1800-1808 Mayport Rd - Permit ROOF18-0045 J }7
CITY OF ATLANTIC BEACH
v�
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: ROOF18-0045
Description: re-roof-shingle & modified bitumen
Estimated Value: 4000
Issue Date: 4/24/2018
Expiration Date: 10/21/2018
PROPERTY ADDRESS:
Address: 1800-1808 MAYPORT RD
RE Number: 172075 0100
PROPERTY OWNER:
Name: OSSI KLOTZ LLC
Address: PO BOX 330833
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: MASTER BUILDING CONTRACTORS, LLC
Address: 310 East Jackson Street
Orlando, FL 32801
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.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions
applicable to this property that may be found in the public records of this county, and there may
be additional permits required from other governmental entities such as water management
districts, state agencies, or federal agencies.
* 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.
City of Atlantic Beach APPLICATION NUMBER
rj�r Building Department (To be assigned by the Building Department.)
is
J ;J 800 Seminole Roadr--
� Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: � q(. D --Department review required Yes No
A BuiIdin
Applicant: Akas+e t �1�t�VA h
)Is
oning
_ r 1 Tree Administrator
`
Project: is MX"1\yi d- �(,� �l Q(� b �T(� (� Public Works
_Ce Public Utilities
�� Public Safety
Fire Services
Review fee $ 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 oved. [NrDenied. Not applicable
(Circle one.) Comments:
BUILDING
PLANNI ZONING Reviewed by. Date:e/-/7'2v1 0
TREE ADMIN. Second Review: A roved as revised.
❑ pp []Denied. ❑Not applicable
PUBLIC WORKS Comments: S L/� `J p S Q Y1 I7 /I
PUBLIC UTILITIES /, J
PUBLIC SAFETY Reviewed by: / Date: C>-19'2olr
FIRE SERVICES Third Review: []Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
Building Permit Application Updated 12/8/17
``. City of Atlantic Beach APR 1 3 2018
800 Seminole Road,Atlantic Beach,FL 32233
n Phone:(904)247-5826 Fax:(904)247-5845
Job Address: /oj2? /n�•,a�zr &,g d Permit Number.
Legal Description /7-1?S -.296, .;//16 RE#17�c 0 - 1V
Valuation of Work(Replacement Cost)$ 7 tld a Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteratio _pair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercia 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 to be performed: -�
ih
Florida Product Approval# :L 3'1 q.2 3 5.T.. S 3 3 -A?/9 for multiple product use proWuct approval form
Property Owner Information
Name: OSS I �</0_17- 4- C` Address: '000 &)'e A 3 3
City fitrLnA)Ti% AJ ge-1) State F( zip 3..2.23 3 Phone U0
E-Mail _7, 167Z [� 1/mj 'c5i qR> eZ/Y) _
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) JEFF /�Z Z
Contractor Information �� 1 .SAo�"{ -1- S33y
Name of Company: S C` _ Qualifying Agent: nJy-f x"I IS'
Address �`' � city X11 AA.,-�L State 00, 1 Zip 5,;l-'ar, _
Office Phone Job Site/Contact Number - - —
State Certification/Registration#�Lt 7 _E-Mail
Architect Name&Phone# A "C
Engineer's Name&Phone# K
Workers Compensation_ rV AY EL71L-t rZ41,61,s 047ie ,,;e -&S4/<AVC< 0 I 8 i ,?0
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 instal lation 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.NOTICE:In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that may be found In the public records of this county,and
there may be additional permits required from other governmental entities such as water management districts,state agencies,or
federal agencies.
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.
(Signature of Agent) *ignarentractor)
(including contractor)
Si ned and sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed)before me this day of
elf' .by Z-/5.4 H e;ti�o 2 f}/'�rl �by &IYq A.
(Signature of Notary) (Signature of Notary)
Personally Known OR `may LISA A. BINDER Personally Known OR ` y LISA A. BINDER
[ ]Produced identification o't' NOTARY PUBLIC ( ]Produced Identification NOTARY PUBLIC
Type of Identification: r. FLORIDA Type of Identification: - CTATC OE Fl ORIDA
Comm#FF189043 :Comm#FF189043
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