420 Main St re-roof permit CITY 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-3304
Job Type: ROOF PERMIT
Description: re-roof FI-15-1102.03 & FI-15216-R2
Estimated Value: $11,091.34
Issue Date: 2/22/2017
Expiration Date: 8/21/2017
PROPERTY ADDRESS:
Address: 420 MAIN ST
RE Number: 170900-0300
PROPERTY OWNER:
Name: WILLIAMS, PATRICK M
Address: 420 MAIN ST
GENERAL CONTRACTOR INFORMATION:
Name: OAK CREST CONTRACTING, INC
Dustin L. Doll,CCC1330407
Address: 536 SE 291 HWY
Phone: 816-207-6185
FEES:
BUILDING PERMIT FEE $105.46
STATE DBPR SURCHARGE $2.00
STATE DCA SURCHARGE $2.00
Total Payments: $109.46
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
JobAddress: q2,0 An s f}}1 1'c ge-4 i:/ .3 2Z?3 Permit Number: I�-L.pOF' $3011
Legal Description -Z . II Af larlie. Parcel# 11 -03cc,
nor Area ol 1q.Ft. Lai f Sqrt
Valuation of Work$ I I 0 • 3 Proposed Work heated/cooled 1 5 3 non-heated/cooted
Class of Work(circle one): (S; Addition Alteration Repair Move Demolition pool/spa window/do)r
Use of existing/propposed.structure(s)(circle one):. Commercial esiden '
H an existing strneiare,is a fire sprinkler system installed? (Circle one): No N/A
Florida ProductApproval# 16- 1102 .y3
For multiple products use product approve form rL /S2-/6 -A2-
Describe
Describe in detail the type of work to be performed: II-�° ace.ww'1' a�s
y`utri CQ6&u, C4AfnA �a 10A ,2 , nelg��PI�i..?
v
Property Owner information:
Name: cns .Il icrvlS Address: ''fes �°•in S>'-.
City -o eAcl. state LLZip '727,73 Phone 90 - 305 - X71
&Mail or Fax#(Optional)
Contractor Information:
Company Name: da k Cce sF- Qualifying Agent:
Address:��a7 �rxtn dw'1 Rd 6 3 City `ay-%6Nviltt- State P�- Zip y?-j7
Office Phone 90� 680- 0058 Job Site/Contact Number 9.9-451- 2977 Fsx#
State Certification/Registration# CGI 3340
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
App/icatian u hereby made to obtain a permit to do the work and instal/anon as indicated I rertify that no work or irurdlation has comm wedprlor to the
tssaanceofapermit and that all work will beperj(morm¢d to meet the standards ofdllawusreegulating connection in thujurisdictio/n Thispermit becomes null
andk id amme»ced 'a
usa
nder�t�that separate[RnNts s,t bye securedfor E kleMrlcul wo kd Minding.Sig,a dis•Pofuts, Amami Balm'•Hem s'
Tanks and Air Condaloun, etc
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO OUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OFB
COMMENCEMENT.
I hereby rerdfy that I M1ove read as+d eramind lhk +cation and know the same to be true and cmxct. Al(provision oflaws and ordtnancet governing du's
type o/work wJ/be complied with whether sppeeci+ed herein or rwt. The granting of a permit does not presume ro%+v°authoriry to violate or cancel the
prov+mon of any other fed�er/af[l��,state.ar local]aw regulafin8 contraction or the performane ofcontrucfion.
Signature of^ ^'�1� �'�'��� Signature of Contractor
Prim Name (p w l l/lQ ... ... ... Prin[Name ,L�..ksi.[1_.. _rte .. __...._....._..._.._.._...._...........__....._..
Swo tq,anI subscri db fore me Sworn to and sub 'bed before me 2017
this ay of this Day of _
,o•�••n„ u5A uONDILLO a�A �ar.�lar—
..c .,.olwon
NotaryPublic �",• C n#FF 9 4 I"a as 055707
a uaaY 7.TJfi W ewes.EWa as tE. Revised 01.26.10
Ez es Fe .,,x Naa7A
�'• vavte.u,srs