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1165 OCEAN BLVD - ROOF 0 L-41-170,1 ,), I = t , CITY OF ATLANTIC BEACH ss --"` • J 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 s�Ji31W'r ROOF PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 17-ROOF-3430 Job Type: ROOF PERMIT Description: Re-roof shingle Estimated Value: $6,500.00 Issue Date: 3/7/2017 Expiration Date: 9/3/2017 PROPERTY ADDRESS: Address: 1165 OCEAN BLVD RE Number: 170276-0010 PROPERTY OWNER: Name: JASKIEWICZ , ADAM Address: 913 SORRENTO RD 913 SORRENTO RD GENERAL CONTRACTOR INFORMATION: Name: RELIANT ROOFING INC RYAN SHOUPPE Cameron Ryan Shouppe, CCC1330615 Address: 528 Millhouse Lane Orange PARK Phone: - - FEES: BUILDING PERMIT FEE $82.50 STATE DCA SURCHARGE $2.00 STATE DBPR SURCHARGE $2.00 Total Payments: $86.50 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. =�� 3W � mD � oDn r cn _. z , d -11 -r1 - c n < r j-)C:A� O 0 N (m A .�•r "_"., C0.. 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NOTICE OF COMMENCEMENT (PREPARE IN DUPLICATE) Permit No. Tax Folio No State of f L County of ( To whom II may concern: The undersigned hereby Informs you that Improvements will be made to certain real property,and In accordance with Section 713 of the Florida Statutes,the following Information Is stated In this NOTICE OF COMMENCEMENT. Legal description of property beim,improved: (0—� Y�JI ^ 2/�"i6 Qc c.Y-► k4 13\.k. Address of property being improved GU 5 OC --) �3eAl_v-) FI- 32.233 General description cf improvements 'RC. 1/151)� Owner A irvAA4 �yrQ � tTl.�)1C.2. Address 11q5-` Cuor 1CJLuck M -o r C- l l.. 332.233 Owner's interest in site of the improvement Fee Simple Titleholder(if other than owner) Name Address Contractor / Yl • N Address vtZ • PGA- 'OW 3P %Mc, V'am B if FL 52. Phone No.904'65?0880 Fax No. Surety(if any) Address Amount of bond S Phone No Fax No. Name and address of any person making a loan for the construction of the improvements. Name Address Phone No Fax No. Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may be served: Name Address Phone No. Fax No. In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.06(2)(b),Florida Statutes.(Fill in at Owners option). Name Address Phone No. Fax No. Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLY OWNER Signed. _ DATE Before rte this day Cr 1;t., In the Co my of Do I or Fort.na personasy appear )tKJ.iL herein by,trnHK Kraut hi fl,iii n.run end affirms that ar,statements and cc!arae. .5 ELIC are true and accurate ,A' NOTARYPUBLIC 1STATOF FLORIDA E •. Z.coffin*FF951 f564 ts't1a3 expires 1119!2020 t Fut;:r.al!erg�,00f�, County or__ j,�j„[A-•5r 1.47 commission ex^t• _�L Personally Kns.•. or Produced Idedlf tion PRODUCT APPROVAL INFORMATIONj� SHEET FOR THE CITY OF ATLANTIC BEACH,FLORIDA Project Name: `t t 5 a n IU VC Permit # Project Address: 11 L 1CUQ.neeptu 4 Attofific, tcf /, p L 3 22 3 As required by Florida Statute 553.842 and Florida Administrative Code Rule 913-72.please provide the information and product approval number(s) for the building components listed below as applicable to the building construction project for the permit number listed above. You should contact your product supplier if you do not know the product approval number for any of the applicable listed products. Information regarding statewide product approval may be obtained at:www.floridahuilding.o Category/Subcategory Manufacturer Product Description Limitation of Use State# Local# A.EXTERIOR DOORS I.Swinging 2.Sliding 3.Sectional 4.Roll up 5.Automatic 6.Other B.WINDOWS 1.Single hung 2.Horizontal slider 3.Casement 4.Double hung 5.Fixed 6.Awning 7.Pass-through 8.Projected 9.Mullion 10.Wind breaker I 11.Dual action 12.Other Category/Subcategory Manufacturer Product Description Limitation of I'se State# Local# C.PANEL WALL 1.Siding 2.Soffits 3.EIFS 4.Storefronts 5.Curtain walls 6.Wall louvers 7.Glass block 8.Membrane 9.Greenhouse 10.Synthetic stucco 11.Other D.ROOFING PRODUCTS 1.Asphalt shingles ./r‘. Orlyucs `0124-1Z 2.Underlayments 1(10 cOl)c 152-1t4),1_R-0 3.Roofing fasteners 4.Nonstructural metal roof 5.Built-up roofing 6.Modified bitumen 7.Single ply roofing 8.Roofing tiles 9.Roofing insulation 10.Waterproofing 11.Wood shingles/shakes 12.Roofing slate 13.Liquid applied roofing 14.Cement-adhesive coats 15.Roof tile adhesive 16.Spray applied polyurethane roof ti 17.Other Category/Subcategory Manufacturer Product Description Limitation of Use State# Local# E.SHUTTERS I.Accordion 2.Bahama 3.Storm panels 4.Colonial 5.Roll-up 6.Equipment 7.Other F.STRUCTURAL COMPONENTS 1.Wood connector/anchor 2.Truss plates 3.Engineered lumber 4.Railing 5.Coolers-freezers 6.Concrete admixtures 7.Material 8.Insulation forms 9.Plastics 10.Deck-roof 11.Wall 12.Sheds 13.Other G.SKYLIGHTS 1.Skylight 2.Other Category/Subcategory Manufacturer Product Description Limitation of Use State# Local# H.NEW EXTERIOR ENVELOPE PRODUCTS 1. 2. In addition to completing the above list of manufacturers, product description and State approval number for the products used on this project, the Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and installation instructions along with this Product Approval Sheet. I certify that this product approval list is true and correct to the best of my knowledge.I further certify that use of different components other than the ones listed in this document must be approved by the Building Official. �arat101 Shp — (Contractor Name) (Print Name) 1^ (Signature) Company Name:9.-e_U t/1�� �� 1 ` — l L Mailing Address: 2,2 1`j• ALA Ad % 310 -RDY\ V ect -_ CS/`Gh RL 3z 08?_ City: II,^, State: Zip Code: Telephone Number:(q(4 W51- 009 0 Fax Number:( ) / *kit-Phone Number:(q(U41) 112.— '311 I E-mail Address: ataV)riCin re L r QvvJ r C(