2233 Seminole Rd #34 roof permit .' 0 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
;t »' INSPECTION PHONE LINE 247-5814
ROOF NON SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0042
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 34
RE Number: 169519 0162
PROPERTY OWNER:
Name: COPLEY ELIZABETH A
Address: 2233 SEMINOLE RD APT 32
ATLANTIC BEACH, FL 32233-5940
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 RVAC work,a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
Building Permit Application OFFICE COPY
City of Atlantic Beach
_rll„ 800 Seminole Road,Atlantic Beach, FL 32233
1� �nI,
Phone:(904) 24417'-5,826 Fax:(904)247-5845 1-?GRI' 7-CD4 Z.
Job Address: 1nLMWt R &Vaafly B�QtA�"d.i733 0 �-may
Permit Number"r— rT� V
Legal Description Q $ 9e dCEgg V Ung} 0 5
Ll •l' dA7/.r/r/r"mml I /m )Wed
Valuation of Work(Replacement Cost)$_-7()O
Heated/Cooled SF
Non-
• Class of Work(Circle one):CEP Addition Alteration Repair Move
��Demo. Pool Window/Door
(gy Qz)
• Use of existing/proposed structure(s)(Circle one): Commercial
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe In detail the type of work to be performed:
e-2vof
4 c4 ( , — Sane As �`EL�er S
Florida Pro uct Approval#
Pro ert O nor 11 for Ion � for multiple products use product approval form
Name: ;net
f��QP /7'�sOCC Address:
city wnu,.,r. 5 v' v e 3y
- ar�5tate (_Zip 322 _phone --
E-Mail fsFrbrZ�pCJJ
Owner Agent(If P,scrit,Power of Attorney or Agency Letter Required)
Contranor Information
Name of company: klmec Shells, 0-41 i—j
Address, fT1Gn Wn M Qualifying Agent:
Olfice Phone (lry lob Site/Contact Number
R7R city , )Ii State_- -ZIp322S
�'0 9
Slate Certification/Registration If E-Mail
Architect Name g Phone q a ,$ K 1
Engineer's Name$Phone g
Workers Compensation
Exempt/Insurer/lease Employees/Expiration Dace
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
RECOR ING YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or nt incl ding ConPro (Sign urea ontractor) [,
Si ed tl sworn to( it d befo m tis ( y of ed and sworn to( Firme ) efo a this Utley of
ed by `—"Y'd an b
Y
(Signatureo No ary (Signature of No ry)
,F''S n4Fs TONI GINGER iONI GI1NtE5PEgGEq
My COMMISSION#FF924951 MY WM1IMISSION aEF 824951
@' EXPIRES
( I Personally Known Rw;;e.•' saayinmW C�faber 6,2D19 dl '.-, y:' EXPIRES:October6,2019
w,ruors u.a [ )Personally Known OR a. ca rn�,wav cram uceemnnrs
I Produced ItlendFlc d
Type of Identification: I I Produced Identification
Type of Identification: U
I ooPl7- 00z 1
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building apartment.)
8DO Seminole Road ROOFC7-O0z ppF 17- OCJI
Atlantic Beach, Florida 32233-5445 �7WF-17-ao I p ✓ -dOl
Phone(904)247-5826- Fax(904)2�7-5843
E-mail: building-dept@wab.us R00F.(7-001 8 Date routed:
Chyweb-site: http://www.coab.us
RooFl7-0017
APPLICATION REVIEW AND TRACKING FORM
Rp_-. 32 , S4 r3� Z �, r 3 1 , 4 Z , 8
Property Address: S ern to Le �� _QApffb3nt review required Ye No
` ((�� _Building Applicant: c)(-�mFS SHGLx'ON ROOF,ANC Planning &Zoning
Tree Administrator
Project: E ^(Zi (- Public Works
Public Utilities
S l-kttJC>LC_ Mo Qt g7I_(-) `F 1iOSO -ATIO Public Safety
I Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review of Permit Verified 13 or Receipt Date
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. ❑Denied. ❑Not applicable
(Circle o Comments:
BUILDING
PLANNING&ZONING Reviewed by: Date: -02 9'77
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denie ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
PWsed 06119/2/7
2017 FLORIDA NOT FOR PROFIT CORPORATION ANNUAL REPORT FILED
DOCUMENT#729301 Apr 24, 2017
Entity Name: OCEAN VILLAGE ASSOCIATION, INC. Secretary Of State
CC9609787506
Current Principal Place of Business:
1825-A NORTH 3RD STREET
JACKSONVILLE BEACH, FL 32250
Current Mailing Address:
P.O.BOX 330026
ATLANTIC BEACH, FL 32233
FEI Number: 59.1697543 Certificate of Status Desired: No
Name and Address of Current Registered Agent:
MARVIN 8 FLOYD REALTY,INC.
1825-A NORTH 3RD STREET
JACKSONVILLE BEACH,FL 32250 US
The above nemetl entM submgs this eleleorent rorthe purpose o)ahrWfr,,as regWeredoMloe orreglstared agent,or both,in Me State ofFdWS
SIGNATURE:
Electronic Signature of Registered Agent Date
Officer/Dinector Detail :
Title DVP Title PRESIDENT,DIRECTOR
Name LASETER,SCOTT Name RIDGE,GEORGE
Address P.O.BOX 330028 Address P.O.BOX 330020
City-Slate-Zip: ATLANTIC BEACH FL 32233 City-State-Zip: ATLANTIC BEACH FL 32233
Title TREASURER,DIRECTOR Title DIRECTOR
Name MCLAUGHLIN,BARBARA Name LUCKIE,MIKE DAVID
Address P.O.BOX 330026 Address P.O.BOX 330026
City-State-Zip: ATLANTIC BEACH FL 32233 City-State-Zip: ATLANTIC BEACH FL 32233
Title SECRETARY
Name KARPF,DAWN BERCAW
Address P.O.BOX 330026 19DO 3536555
Cay-State-Zip: ATLANTIC BEACH FL 32233
GEORGE E. RIDGE
ATTORNEY AT LAW
FLORIDA SUPREME COURT
CERTIFIED CIRCUIT MEDIATOR
COOPER RIDGE, P.A.
BAYWATER SQUARE BUILORe
140 EAST BAY STREET FAA'.(90,1)353 7550
JACKSONVILLE FL 32202 pF100E9PT0RryEYlAX.fAM
hen..I lA&Ner ar..i Ioe xiimrab-or RvuppWmnMnpwlis tnn aM+uv ale entllM1elmy W[bnM[a1TneWn MW hew Il,s sena N9....leiilmuN rmMr
aeM�Chef I em woMnrwElrecbral Ms mNcra0.'nwll,e nniWrpr W We empoerra3 N em'ute IMe npwlearpuireJOy CMp1ei81)Fb,IEe SIe1Wµ'eMPelmynameappxm
BMT.NOn MMevNneM xiMWdMrA'M empaxnrW.
SIGNATURE:GEORGE RIDGE PRESIDENT 04/24/2017
Electronic Signature of Signing OfficarlDiredor Detail Date
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