91 Stanley Rd re-roof permit ,1
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
s�
� ATLANTIC BEACH,FL 32233
--_-, INSPECTION PHONE LINE 247-5814
rI
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-ROOF-3444
Job Type: ROOF PERMIT
Description: re-roof modffied roof FL 2533.1
Estimated Value: $9,010.75
Issue Date: 3/27/2017
Expiration Date: 9/23/2017
PROPERTY ADDRESS:
Address: 91 STANLEY RD
RE Number: 172188-0000
PROPERTY OWNER:
Name: MUELLER, WILLIAM K
Address: 4814 S 30TH ST
GENERAL CONTRACTOR INFORMATION:
Name: JACK C. WILSON ROOFING CO.
Harold Kertis Voss,CCCO49358
Address: 4522 ST AUGUSTINE RD CIA HAROLD KERTIS VOSS
Phone: -
FEES:
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
BUILDING PERMIT FEE $95.05
PLAN CHECK FEES $47.53
Total Payments: $146.58
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445 I�—Q—oc�f— -t L4
Phone(904)247-5826 Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City web-site: http:/Aw .ccab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: -I I S-yllaktN M • rtment review required Yes o
Applicant: JQL`wt �S�Y� K-(�Uh�l(d Planning&Zoning
f� ,t 1': Tree Administrator
Project: �Q- �00� nnb& (L)OF, Public Works
Public Utilities
Public Safety
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
M
Reviewing Department First Review: 4proved. [—]Denied.
(Circle one.) Comments:
BUILDI G
PLAN ONING
Reviewed by: Dale: � LZ
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
BUILDING PERMIT APPLICATION OFFICE COPY
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office( (19,0^4)'247-5826 Fax(904)247-5845
Job Address: Per
nu Numger: 1*1_MF— 3444
Leal Description,g P ��'��a YI �S�J Y 1 C 1 Z arcel is K l l rk.�_ -&,,D
F oor�q.lt. — Sq F�
Valuation of Work S.ClLl\ Proposed Work heated/cooled non-heatedurud
(e.rex;7—
Class of Work(circle one): New AMitimr-e I1\laration Repair Mo : molition poollspa window/door
Use of eaistiag/proposed s (s) circle ooe • Commercial estde
If an existing structure,is are sp' er system install T(Circle one): No N/A
Florida Product ANpP' # S
For multiple produe use product approve form f 1
Describe in detail the of work to be ed: (UO(7� l� CGLS
Property Owner Information: (�
NameAddress: _
City Stat Zip _Phone �� 1
E-Mail or Fax#(Optional)
Contractor Information: _ (�
t Q fy llAgent: l \ I
Company Name: �-- v Su\�uk\ ueli @
Address: �-�' . \tr+�.. C' \&n State Zip s
Office Phone Job Site/C _t .ymhe, `il)`r C:[tl. S'1f}"1 Fax# City-f 34e -I'ltl\
State Certificate egistration# SX
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address 1
Bonding Company Name and Address
Mortgage Lender Name d Address
cwRooF installations m I,1
Application is hereby made to obtain a permit to do the work and installations indicated I ear, that na work or im9d! corrlln need prior to the
issuance ojjapenn11 and that all work will bepuforn¢d to meet the standards of all laws regu(aBng e0mema s�don/This permit Domes nu!!
and void iJwork is not commenced within six(i momW,w lfcomhucdon w work fs suspznded w a fora rshul o str 6 months ata time ager
work Is commenced f understand that separate permfa most be secured for Eledrleal Werk,Plumbing,Sfgn; Wells,Pw* maces,Boilers,Healers,
Tanks andAhr Condllloners,do
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.
liters cedljy thatlhave res ndexaminedfhi ffcation and know the same to be five and correct Allprovber oflaws ad di gove'uhtgthis
type of work wit!be complied 'h whether sO d here/n w,ml. The granllrtq oJo permit does net presume to give aulhwlry to vidafe w cancel the
provlsfom oJarry whwje rads( ,or! 1 latingcomimationwfieperfwmarc ofcowtruction.
Signature of Owner Signature of Contractor
Print Name w,wq.ea.._F__i kIkK t— Print Name .... ....�'4J ........ ...OrjY.-__._._..............
Sworn to and sub r'bed before me Sworn to and subscrib before
this i4. Day of%e re 20 17 thiay ofT .20
,FIT ff_P _ I
-T
Notary Pub ' o Public
• TIMOTHY R. PITTS18707 eM. Revised 0126.10
Commiss1on10G te]0] o` e+ GbSm9ft
My Commission Esoirea State M Flodde
August 0<. 2020 MY COMMISSION#FF 21799
OV Exores:Mandl A 2019