480 Ocean Blvd RERF18-0154 CITY OF ATLANTIC BEACH
r1 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: RERF18-0154
Description: SHINGLE ROOF REPAIR
Estimated Value: 2000
Issue Date:
Expiration Date:
PROPERTY ADDRESS:
Address: 480 OCEAN BLVD
RE Number. 170173 0000
PROPERTY OWNER:
Name: FISHBAIN FAMILY SUPPORT TRUST
Address: 3798 MATHESON AVE
COCONUT GROVE, FL 33133
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: NELIGAN CONSTRUCTION
Address: 910 S 11th Ave
JACKSONVILLE BEACH, FL 32250
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$7,500.
Building Permit Application Updated 12/8/17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845
Job Address: 480 Ocean Blvd. Atlantic Beach, FL 32233 Permit Number:
Legal Description 5.69 1&2S-29E Atlantic Beach Lot 5 Ellis 23 REg 170173.0000
Valuation of Work(Replacement Cost)$ 2000.00 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Orck oris): New Addition Alti Re M Pool Window/Door
• Use o(existing/proposed struaure(s)(Circle one): Commerci Resid lal
• If an existing structure,is a fire sprinkler system Installed?(ClrrA . N N/
• Submit a Tree Removal Permit Application N any trees are to be removed or Affidavit of No Tree Removal
Describe In detail the type o(work to be performed: Root repair, valley over front door, remove shingle, replace rotten
rotten wood,ra-shingle.
Florida Product Approval�llntleneymentl117420/Sh'nglese10671 for multiple products use product approval form
PMR@rtV Owner In(orroation
Name: David Fishbaln Address: 7796 Maflmmn Ave.
City Coconut Grove State FL Zip 33133 Phone 705771-7839
E-Mail aw,oy.b,gypmnl.,.om t aqa
Owner or Agent(If .Q 4.L
Agent,Power of Attorney or men,Letter Required)
COArector Information
Name of Company: Neligen ConsWrtlpn&Rooflng,LLC qualifying Agent: Brion D Nallpen
Address 91011th Ave.Boum City Jax Beach State FL Zi 31233
Office Phone e5a ssz3 lob Site/CCM O Number Eddene a$Ae6o6 p
State Certificatlon/Registration g =132+88uco E-Mail^elbenm ewcnm®p,rell.mm
Architect Name&Phone g
Engineer's Name&Phone a
Workers Compensation Bndgefleltl Employers Ineumnce 0830-29147 exp 3/232019
Exempt/Insurer/[safe Employees/Expiraaloo pate
Application is hereby made to obtain a permit to do the work and Installations as indicated.I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS, FURNACES, BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc.NOTICE:In addition to the requirements of this
Permit,there may be additional restrictions applicable to this property that may be found In the public records of this county,and
there may be additional permits required from other governmental entities such as water management districts,state agencies,or
federal agencies.
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and toning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMM „BL4EMENT. l�L�
j1 ti' .I
-� (Signaturect Ow nor ) (Signature of Contractor)(including contractor) •,
Sj&wcJ and sworn to for affirm
Vlore rpeihis day of Signed and s,Q,mt (or affirm9 q before mets d of
E / by t�S 1 /9'UD( W ID�b CI s,-t
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MYC4MM15$pxla GG F25ttSOran Pu61ic $late of Florida
1iPersonalN Known OR EXPIRES'.Bep'ea0e�26.N29 Personally Known OR Y( iPrdducetl Identiflationy vacp. ws Produced IdenORcatbn Commission # FF 994782
Type o/Identification: ';> ' My COMM.Expires May 31,2020
e of ldentlfication: x.®,+'
Assn.