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2233 SEMINOLE RD #39 - ROOF ` ss1 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD J r ATLANTIC BEACH, FL 32233 ri;3 r) INSPECTION PHONE LINE 247-5814 ROOF NON SHINGLE - MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: ROOF17-0020 Description: SHINGLE, MODIFIED AND INSULATION Estimated Value: 7000 Issue Date: 7/27/2017 Expiration Date: 1/23/2018 PROPERTY ADDRESS: Address: 2233 SEMINOLE RD 39 RE Number: 169519 0176 PROPERTY OWNER: Name: STRAUGHAN JERRY S Address: 1201 1ST STN#104 JACKSONVILLE BEACH, FL 32250 GENERAL CONTRACTOR INFORMATION: Name: GEORGE RIDGE Address: 140 E BAY ST JACKSONVILLE, FL32202 Phone: 9043536555 Name: JAMES SHELTON ROOFING 1 Address: 252 SANTA BARBARA AVE QA JAMES W SHELTON, III JACKSONVILLE, FL 32254 Phone: 9043536555 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 4 exceeds and estimated value of$7,500. '',i-k !j' iBuilding Permit Application �.�'rAr\p�\ AI r City of Atlantic Beach 800 Seminole Road,Atlantic Beach, FL 32233 Jiil>� Phone:(904)247-5826 Fax:(904)247-5845 • n� lLu� 32.133 F i D�a� Job Address: a�3.3 Sen inO/Z'Rd. 41 39 14t'�c iL Zeaa r4 Permit Nu er: IOC) d N INtlnr N6 /uur39 B REP y`f�c9d' Legal Description 09aS a96 OCEAN Y/.LA6E ON CD Don ! lx eti,l Valuation of Work(Replacement Cost)$ Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): Addition Alteration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial tBesicteti`al • 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: Re,e(5° Florida Product Approval ft for multiple products use product approval form . Property Owner Information nn//''..� �/ Name: Mean UII1� i UC• TYK• Address: iRcR33 geviin0k ,&L. 417' 3.9 City A-+-(0.4 kv Beack State rL Zip 322-33 Phone E-Mail Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) Contractor Information Name of Company: )O.fl1e,c . h&I$on R 0 o'6r Qualifying( Agent: ll/e Sia.- iF(r zip 3.2.2,5-V Address 53ei0 -�p3 -zsoi,t - Office Phone 90 3 f8 lob Slte/Contact Number ��i — 0.- '" •d'State Certification/Registration f9014z, E-Mall �Ii7©.�. � TS/` ` Architect Name&Phone ff Engineer's Name&Phone U 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 l 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 NOT E OF COMMENCEMENT. �,.� 1 ii 4 . ...., ilLt31C.1 J =; 1 (5 natur-4 Owner or Agent inclu•f' g Cont :ctor) (Signa a of Contractor) Signed and sworn to(or affirmed)before me this /i day of S' ned an worn to(or abY meal) `i motes(9tv of COA _ HS 1� �UJ� ,by Cvr•t r �•"___ C Z"' _ \ � - • ` • . (SignatVe of N ) a a, SHERRY R.COKER JENNIFER JOHNSTON 1 Notary Public-State of Florida 'r°,'' t'- MY COMMISSION GO 042984 �� •- Commission FF 245368 `m y: ( )Personally Known OR y,•,��..o EXPIRES:October 27.2020 t4PersonallyKno Ft;''�� My Comm.Expires Oct 19.2019 %;Eo«o? BondedTlwNoaryPuWicUnderwriters I I Produced Iden iflc' ', ;t ' 8ontUddIroughNational NotaryAssn. (*Produced identiflcatio _ , Type of Identiflca • �. — — — — — - - Type of Identification: