2190 FAIRWAY VILLAS LN - ROOF �s� CITY OF ATLANTIC BEACH
� 800 SEMINOLE ROAD
;� ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-ROOF-3675
Job Type: ROOF PERMIT
Description: RE-ROOF
Estimated Value: $5,905.00
Issue Date: 4/4/2017
Expiration Date: 10/1/2017
PROPERTY ADDRESS:
Address: 2190 S FAIRWAY VILLAS LN
RE Number: 169398-1002
PROPERTY OWNER:
Name: Keane, David
Address: 2055 Beach AVE
GENERAL CONTRACTOR INFORMATION:
Name: DS KILLIAN ROOFING
David S. Killian, CCC1328203
Address: 3898 DUPONT CIR QA DAVID S KILLIAN
Phone: - -
FEES:
BUILDING PERMIT FEE $79.53
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $83.53
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
...„: Building Permit Application
ir . „ City of Atlantic Beach
800 Seminole Road, Atlantic Beath,FL 32233
3BiA'',` Phone. (904)247-S826 Fax (9O4)247•S945 I 7_ROOF - 34275
Job Address:, 1A L f Air;,. \t.t14i £..r.1 rt.`, 66' . S,5 Permit Nunibrr
Legal Description,3_41-A.),, o g -- .a S . Ac:t0 +7t.V V14:t RE.;/7 �. �.._-oo y 7/.__..
Vafuatloa of Work'Replacement Cost)S 1 Heated/Cooled SJ! port-Neared/C,00Md _..._ _.
• Class of Work(Orde one). New Addition Alteration Repair Move Demo_Pool Window/Door
• Use of existing/proposed structure's)(Ortle one)- Commeicial(,Resi,:r,•'I,.it
• If an existing structure,is a fire sprinkler system installed?(Orde one) yes (".ii' N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Afhdav:t e' No Tree Removal t
Describe in detail tt%e type of work to be polo,' S° �� /6'1/6A6-14-Pt
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Florida Product Approval a__ 1.• .1.0. 1P-_4., ) _ .._. for multiple products use product approval form
el Otyner Infant#19.11
Name cx.vi0' 14 t'' "y hCo+,,r.CtVtit....1,iii bly,t',-.' •..,1 ,,e,.•. 4)04 (')1,. ti. A'if
City, fft tanht. ill w.'r 'tat,- ,7, ;,tt Sl-r3 Phony (ryc.) 2.-'>'.,.1:1P1 kJ:I
E•Ahaii -t ' ' ' - - _ .__
Owner or Agent id Agent.Power of Attorney or Agency Letter Reaulred}
Contractor lnforttt&tiOn
Name of Company: DS [T L L 1 AN ROOF b •7;C 7 NC nualifyinrt(Agent 13AV I D S K1LL4LAN
Address 1031 MIMOSA COVE r'. E c1t A1'14Am I C BCH tat _, z'p'32133.._____r
O'f+ce Phone 9 04 2 4 6 7 6-6-7 rob Site/Contact Nu nber
Stale certification/Registration 14 1—,7(1 1328203 E•Mail DAVE`°DrK T lit,AA . C')N!
Ai hitect Name A Phorir U �._..__...__...
Engineer's Name&Phone a_ ____ _ ___._... __.__.._._w_ ___..._..._..._
Workers Compensation ._.._____ _.__.._..____._.___........._
t menet/rr i.vri/1...•f ropitr ws/I myW atii„Rite
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 unde-stand 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 s 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.
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(Signature of Owner of Aunt rnt,idrtlg Com.i:t_ I,\ 'grieve of Contractor)
Signed and sworn to(or affirmed)oefore me this 2 tear of ned a,nd sworn to for affirmed)before me this 3_day
Ckk _ i1 l .try1'i cttYtCtt71_.oyIA _
_LisauLtoak i.,,k_tx.. ..v
(SlInature of Notary) 1 (Sipnaluro of Notary)
Pel Personally known OR 14Pefsonally Known QR
I I Proouted Identification i I r'roaucnd idcnt.ficat,an
Type of lda MARGi 8O0ORIGH lyoe or identification _ ..__________.__.____._._....._ _.... _..
Notary Public-Notary Seal �...��� —
State of Missouri *:':' KARA I.CHALMERS
Commissioned for St.Louis Cougy =..7.,., Commission#FF 216646
My Commission es:Sepbenber 01 2019 • :' Expires Apri12,2019
Commissiari m>>er 1562925 ��' • Bonded Info Tray f min Intranet)800-385.7019
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