386 10th St re-roof permit ?i�Yr rl
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
u 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-3267
Job Type: ROOF PERMIT
Description: RE ROOF - NEED N.O.C.
Estimated Value: $11,142.00
Issue Date: 2/17/2017
Expiration Date: 8/16/2017
PROPERTY ADDRESS:
Address: 386 10TH ST
RE Number: 170056-0000
PROPERTY OWNER:
Name: Weisner, Matthew
Address:
GENERAL CONTRACTOR INFORMATION:
Name: J & M ROOFING SERVICES INC
Michael Anthony Koehler,CCC1328543
Address: 2021 ART MUSEUM DR STE 115 MICHAEL ANTHONY
LOEHLER
Phone: -
FEES:
BUILDING PERMIT FEE $105.71
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $109.71
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC REACH ORDINANCES AND THE FLORIDA
BUILDING CODES
BUILDING PERMff APPLICATION ,
CITY OF ATLANTIC BEACH
800 Seminole Road,AtlaadcSeac6,FL 32233
�y/� n/,._O'ffice(9/04) 1247-5826 Fax(904)247-5845 17-Roo-C- 3ZO
Job Address: ✓O� Mfi 1(r t4 sc/'J/QlT,� zrbl; Permit Number:
Legal Description.6—kq&g WE L'8n4arcel#
kloor Area of—Sq.rt. —5q.k} —
Valuation of Work$ _Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/prouosed structure(s)(circle one):, Commercial idea
If an existing struccttuure,is a sphn er system installed?(Circle one): o N/A
Florida Product Approval# 10 2
For multiple products use pronct approval torm
Describe in detail the type of work to be performed:QW VQ, at-%d Ir'Stfi 11 (10441tj C�-
Property ner Info ation: //�� I
Name: Address:�[RIF, �8 bL
City StateMZip '''"""��� P��Lhone �flR.11
E-Mail or Fax#(Optional) tar. :t.`n (lith
Contractor Information: I
Company Name: f Quali g Agent:, '
Addres City r yri���� State — Zi IQAJprl
Office Phone Job Site/Contact Number Fax# . e7
State Ce rtification/Registratiou#
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application u bereby made to obtain ape it to do the work aM irulallatioa a/Micated /cert fy that w work or imrdlation has mmmewed prior m the
issuawe ofapermn and that elf work will bepe osmedtomeet the standards ofdllaws regulating construction in lhajeriediction Thispermubwcomes null
and void ifwork is not eommewed wlthln
six(6, or ifcamavction or work is suspended or abandonedforo nod ofrix/6)months of airy time ager
work Lr commenced /understand that separme permits mutt be secured jor ElarAcal Work,Plumbing,Slg% 1 ela,Pool, ftirnaca,Boilon,Heelers,
TanksaMAir Condtloners,«c
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.
/hereby Corti thaI have read and examined fhu plicmion and know the same robe true and correct. All provniom oflaws and or "
type aJ work will be compiled with whet r sppeeci d penin 1 T e sing of a permit does me presume to gm authority to vio a or-ian t
provuions ofany otherfederal,state,or local law reguT20 �1
performance ofcorvuwtion.
$1 Inre Of Owner " $j gree gnature of ContractorPrintName (�KYh vJ WQ� 2f . PrintNameBefore me =E Before me a 'this 1�Day of Feb CmP r a this 15 Day of Fib 20�-Notary Pubhe "':; otary c ,a_
1. et Revised 01.26.