522 Selva Lakes Cir re-roof permit .j iyL`Jr
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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
30S INFORMATION:
Job ID: 17-ROOF-3459
Job Type: ROOF PERMIT
Description: REROOF 24 SQUARES 7/12 PITCH SHINGLES
Estimated Value: $7,097.00
Issue Date: 3/10/2017
Expiration Date: 9/6/2017
PROPERTY ADDRESS:
Address: 522 SELVA LAKES CIR
RE Number: 172027-5598
PROPERTY OWNER:
Name: SILLIMAN, ANNA M
Address: 1608 STRAND ST
GENERAL CONTRACTOR INFORMATION:
Name: ROGERO &WILLIAMS ROOFING CONTRACTORS INC
7eremey S. Rogero,CCC1330387
Address: 883 Lawhon Dr ST
Phone: 904-518-5463
FEES:
BUILDING PERMIT FEE $85.49
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $89.49
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Building Permit Application
0 City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-58!26 Fax:(904)247-5845 r�/,
Job Address: Sad v��V� r,-u-rzLS Ci rC-t Lf- Permit Number: � F'^ J-1
Legal DescriptiongC-,J e 11/d,(L./ces 1R A'.1 t CTT- /0J RER /" o -J- S-
Valuation of Work(Replacement Cost)S /OqJ /. ' Heated/Cooled SF i 953 Now Heated/C0oIed�-7 ��s/�g_
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door & ke 01r—
•
• Use of existing/proposed structure(s)(Circle one): Commercial R ential
• If an existing structure,is afire sprinkler system installed?(Circle one): Yes No
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe In detail the type of work to be performed:
Re roof Zc( 0//-c (ti s, k:v\e) e s
Florida Product Approval If %L ( -k(Z- I FL I SZl G for multiple products use product approval form
Property Owner Information _
NamAddress: SZZ ,5dvet- L dv- s C- /-C/C,
ay Ank a state P�Zlp 32239 Phone 9oV a 000
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information / �1
N rmm�any: } $rJill l'Af 264fi" qualifying Agent:
Address - X14/.S cr. city State FL- Zip 3ZZS7
OfFice Phone fit( �J $ S lob Site/Contact Number 4p4e 40�z1SIt 77,90
State Cerdflution egistration a C(' 1 3 3()3 $7 E-Mail /5 ,4(4) (-W Cow
Architect Name&Phone If
Engineer's Name&Phone If
Workers Compensation
Exempt/Insurer/Lease Employees/Expiration Wte
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg
construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc.
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
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.
a4f,,, ,�]'h,
(Signature 6f Owner or Agent including Contra (Signature
Signed and sworn to(or affirmed)before met is7_"tlay of Signed n&-1 sworn t/7 rat�rmeaj%—g0 hisday of
/ (Signature of Notary)
PAUL ROBERT CASSETTA PAUL ROBERT CASSETTA
Commission X FF 39t56 '
°c ` My�",mmisson Expires ! Commissl..n xFF39t55
�..:f July 2a, 2017 ` MV "'m 'os�on Expinr
IJP nallY I enonalhl, l nOR B2y(( July 24. 2317
[ roduceci ldentifcatigRrM�s r+FgCduced ldendfira[ion
Type of Identification: I6 ��n St- Type of Identification:
Doc M 2017056031, OR BIC 17905 Page 906, Number Pages: 1, Recorded 03/09/2017
at 03:36 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00
NOTIC$ OF�COMMENCEMENT
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