288 MAIN ST - ROOF NSI ,,,� , CITY OF ATLANTIC BEACH
4 s 800 SEMINOLE ROAD
t:)V_y.. meas. ATLANTIC BEACH, FL 32233
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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-3541
Job Type: ROOF PERMIT
Description: RE ROOF
Estimated Value: $6,150.00
Issue Date: 3/21/2017
Expiration Date: 9/17/2017
PROPERTY ADDRESS:
Address: 288 MAIN ST
RE Number: 170867-0005
PROPERTY OWNER:
Name: SMAIL, ANDRA
Address: 288 MAIN ST
GENERAL CONTRACTOR INFORMATION:
Name: PATRIOT ROOFING SERVICES, INC.
, CCC1330098
Address: 1695 Hereford RD
Phone: 904-509-7732
FEES: - - -------
BUILDING PERMIT FEE $80.75
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $84.75
PERMIT IS APPROVED ONLY IN ACCORDANCE Will! ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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4)•4,, Building Permit Application
• 1'•,' City of Atlantic Beach
\. - -7% ROO Seminole Read,Atlantic Beach,FL 32233
'. r;;''- Phone:(904)247-5826 Fax:(904)247-5845
GE� Yt i7_ R�F_ 354
Job Address: GO lr f v VI i� .3' i; �-z'1 Permit Number:
Legal Description 1<k-3,1 isi.,16- 2(1 C.O'ri'3 1l i14 itri rc ,5.Af.cf,5afc•li L .3 ei l#' 1.7M7- GLJG>j"
Valuation of Work(Replacement Cost)$ 16,/CO °C' Heated/Cooled SF-M 5 ST Non-Heated/Cooled a,f8"
• Class of Work(Circle one): New Addition Alterat n Repair '/love D.etao ^Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Cammercl Residential
• if an existing structure,is a fire sprinkler system installed?(Circle one: Yes Jj1/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe Alt:—
detail the type Of work to be performed;
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Florida Product Approval It rt.. /004, I 2r -Mi (4..a for multiple products:use product approval form
Property Owngr Information
Name: /(v. ,24 ,•=i.1")AlL_ Address: isl 1'8 /t'l~i1'( ?i.. . i
City ./-01/t/47,c,._ al.ezt(/f State ft-- Tip •3a7!'r"'a Phone S.-3 - £ `>171'`Li e
E-Mail rclrN' '46 J"Y)'r - -i4V)r Let'
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Conttractor Inform i .. 7
rr� L Name of Company_ r • r r,�l Lc?<� Z`�.ZtvCc'.Sr LysL Qualify# g A enc:. D'`•�'Z�c;c ��.(lJ((n3 '�✓�
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-" Address Pe 1 j>:u41C 'l� 1171/40 City . . State Zip .
Office Phone 'Or/- �/L-1 ••22-7.<-
I
2.7-Sr Job Site/Cantact Number oil-: l7 7'7.1 _,)•-•State Certification/Registration# Le / a 4uOL2 E-Mail -J'5. ee.J' /Cul€.'C' e
• Architect Name&Phone N !�
Engineer's Name&Phone# I
workers Compensation %.y:it5c/) ,•^iC1.i7// -41i
Exempt/tourer(lease Employees/Expirarion nate
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 taws 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 AFPIDAVlT: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
I2 , RECORD! YOU OTIC,E OF rI/IENCEMENT.
(Signature of Owner or Agent t�nclu g Contractor) (Signature.of Contractor)
X p . Signed and Sworn to` (or affirmed)r� � before me this 1'5 day of Signed and sworn to(or affirmed)before me this I'S,day of
„ 3 3' ( \C4 r .., dour ,by J hvy.,.Ccn • til _ l (c in, •'�U1-D ,b . -'e. 1 + :~• c.
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li
N (Signature of ty) (Signature of Not
$ 8 Z ' A S JENKINS ;;"I'~�''•.
11 x
a i co { 1 Personally Known OR .iii M"COMMISSION*FF93 , aRy Known OR . :•.
mg Produced Identification ' ,�;:t' k.)CPIRES November 24.: )eroducedidentlflcatlo 'Oo.1 '• , tl," N
type of identification: '`'h° �:> ror a sN,,,wx.Type rf identification: At o- C�.1,vea .
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Doc t 2017061759, OR BK 17912 Page 2333, Number Pages: .1, Recorded .
03•/1.6/2017 at 02:47 PM, Ronnie Fussell CLER( CIRCUIT COURT AUVAL COUNTY
RECORDING $10.00
NOTICE OF COMMENCEMENT
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