128 SEMINOLE RD 1 - ROOF -S v�Jr
' J CITY OF ATLANTIC BEACH
riS
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: RERF18-0193
Description:
Estimated Value: 7129.04
Issue Date: 8/2/2018
Expiration Date: 1/29/2019
PROPERTY ADDRESS:
Address: 128 SEMINOLE RD 1
RE Number: 170589 0090
PROPERTY OWNER:
Name: BLACK DONALD F ET AL
Address: 128-1 SEMINOLE RD
ATLANTIC BEACH, FL 32233-4154
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: HOUSE DR DEVELOPMENT LLC
Address: 5782 SAWYER AVE JAMES HOSKINS JR
JACKSONVILLE, FL 32208
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$7,500.
�1�'''!/,.; Building Permit Application Updated 12/8/17
,
z) City of Atlantic Beach
F,;,,,/ 800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845 ¢ /A
Job Address: pe-I Seal, /10 /e ,� Permit Number: k'LF((� QI (3
Legal Description/G-d 17 `aS [E .06 ct.i'i0 5 ec / C oc't ARE# t7 Sgt " 0090
Valuation of Work(Replacement Cost)$ 7) o 0`/ Heated/Cooled SF/,c-o0; Non-Heated/Cooled 572/O
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial 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:
cue — C'A'F
Florida Product Approval#�G /0/ �� for multiple products use product approval form
Property Owner Information
Name: 6.a..r h&e-r• eA..-QJ( Address: /Z g- 1 Sets-►i v1 0 k k
City 1 r/4_,,,t4-i L 41.eatC State F/ Zip 3 .)-Z3 3 Phone 9o,/- RS3- s c 7'3—
E-Mail C.-COc(�t yx rntu Co vvi C at . /'1.42..-1—
Owner
2..—fi
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: 1-toct Se 0` Dew op,,,P/1-4- LL Qualifying Agent:
Address-71(03 iit+f •ftiC jLVD S',Ac 4 t-r City Tcrwrcy)0-th State fLZip 3- -)(
Office Phone'D'{- `/
4 —L/QQ( Job Site/Contact Number 9F Lf 79'
Q G{471
e.
State Certification/Registration#<CC t-[(`'5 E-Mail (--) '-0c(--' � evci p)oyc.cGekr
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation ext,p1 p`t cwt C'a�/ '
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 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
RECORDING YOUR NOTICE OF COMMENCEMENT. 2
-43 / /
(Signature of Owner or Agent) (Sig ature of Contractor),"
(including contractor)
Signed and sworn to(or affirmed)before me this(T„rt"day of Signed and sworn to(or affirmed)before me this .tt"day of
( .)(-1-1 ,)--0t.Z3 ,by L. As,_.tfI L _4: SU? , 55,by l—&l—i t, lim
atul IPi oiFK .{S', ature is MBUCK
%,, No ary Pip c- ate Fonda :F,�;" Notary Ppb is-S:a:e of Fonda
,a 1~•` Commns4,=GC 17922' • A`\1 • Commission=GG 179227
[ Personally My Comm Exp es Jan 25 2022 personal) Known OR _ ''My Comm Expires Jan 25 2022
Known OR =.�_,, Y
zrco-r.,,£-Wes J n 25 3oroec Tn�Sr\adcrai�etary Aas-.
Produced Identification [ ]Produced Identification
Type of Identification: pr:}(--"l `, Type of Identification: