2233 Seminole Rd #27 roof permit �sLay
CITY OF ATLANTIC BEACH
� .
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
ROOF NON SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: ROOF17-0019
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 27
RE Number: 169519 0101
PROPERTYOWNER:
Name: OCEAN VILLAGE ASSOCIATION INC
Address: C/O SIGNATURE REALTY 8 MANAGEMENT4003 HARTLEY RD
JACKSONVILLE, FL 32257
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name:
Address:
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$7,500.
Building Permit Application
City of Atlantic Beach OFFICE COPY
800 Seminole Road,Atlantic Beach,FL 32233
�aqa��r� c Phone:(904)247-5826 Fax:(904)247-58455
Job Address:Oyr ] rY1aY'f-t�p O� lfl. ,. /q
"' •1t�7�"� Permit Number: �Q I
Legal Description�, j- >c-p „t•t t�-�
Valuation of Work(Replacement Cost)$ 74Q�
Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one . Ne Addition Alteration Repair Move mo Pool Window/Door
• Use of existing/proposed structu re(s)(Circle one): Commercl Resident,
•_ 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 Affldavlt of No Tree Removal
Describe In datell the type of work to be performed:
Florida Product Approval N
Property Owner 1pforMatio
for multiple products use product approval form
Name: n Vey 5 Address: ` �Fof?y
3CtryLnrl
City State'P-L Zip
E-Mail 9dd.+s Phone 9g� t� 'C9
Owner or Agent(if Agent,Power of Attorney or Agency L ter Required)
Contractor Information Q n1�
Name of Company:
Address I Qualifying Agent:
Office Phone - — city lTIK1 —State G(. Zip L4
Job Ate/Contact Num r
State Certification/Registration g O E-Mall r rZP 4
Architect Name&Phone q
Engineer's Name&Phone g
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.
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.
i t
(Sig tureture L
ncluding Contractor) (Slg�r ature of Contractor)
Shine worn ttfore h' /Qdayof Signed and swo- too(or afgr )befomethis y of
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S'.Odabe 6 0 TDNIGIMLESPERGER
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[ 1 Personally Known OR rI E%plfl 5 October 6 2019
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Type of Identification- Type of Identification.