2233 Seminole Rd #32 roof permit �{ �lrr
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
' ATLANTIC BEACH,FL 32233
y' INSPECTION PHONE LINE 247-5814
ROOF NON SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: ROOF17-0021
Description: SHINGLE, MODIFIED AND INSULATION
Estimated Value: 7000
Issue Date: 7/27/2017
Expiration Date: 1/23/2018
PROPERTY ADDRESS:
Address: 2233 SEMINOLE RD UNIT 32
RE Number: 169519 0180
PROPERTY OW NER:
Name: DOBBINS WILLIAM T JR
Address: 7175 CHARLES ST
PHILADELPHIA, PA 19135
GENERAL CONTRACTOR INFORMATION:
Name: GEORGE RIDGE
Address: 140 E BAT ST
JACKSONVILLE, FL32202
Phone: 9043536555
Name: JAMES SHELTON ROOFING
Address: 252 SANTA BARBARA AVE OA 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
exceeds and estimated value of$7,500.
�a Building Permit Application
City of Atlantic Beach OFFICE COPY
^••<v ,/ 800 Seminole Road,Atlantic Beach FL
32233
Phone:(904)247-5826 Fax:(904)2475845
lob Address: q'rf�5 if Se1'YlIn DI „l �� R•F1anNL BawA Fj-
Legal Descriptionv .s c 3,23-13 Permit Number: rI� � '�� bOZ
I (7(� MecolyiDo ll it )Y mNE#
Valuation of Work(Replacement Cost
$Z Heated/Cooled SF Non-Heated/Cooletl
• Class of Work(Circle one): (6;) Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structures)(Circle one): Commercial esi
• If an existing structure, Is afire 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 n detall the type of work to be performed: na�Q�
nc—/CDOI
Florida Product Approval#
Proe t 0 net 115LOI It for multiple Products use product approval form
Name: Cpan a ..� Address: ,?1 A SPmrjtp( 3a
City State rj F1 Zip jr J;�
E-Mall_f2� p ,�� a Phone T99 --
Owner or Agent(If Agent,Power Od Attorney or Agency Letter Required) --
Contractor Information —_
Name of Company: �pt 1t?. DO
Address Si5a /.(.rt Qualifying Agent:
CItY. 1 Attn rn`((e State _ZIP .3aas
Office Phone 9pfj- ,$7- 9705 Job Sit /Contact Number
Stale Certification/RegistrationN E-Mail
--
Architect Name&Phone#
Engineer's Name&Phone# __
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 regulatlong
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.
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. /7
(5t azure of04by
utlln Con aFt (51 Lure o(Contractorl
S' nelg tl arld sworn two(or affirmed) a me 's J day / Signed and sworn to(or affir d)before me this./I of
--d GINDLESPERGEPMMISSICNaFF9249FtTONIGINDtEGP R
ES:October 6,2019a ` '' MYCONMI55101 FF249E1(Personal Known OR e�N'�Puu��u�a.o-mers SI tga, EXPIRES.October 6,2019
Personally I I Personally Known OR R ?�-f eooeeeTnN xxanP er ux«.,n.rs
I ]Produced Identification -
Type of Identification: I I Produced Identification Q /J T
Type of Identification:_ _6 S30_Z p( Z—���H� —V