633 AQUATIC DR - ROOF 04 1-$1,!,
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
5 � � 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: RERF18-0241
Description: shingle re-roof- FL10674.1 & FL20876.1
Estimated Value: 5883.43
Issue Date: 9/28/2018
Expiration Date: 3/27/2019
PROPERTY ADDRESS:
Address: 633 AQUATIC DR
RE Number: 171818 5356
PROPERTY OWNER:
Name: CLACK GREGORY
Address: 248 S 39TH AVE
JACKSONVILLE BEACH, FL 32250
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: RED STAG CONTRACTING INC
Address: 9803-1 Old St. Augustine Rd QA ANDREW MAJED HASSAN
JACKSONVILLE, FL 32257
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$7,500.
II 1)' Building Permit Application Updated 12/8/17
w City of Atlantic Beach
f:),'' 800 Seminole Road,Atlantic Beach,FL 32233
(.0, /� Phone:(904)247-5826 Fax:(904)247-5845 `'
Job Address: j J 1Q�(,12�1 C D(�V4Q ) AR j F L 3aa3;� Permit Number: vs 11-oak-Ai
Legal Description 38"'I 11-a$ - E Avu xI-k_ 2..,t _REtt 1'7 IS 18 —63. c,
Valuation of Work(Replacement Cost)$ ,Sgg3 ,--)3 Heated/Cooled SF WA 132 Non-Heated/Cooled a�
• Class of Work(Circle one): New Addition Alteratio Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residentrall
• 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:
Re_ — KOO-C
Florida Product Approval tt L._ 10G-11-4 , I / 1 - Z(:-=17C,-,s ` for multiple products use product approval form
PropertyOwnerInformation A 11 Il!l {n�
Name: G e�orv� (.UQC IZ Address: c yi S Sol tl'�• AV�t,.2 , SALf4So'tvill(�l �Ft3MO
City ,"Sos{kSvr.✓',tie ectc J& State FL c(
Zip Taa,,0 Phone '9O — 33 -8'7`f 7
E-MailOCtQc.kQ 1tiI AX . C. -A
Owner or`A ent I Agent, we f Atfo ney or Agency Letter Required)
Contractor Informationr ( r � � r( /� 1 _ f'
Name of Company: `Ctck..s'tC `.t�vtpt-fUc fst� 1-C, Qualifyin Agent: A 1�t ' Raf-A6 vt.
Address C(f'Q ~I Cta ti�t-t City S0-t- oti✓�1r� State F1- Zip & 7
Office Phone (1G`-I 3177-�a '2) Job Site/Contact Number 904-aa�-yi 7
State Certification/Registration tuCCC I Abet(icf j E-mail Anes , u e I S k, 0111. • .(C-w A , l'.,14' -•
Architect Name&Phone U
Engineer's Name&Phone tt
Workers Compensation 'tkv✓.Wt.i' e.-6E1/PS WVa0 l7 --
Exen pt/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 % " AN i T • NEY BEFORE
RECORDING YOp"N9TIC OF COMMENCEMENT. I I I
J , ,
111
ILIIIIIINb
/
( ' na re of Owner or Agent) (Signature of Contractor)
(including contractor)
Signed and sworn to(or affirmed)before me this (v day of Signed and sworn to(or affirmed)'befDre me thisZril day of
Esu _ , 001 by T 4C1T .( M(Dre stir fnaeg aQI_t_, by AND _144266,A44
\---It'LJ .-- laifsliclief_____
,.•- t2ature of No ar t (Signature of Notar
47/' ,.•.•'''.1, f�A�HEL MOORE
� � iitl NotaryPublic,State of Florid
(vl Personally Known OR €• I•�i ';•i ersonally Known OR C C
( I Produced Identification ;►„,.,i `; / My Comm.Expires July 15,20 Produced Identification s'+''ai.-•. PATRICIAL HODGE
!�� e«P+ Commission No.GG 12712 +� :
Type of Identification: __,„c► �,� I ype of Identification:__ : ' �� '•.c MY COMMISSION Y FF 165979
.,„;-a, EXPIRES:October 28,2018
1 oe tk4c Bonded Thin Notary Pudic Underwriters