310 8th St A & B re-roof permit y1 y.LJ
�+ CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
' ATLANTIC BEACH,FL 32233
;i INSPECTION PHONE LINE 247-5814
ROOF NON SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: ROOF17-0030
Description: re-roof 11 sq. Flat roof&8 sq. shingles
Estimated Value: 6700
Issue Date: 8/25/2017
Expiration Date: 2/21/2018
PROPERTY ADDRESS:
Address: 310 STH ST A
RE Number: 169918 0100
PROPERTY OWNER:
Name: GROSHELL BENJAMIN S
Address: 107 S ROSCOE BLVD
POINTE VEDRA BEACH, FL 32082
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: AMERICAN ROOFING OF JACKSONVILLE
Address: 1720 Wildwood Creek LN
JACKSONVILLE, FL 32246
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$7,500.
?cav> City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
i 800 Seminole Road �1 �71 L•y-7 p3 /JJ�
Atlantic Beach, Florida 32233-5445 f V
J Phone(904)247-5820 Fax(904)247-5845 c ` �t
"j p9 E-mail: building-dept@mab.us Date routed: O O )tl lig
City web-site: hep:/Avww.coab.us
APPLICATTIO�N REVIEW AND TRACKING FORM
Property Address: 3 c
I V U-ID DeItrnent review reuired Yes No
Applicant: Arnalcai to4nN JJay ammng &Zoning
f Tree Administrator
Project: cu foo ��• �t�P� � Public Works
r' / Public Utilities
) I sq• ` 1 k Public Safety
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Penni=Verified B
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: Date: �
TREE ADMIN. second Review: ❑Approved as revised. ❑Denied. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05K9120=7
Building Permit Application
OFFICE COPSCit of Atlantic Beach
AUG z z 2017eminole
Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845 ..
Job Address: 3108th Street,Atlantic Beach,FL 32233 Permit Number:
Legal Description 5-69 16-25-29E ATLANTIC BEACH LOT 3 BLK 9 RE# 169918-0100
Valuation of Work(Replacement Cost)$ 6,700.00 Heated/Cooled SF 2,143.00 Non-Heated/Cooled 2.982
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)larder one): Commercial Residential
• 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 t\oLbep rmed: Co plet roof tear off and
replacement. O 59v�5
la/Jd y�3fcf, /dYr�r.TP/t�Vnr� 55jr�/�`S•
Florida Product Approval# 5� N/N,_4for multiple products use product approval form
Property Owner Information
Name: Benjamin Groshell Address: 1075 Roscoe Blvd
City Porte Vedra Beach State FL Zip 32082 Phone (904)838-1149
E-Mail
Owner or Agent(if Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Nameof Company: American Roofing of Jacksonville Qualifying Agent: Daniel P.Kinkel
Address 3047 St Johns Bluff Road S,Ste? Citylacksonville State FL Zip 32246
Office Phone 904-3853375 Job Site/Contact Number Chris Dennis,904-6263636
State Certification/Registration# RC90227546 E-Mail dan@americanroofim a.com _
Architect Name&Phone# NA
Engineer's Name&Phone# NA
Workers Compensation Plymouth Insurance Agency,WC71949,expires 01/0112018
Exempt/imurer/lease Employees/Espiratlon 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 caning.
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 FIN ING, CONSULT ITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING Y R NOTICE OF MENCEMENT.
(Sign re of Owner or Agent including Contractor) (Signature of contractor)
'gned and sworn to(or affirmgd)before me this d Si ed and mom to(or affirmed)before me this a1 day of
l O ni rr (,I SIM / b 15}. �GYx .W rid At R t ILA A t Q
(Signature of Nota - (Signa a of ry)
J MauIYPWkeYY WFME• ":N..",•.e JENNIFER JOoW04
WcoMNIS510NGG 0a2�d
[ rsonallY Known OR 134FTd Personally Known OR EXPIREa:OCW%r 27,3091
[ ]Produced Idents ica[i ww�� (I Produced Ident'dicati w`..? d'', QanOa° �d'cuM•rMwe
Type of Identification: Type ul Identification:
OFFICE COPY CITY OF ATLANTIC BEACH
800 Seminole Road
Atlantic Beach,Florida 32233
LREVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS
Date y((� Revision ttooIssued Permit_ Corrections to Comments/ Permit# OLF11 —0030
�
Project Address 3 0 b Si t, f� ho
Contractor/Contact Name �Vcf tr0.� Q-DA' cls �axl ho-o
Phone Email
Description of Proposed Revision/Corrections: Permit Fee Due$ o
QiW'(A) 1W4 t nsk f a(A; 3/) A
Additional Increase in Building Value$ Additional S.F.
By signing below,I affirm the Revision is inclusive of the proposed changes.
(printed name)
Signature of Contractor/Agent(Contractor must sign if increase in valuation) Date
(Office Use Only)
Approved. Denied Not Applicable to Department
Revision/Plan Review Comments
Department Review Required:
Building ! '
Planning &Zoning Otevivived By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services
Ctl n a o ry y
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