41 ARDELLA RD - REVISION 3/28/18 r
MAR 2 $ 2018 CITY OF ATLANTIC BEACH
800 Seminole Road
Atlantic Beach,Florida 32233
REVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS
Date 3 a8 Revision to Issued Permit V Corrections to Comments Permit#
Project Address Q'( /) r,de l ( j 14"
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Contractor/Contact Name l (/`o 43 fe00`I I (l SS y
Phone goy- Gil- 8.:2-/� Email ,fY) i SSy P-1 I-or\ /`06 / ,,(0,�
Description of Proposed Revision/Corrections: Permit Fee Due $ / 6 ,S. Q 0
11)_e 5-7-14cc. J�c
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 !r Denied Not Applicable to Department
Revision/Plan Review Comments i` 1/0. Q pit/ s S 7,0 o n a / rn re./,6„ .
D ment Review Required:
Building 771
Planning&Zoning Reviewed By
Tree Administrator
Public Works � p
Public Utilities /2- / 2a 41
Public Safety Date
Fire Services
QC' '
sy
kir City of J PERMIT NO.
Planning and Development co F 11 - 00
,�.
l o� Building Inspection Division
4"ON^``� OFFICE USE ONLY
Application for: Approved by:
Destructive Roofing-In-Progress Inspection Date Approved:
ROOFING-IN-PROGRESS INSPECTIONS
A Roofing-In-Progress Inspection is a required inspection per the Florida Building Code—Existing Building (FBC-EB).
The purpose of the inspection is to confirm any required deck nailing has been completed and proper installation of a
secondary water barrier as required by Rule 9B-0475. This required inspection was not requested by the contractor
prior to completing the shingle installation for the above referenced permit, and now a Destructive Roofing-In-
Progress inspection must be performed by removing certain portions of shingles and/or underlayment to insure
compliance with state law. Not complying with this requirement could affect your insurance coverage for storm
damage.
Owner Affirmation
I understand that the contractor, for the reason listed below, was unable to acquire a Passed Roofing-in-Progress
Inspection. I also understand the Destructive Roof in Progress Inspection will require the Contractor to remove and
replace shingles and/or underlayment as required by the City of Jacksonville Building Inspection Division to verify
work is in compliance with all state and local codes. ^/� ,/�
Before me this a-7day of /'1 4ft/' in thy t f Duval,State of Florida,
has personally appeared j c,e Ii' CQ+fD.rdr�� herein by
him h .elf.nd affirms all statemen la . iiEp rein . u-and
Signed: �'�t _ — ' ' ` - f M �4��6 �1Ty 1 a1r1 ' 1`\�
/ -- " 1 v �W t 1
Prop- y Owner Notary Public at Large,Slate of F/orr�(Z jf�bd_Tb 'y: �.-
Personally known i/ or Produced Identification - '4S .'.
ID Type:
Contractor Affirmation
Company: Tr;ton R006/1 4 � oJ/ C�
Address of Project: 41/ air /, // IQGQ[X
Requested By: O-4-/ 5; ‘,„
/ G
Reason for Request: 110 (l l progp-96s az
1&)5C(1 , understand City of Jacksonville Building Inspection Division procedures
as outli ed in Bulletin G-04-08. I also understand the Destructive Roofing-in-Progress inspection is not part of those
procedures and is an exception to the procedure. In addition, I understand that any non-code compliant work identified during
this inspection may result in the assessment of additional re-inspection fees.
/ Date: *7-7/fi7
Signed: d.�I A
An Approved Copy of this Application Must be On-Site at Time of Destructive Roofing-In-Progress Inspection
SyLyri
Cash Register Receipt Receipt Number
City of Atlantic Beach R4633
DESCRIPTION ACCOUNT QTY I PAID
PermitTRAK $165.00
ROOF18-0034 Address: 41 ARDELLA RD APN: 172077 0000 $165.00
REINSPECTION $165.00
REINSPECTION 455-0000-322-1002 0 $110.00
REINSPECTION 455-0000-322-1002 0 $55.00
TOTAL FEES PAID BY RECEIPT: R4633 $165.00
CITY OF ATLANTIC BEACH
B00 SEMINOLE RD
ATLANTIC BEAC,FL 32233
)3,29/2018 11:52:26
CREDIT CAD
VISA SALE
CARD# ;000°0000000(2670
INVOICE 0003
SEQ#: 0003
Batch#: 000766
Approval Code 038219
Entry Method: Manual
Mode: Online
Tax Amount, $0.00
0.0
Card Code:
SALE AvIOUNT $165.00
CUSTOMER(OPY
Date Paid:Thursday, March 29, 2018
Paid By:Triton Roofing & Restoration L
Cashier: CB
Pay Method: CREDIT CARD 038219
Printed:Thursday, March 29,2018 12:04 PM 1 of 1
MCI