1875 HICKORY LN - PERMIT RERF18-0126 CITY OF ATLANTIC BEACH
r s 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF18-0126
Description: Reroof Shingle FL#10124 FL#15487
Estimated Value: 11815
Issue Date: 5/30/2018
Expiration Date: 11/26/2018
PROPERTY ADDRESS:
Address: 1875 HICKORY LN
RE Number: 172020 1430
PROPERTY OW NER:
Name: PRICE ROBERT W
Address: 1875 HICKORY LN
ATLANTIC BEACH, FL 322334548
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: TOWNSEND ROOFING & CONSTRUCTIONS SERVICE
Address: 10418 NEW BERLIN RD UNIT 115 QA RANDY CRISS
TOWNSEND
JACKSONVILLE, FL 32226
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.
Building Permit Application UpdateddSN17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845 R 5 I $_ Oil II /r��
Job Address: I8�5 I �11+ Le,e Permit Number:� .
F18 pV4e
Legal Description 11.21 Sclvn/ rAA VAif IL C ffrinr Lot- 11 RE#13ZOU-IY30
oa
Valuation of Work(Replacement Cost)$ ) IrglS' Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(arcle one): Commercial eslde
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes 0 N/A
• Submit a Tree Removal Permit Application If any trees are to be removed or Affidavit of No Tree Removal
Dexdbe In detailthe type of work to be performed: F084 �ylgavm-f 6hf fit, rlk- HD
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Florida Product Approval# IPI LH for multiple products use product approval form
Prooerty Owner Information II� � �� II
Name: Gnce- {a Kvl,e/r Address: 18Ts Ni3wry LA-�
city MSL &8 State Ft- Zip "52233, Phone ' 104•S39-7-7'13
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information mr�us y� )
Name of Company:0WA5-0 R•aF�^9 rCftsi�f1mk Qualdymg Agent: rpavl� TwMJc+O
Address 10414 New fat/I;A Rd Its city 'S. x p szaZE
Office Phone 10'1- 645-37867 Job Site/Contact Number - 47Z- 4
State Certification/Registration# Ca-MlIZ-0 E-Mail c-%%c;S iouvssers a io Te, 4414
Architect Name&Phone ft
Engineer's Name&Phone N
Workers Compensation 1 r esl ow i0s5 Z 31 11
Exempt/Insunr/Lease Employees/Expindon 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 most 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 FINAIYCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
112M Y NOTICE OF COMMENCEMENT.
wry
�0
(Signature of Owneror Agent) (Signature of Con c
(Includingcontractor) ,yt�
Signed and sworn to(or affirmed)before me this5l�day of Sign d and swom to(or a 1 )before l M iy yf
.bYMik nl h-
�tytJ i�naturIC0 SEND Af ature of Notary)
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