2233 SEMINOLE RD #22 - PERMIT ROOF18-0057 CITY OF ATLANTIC BEACH
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 INFORMA77ON:
PERMIT NO: ROOF1 8-0057
Description: SHINGLE TO SHINGLE AND MODIFIED
Estimated Value: 5999.58
Issue Date: 6/13/2018
Expiration Date: 12/10/2018
PROPERTY ADDRESS:
Address: 2233 SEMINOLE RD 22
RE Number: 1695190142
PROPERTY OWNER:
Name: MEGNA SUSAN C LIFE ESTATE
Address: 55 CAMPBELL AVE
CASTLETON, NY 12033
GENERAL CONTRACTOR INFORMA77ON:
Name:
Address:
Phone:
Name: Triton Roofing & Restoration LLC
Address: 480 State Rd 13 Ste 106-348
St Johns, FL 32259
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$7,500.
City of Atlantic Beach APPLICAT16N NUMBER
Building Department (To beassigned by the Building Department.)
800 Seminole Road
C,
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us L__�ate routed:
City web-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
r,.-o 2—Z--Dpp"ent review required Yes No
Property Address: ZZ33 ,A,,(,e--
Applicant: c�� CN, -Planning &Zoning
Tree Administrator
Project: Mo C) Public Works
Public Utilities
Public Safety
Fire Services
,Review fee. Dept Si nature-
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
'Reviewing Department First Review: R rApproved. E:]Denied. [:]Not applicable
(Circle one.) Comments:
PLANNING &ZONING Reviewed by: Date:6—/P,?0�e
49
TREE ADMIN. Second Review: F d. F V
_]Approved as revise ]Denied. F]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: FlApproved as revised. E]Denied. E]Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
OFFICE COPY
Building Permit Application Upcl�bjfll�!ij�.i
I'!� 'i; ! JUN
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845
7no
-9- —_ x�
JobAddress: 6fokaa Sern) le 1�00d uAit Permit Number:
Legal Descript1on0? ,25-"0MnV1/ aogmo�-,, &Q,57/19- olqa
Valuation of Work(Replacement Cost)$ I % :eated/Cooled SF Non-Heated/Cooled /033
• Class of Work(Circle one): New Aciclitio%�A�Iterat�lo Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): � ommerci Residential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes Noqc�D
• 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:Pe-ra" r 111tv
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Florida Product Approval#FU'93_"& Pp5p_0r_RR--for multiple products u�q prod ct approval form
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PropertV Owner Information
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C
ess:
Name:1Y,-,.-1f7 1 -Acl�dr�A A10 Y 15 ,
City LTaIRS6hvilleii0each State 17-1_ 7i, Phone 5
3
E-Mail 'IM19 A)
Owner gerd, Power of Attorney or Agentv�iktter Required)
Contractor Information
Name of Compan 1-ri-bli (W tKvifyin Agent:P0Wrt7 1?UGSe_f1
Address 41t�RV_15N_.'X�r W& City hn'S State Zip
Office�hone q I q Job SitelContact Number, V(YJ'i315�:2Z7k
State Certification/Registration# CACC_132M9 E-Mallffi%VO) R-7 Abn IddC666W He-Com
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensationf!-(W k_fT1/LW rx, Wr, 965?600nnA- '1161 kmig
Exempt/Insurer/Lease Employees/Expiration Date
Application is hereby made to obtain a per mit 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.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
RECOR�NG OUR NOTICE OF COMMENCEMENT.
J,_0 10 1 JA IC P&-Y, '?
of OwVer or tgent) gnature of Contractor)
(including contractor)
Sig d swor ffirmeq)-before me th' a Si and sw ito�yaffirmWefqre me thi day of
'17 1 IAA 0� b
by L b tjW
MISSY K J N C/ I
MY COMMISS(GINA i at Notary)
EXPIRES April 10,2021
FMAIS KJONES
P s a own OR �&onally Known '0"
MY COMMISSION#GG092596 i
Prod cation I Produced Identifii EXPIRES April 10,2021 1
Type of Identification: Type of Identificatio
Doc # 2018114757, OR EK 18386 Page 2498, Number Pages: 1,
Recorded 05/14/2018 04 :35 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
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NOTICIM OF COMMENCEMENr
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differeM date is spedfiedt.
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