501 SEASPRAY AVE - ROOF 6 ' '-? 'i CITY OF ATLANTIC BEACH
,..,:cillz,,._ ..., _ 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
t
Jsti INSPECTION PHONE'LINE 24.7-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0194
Description: roof repair from storm damage
Estimated Value: 2000
Issue Date: 12/1/2017
Expiration Date: 5/30/2018
PROPERTY ADDRESS:
Address: 501 SEASPRAY AVE
RE Number: 170431 0030
PROPERTY OWNER:
Name: SPECKMAN JOSEPH J
Address: 501 SEASPRAY AVE
ATLANTIC BEACH, FL 32233-4178
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.
i City of Atlantic BeachAPPLICATION NUMBER
Building Department (To be assigned by the_Builtlmg Department)4 e
800 Seminole Road
E-1 Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
E-mail building-dept@coab.us Date,routed V �a
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: SO ` Scc Sp u.I Lreview required Yep No
Bui Id nig !/
Applicant: DIA) .Qir Planning &Zoning
�,
�� Tree Administrator
5 1�
Project: { 11LLL r 5 Le_ 'WO --A Public Works
Public Utilities
Public Safety
Fire Services
Review°fee $ m s Dept:Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
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: F pproved. ❑Denied. nNot applicable
(Circle one.) Comments:
:•BU41�D1NG '
PLANNING &ZONING Reviewed by: Date: /2' /1
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:
Revised 05/19/2017
r=
1'LA,r�,, ing Permit Application °`1\ L dywo)
,v-±,,...,A OFFI E ► � ��,�
C C�`
7.14 -�_- �� City of Atlantic Beach � III 1
x.'_•.`"' ' 800 Seminole Road,Atlantic Beach, FL 32233 Jill
NOV 2 9 2017 Ilx�Jfi 9� iPhone: (904) 247-5826 Fax: (904) 247-5845 iE
Job Address: 4d/ 5,4Pk!4-yki(e Permit Number:
n "c - �
Legal Description RE# 1'
Valuation of Work(Replacement Cost)$ Z000 Heated/Cooled SF Non-Heated/Cooled X
• Class of Work(Circle one): New Addition Alteration el_ Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial CResidentiai)
• 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: / v 0 p 74 6,(' , 'g: 44 s7z),-,41
jic�7 z,4L6- - d °l
Florida Product Approval# for multiple products use product approval form
Property Owner Information ``
Name: x'0 5 &PH Si C7</i/f/9"A/ Address: 5-0/ S Sn/e..4-'7 /,/OE F
City -fZ 6 C/I State Fe-- Zip 3 Z 019 Phone 901/- 2- O5 t..c(
E-Mail 44 OM E-. 73'5'.727 4e✓U !V C 2 i Ct4.c' _'.NC—r'
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) -
Contractor Information •
Name of Company: Qualifying Agent:
Address - City State - Zip
Office Phone Job Site/Contact Number
State Certification/Registration# 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 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 NOTIC . OF CO •MENCEMENT.
9-414-7%---
(Signature • 0 -for Agent) (Signature of Contractor)
(including contractor)
Signed and sworn to(or affirmed) before me this ael day of Signed and sworn to (or affirmed)before me this day of
$oitc, 30k--1 ,by IO e..43\r) spe_cLvncto , by
\ - 1 --.
(Signa. p- •f N•tary) (Signature of Notary)
t ,rnr?�%iy'•, JENNIFER JOHNSTON
:�* ,
•'':°,1,0% MY COMMISSION#GG 042984
• }°:'. �,,;�,�? EXPIRES:October 27.2020
[ ]Personally Known OR v °a';R.,0. Bonded ThruNotary Public Underwriters [ ]Personally Known OR
[)roduced Identification .,-...-.... _... . [ ] Produced Identification
Type of Identification: -LD>1 )l kx /1J c✓ s 1 Lce-n Type of Identification:
•
r,-7t!--'1,5•1`')--,
CITY OF ATLANTIC BEACH
::.:.�e .�- 4%WNIE'. / BUILDE i'� AFF(V)AVIIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
• CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED 1 I1
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT . C)
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS M
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR C)
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS: THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
• IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT .'
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT i
HIRE.AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS ,
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS•
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
•
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
/ S ' -4 14-1/ter— _ eliP t-1 Cf Lj —
ADDRESS PHONE NUMBER
j$ E—/ / ' Sime c 4 eti /
PRIN ' :ME 0 /
11,, _4 ' i - AO -71--A612/66,- ii ' ,f
SIG AT RE AR'' / DAT
. Before me this' day of !v t 1--M/39--( ,20 ilin the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate. I ,�,,•y,,m,ti,.,„, ,.,,......,...,.-_..-.�-,i
Notary Public at Large,State of t ,County of 0(A C7 1 tI µ, .?Gory,` `x JENNIFER JOHNSTON
•
' _ ',, MY COMMISSION#GG 042984 s
El Personally Known n I /� , F. It n1 � EXPIRES:October 27,2020
1 , roduced Identification- \0 V'd t d¢--J` ,-to—r..-its."---
' e •`o' Bonded Thru Notary Public Underwriters
.
Notary Signature: .,,m. 1L _ .
F:BLDG/Owner-BuilderAffadavi,. VISED:4/16/2009
Pr OFFICE COPY
PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH,FLORIDA
Project Name: ,lose O GAG Permit # /28.-/e F - °'C`/
Project Address: / SOS1rj /a & `I Lel') r/ ...V33
As required by Florida Statute 553.842 and Florida Administrative Code Rule 9B-72,please provide the information and product approval number(s)
for the building components listed below as applicable to the building construction project for the permit number listed above. You should contact
your product supplier if you do not know the product approval number for any of the applicable listed products. Information regarding statewide
.roduct approval may be obtained at:www.floridabuildin_.or:.
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
A.EXTERIOR DOORS
1. Swinging
2. Sliding
3. Sectional
4.Roll up
5.Automatic
6. Other
B.WINDOWS
1. Single hung
2.Horizontal slider
3. Casement
4.Double hung
5.Fixed
6.Awning
7.Pass-through
IMINEMMMO
8. Projected
9.Mullion
10. Wind breaker
11.Dual action
Pirr
12. Other
Category/Subcategory Manufacturer Product Description imitation of Use State# Local#
C.PANEL WALL
1. Siding
2. Soffits
3.EIFS
4. Storefronts
5. Curtain walls
6. Wall louvers
7. Glass block
8. Membrane
9. Greenhouse
10. Synthetic stucco
11. Other
D.ROOFING PRODUCTS
1.Asphalt shingles C4-f- .fe. /0/2-V /
2.Underlayments 6.413 d< ,r,�j•Z+� / 7 s' 2
3. Roofing fasteners fr."
4.Nonstructural metal roof
5.Built-up roofing
6. Modified bitumen
7. Single ply roofmg R? Sri
8. Roofing tiles
-f 9. Roofin: insulation p 0--.S'cbvts-i .5"f/?
Q-+
10. Waterproofing
11. Wood shingles/shakes
12. Roofing slate
13. Liquid applied roofmg
14. Cement-adhesive coats
15.Roof tile adhesive
16. Spray applied polyurethane
roof
NW'
17. Other
Category/Subcategory Manufacturer Product Description imitation of Use State# Local#
E. SHUTTERS
1.Accordion
2. Bahama
3. Storm panels
4. Colonial
5.Roll-up
6. Equipment
7. Other
F. STRUCTURAL
COMPONENTS
1. Wood connector/anchor
2. Truss plates
3. Engineered lumber
4. Railing
5. Coolers-freezers
6. Concrete admixtures
7.Material
8.Insulation forms
9. Plastics
10. Deck-roof
11. Wall J rr&l Jr/S,6 y,e)
12. Sheds
13. Other
G. SKYLIGHTS
1. Skylight
2. Other '
Category/Subcategory Manufacturer 1 Product Description 'imitation of Use State# Local#
H.NEW EXTERIOR 1
ENVELOPE PRODUCTS
1. �.
2.
In addition to completing the above list of manufacturers, product description and State approval number for the products used on this project, the
Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and installation
instructions along with this Product Approval Sheet.
I certify that this product approval list is true and correct to the best of my knowledge. I further certify that use of different components other than the ones
listed in this document must be approved by the Building Official.
(Contractor Name) (Print Name) JO 5, k/ '' i 1,4- (Signature) 41111y° e.i�✓
Company Name:
Mailing Address: 519 /
City: A7Z- G�-�_ State: �'1— Zip Code: 5 2
Telephone Number: ( f ) 2—C87 Fax Fax Number: ( )
Cell Phone Number: ( ) E-mail Address: / 4,44 '`i-',5 e-&"1--W Co/Pt C4 4/E1