'3L7bW Proposed Work heated/eooled j-12� non-heated/cooled IIZ-k�
Ciera of Work (circle one): New Addition Ahecaux Repair Move Demolition pcollap. window/door
Use ofexisting/propased structure(s)(circle one): Comm Arial Residentixl�
If in existing strurture, is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval # Ic312•F -RIS -A ' ny Z$ $ �( LS2I is • I 1JY1G�lA LA>�rxp v�
For multiple products use product approval form ��, 1,,
Describe in detail the type of work m be performed:�X 1bi+— l sK SQ — 3 •�.J I Iz P1 •h
Company Name: aa.m naonne, ns V.111,nng Agent: �•�mrt�>asm.
Address: srvan..rsw. stn City rte^ State ^ Zip 32062
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State Certificatior✓llegistration #coexceta
Architect Nacre & Phone #
Engineer's Name & Phone #
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
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Print Name•L 1\VrINY1i6 r•—s _
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OTARY PUBLIC
STATE OF FLORIDA
Carnal FF951584
Expires 1119/2020
614
Signature of Contractor
Print Name Cameron Shouppe
Swog�IQ andsub ed before me
this ate- Day of Yr
N.V public I `
1/ v A dOkW.lfl
NOTARY PUBLIC
STATE OF FLORIDA
Canm#FF951584
Expires 111912020
Doc N 2017002199, OR BE 17832 Page 2147, Number Pages: 1, Recorded
01/04/2017 at 02:39 PIN, Ronnie Fussell CLERK CIRCUIT COURT DUV4 COUNTY
RECORDING $10.00
NOTICE OF COMMENCEMENT
IPREP nn[IN DUEL PAIR l
Permit No. Tax Fo6D No _
Staleof rL countyci 1 _.
To whom R may concern:
The uMercllined Mostly Idorms you that Improv aments will be made to certain nal Property, anal In
accordance with Section 713 Mthe Florida Statutes, the tollowhe Informatloo Is staid In Mls NOTICE OF
COMMENCEMENT.
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