1604 Coquina RERF18-0237 CITY OF ATLANTIC BEACH
" ? 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: RERF18-0237
Description:
Estimated Value: 9000
Issue Date: 9/20/2018
Expiration Date: 3/19/2019
PROPERTY ADDRESS:
Address: 1604 COQUINA PL
RE Number: 169561 0000
PROPERTY OWNER:
Name: HINDER PAUL R
Address: 1604 COQUINA PL
ATLANTIC BEACH, FL 32233-5814
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: Cost Plus Roofing
Address: 1438 Lewis Street
Fernandina Beach, FL 32034
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$7,500.
Building Permit Application Opdzfed 12/8/17
City of Atlantic Beach al
800 Seminole Road,Atlantic Reach,FL v
32233 ly FS Ol$ 021A0
Plane:154761267 5826 Fax:19061247-5815
Job Address: :%OO Lt CG f i 1n !7 14'1p CCi Permit Number: M1l 111 VZ�,
Legal Description/)"'.l'2Gq Z'25.t/T(t'c�n 6t/,.cairn t� $!J/�/k77tV/Y'�XpY/LC/lb/'OOU
Valuation of Work(Replacement Cost)$ fO!➢ O Heated/Cooled SF Z Z 36 Non-Heated/Cooled LQ 60'
• Class of Work(Circle one): New Addition Alteratio Re air Move Demo Pool Window/Door
• Use ofexisting/proposed structure(s)h0rcle one): Commercialesidential
• If an existing structure,is afire sprinkler system installed?(CNde one): yes N/A
• Submit a Tree Removal Permit Application I any trees are to be removed or Affidavit of No Tree Removal
Describe In detail the type of work to be Performed: rj, ,7Ce f O{!,J r S L/.��Q�✓!C�•me(1N�/ ,Cpc/fCi
/7 t '[drib 17.1acJdedn
6r /t
Florida Product Approval# '4`/
G/ /I^ f / for multiple products use product approval form
Property Owner Information
Name 114 v / //,. e-/ Address: /Oo O `l P/, �-
Oty 19 t/c...he / r. rt, State lL- 21p 3 2 2 " Phone c 4 - C !T
E-Mail
Owner or Agent IF Agent,Power of Attorney or Agency Letter Required) 0
Contractor lMorma"on �/''J� F OM/�
Name of Company: C'1 ,- /'/41 �2 LYJfz Qualityin A¢Qnt /Sf-z_k-f ,.,� .Scl //-r l
Address/�, L ec..- � g City&f , Stated f" ZIP
• Y
Office Phone O", 4 � _�- tF 2 '-/_ Job Site/ tatt Num4er / j*"/✓i �7v v' c/L 7 C9 c/
State Certification/Registration p
,-C( IJ k),151 E-Mail
Architect Name&Phone#
Engineers Name&Phone O
Workers Compensation
Gem Inwrcr/Leax Empbwea/Expiration pale
Application is hereby made to obtain a permit to d workand installations as indicated.)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
RECORDIN IOTICE OF COMMENCEMENT.
(Signature of Diener or Arm) - (Signature of Contractor)
(including contractor)
Sif�Jed and sworn to(or affirm )b o me this A day of Signed and sworn to(or affirmed before me this day of
JY/i F 7/!$.by ft" � SrOYklhL5 �11X by A(Signatureof rv)
SALTEDI4`Persunally Mno of Florida /Wewrelly Known OR a ORISTINA NAWBAKER
I I Produced idem •E015127 ';'[ I Produced ldemiRration '?' ';•Type of IdentifkallF a.2M „Type of IdwmB,atei _ My COMMISSION p FF998315
} .'..:: FXR RES June 20
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