2233 SEMINOLE RD #41 - ROOF d ' CITY OF ATLANTIC BEACH
F' 800 SEMINOLE ROAD
J� ATLANTIC BEACH, FL 32233
'''t01319 INSPECTION INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0077
Description: RE ROOF
Estimated Value: 7000
Issue Date: 8/14/2017
Expiration Date: 2/10/2018
PROPERTY ADDRESS:
Address: 2233 SEMINOLE RD 41
RE Number: 169519 0180
PROPERTY OWNER:
Name: DOBBINS WILLIAM T JR
Address: 7175 CHARLES ST
PHILADELPHIA, PA 19135
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: JAMES SHELTON ROOFING
Address: 252 SANTA BARBARA AVE QA JAMES W SHELTON, III
JACKSONVILLE, FL 32254
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
1
At 1„*., Building Permit Application
I"•%� ' .,./01„*.,,,,, Building
City of Atlantic Beach
\f` • 800 Seminole Road,Atlantic Beach, FL 32233
X9)1) r Phone:(90 2,47-5826 Fax: (904)247-5845
• 1 �' Op"�, �-41:46t3
Job Address: �,3� Seminc.�re.l�d• !{j, CU1liGDyl, Permit Number:
nc a>tdonr,nwr, ,t)t uc11 r n 41I o R BK'°RE r
Legal Description 09-A3-1)9C aCeCtn Urltciyap �
Valuation of Work(Replacement Cost)$ 7000 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one):GiAddition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s) (Circle one): Commercial .esidenY-
• if an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
• 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: I I
^ 4--Rbo-f -S �t� l
Florida Product Approval U 0/O(42 71-/-e7 E- I /. 7/k, for multiple products use product approval form
Property Owner Information
Name: 0 evyt l(/,G 4 scoe. . - Address: cc0?,33 SPjn t'rt.)k Rd. 41074. iii
City -Han-1-fv car-4I- State >`'-1Zip 3.2-2-33 Phone
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
csmtractor Information
Name of Company: a{'v1P$ Ske-ifUt't Roo-6n3 Qualifying Agent:
Address 5.35A J ccihui ' • City JU an•1Ji'l1 State F/— Zlp_ 331
Office Phone 1(90 t - •S Job Slte/Contact Number ' "Lt. L](14-( --l0 n 7 /
State Certification/Registration q / (.... ) / -Mall
Architect Name&Phone U
Engineer's Name&Phone ff
Workers Compensation
Exempt/Insurer/Lease Employees/Expiration Date
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.
0 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 0 AN ATTORNEY BEFORE
RECORDING YOUR NOT CE OF COMMENCEMENT.
/ ,_ d . �
(Signature•I Owner or Agent includl g Contractor), (Signa ure of C•ntractor)
`
Si ned and sworn to(or affirmed)before e this /0'day of Zned; ;or to(or aff med •-fore r - day.1
U 'u sle , ?c%7 by �j•c,: e. L.m/<,..e/ _ i iIr b, Ic, 11
• &Jill
(Sia rakot.blotdarvL - (Signature of o •ry)
SHERRY R.COKER -- -11.9araf:A.
(0."4.440,
P V: Notary Public-State of Florida •�:„•.••G;•, TONI GINDLESPERGER
••1 Commission # FF 245368 .' • •,�a COMMISSION 4 FF 924951
� ersonally Known OR EXPIRES:October 6,2019
(.{.{Personally Known OR A �,, My Comm.Expires Oct 19,201 I 1 Produced identificatlo •.'�bs.k ' BtdadthaghNationalNotryAssit, roduced identificationFMY
^.'eo�1__;c Bonded ThruNew/Public Underwriters
Type of Identification: """' of Identification: