459 SKATE RD RERF19-0035 REROOF SHINGLE PERM REROOF SHINGLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RERF19-0035
800 SEMINOLE ROAD ISSUED: 3/7/2019
r'i >r ATLANTIC BEACH. FL 32233 EXPIRES: 9/3/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
459 SKATE RD REROOF SHINGLE SHINGLE ROOF $6000.00
TYPE OF
ZONING: :D •
• • GROUP:
171523 0000 ROYAL PALMS UNIT
02A3.00
COMPANY: ADDRESS: CITY:
NPS INC 1833 LIVE OAK DRIVE JACKSONVILLE FL 32246
• ADDRESS: CITY: STATE: ZIP:
REAL ESTATE PROS OF 8802 RUNNYMEADE RD JACKSONVILLE FL 32257
NORTH FL
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR 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.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $85.00
STATE DBPR SURCHARGE 4SS-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $89.00
Issued Date: 3/7/2019 1 of 2
Building Permit Application Updated 10/9/18
JCity of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us
IS REQUIRED.
pt@coab.us 2
Job Address: Hisog St�Ca�2 �d WJ(C ,[ k Permit Number: LK� 0• �J
Legal Description 3t' �(o (� -�J-24� 6)!`I ?Om3 VA-I Zit Azlit 1 RE# j, I_S23 " W W
Valuation of Work(Replacement Cost)$ 1�nno Heated/Cooled SF (,02 Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑RepairrEl Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial IUKesidential
• If an existing structure, is a fire sprinkler system installed?: Dyes ❑No
• Will trees be removed in association with Proposed ro•ect? []Yes must submit separate Tree Removal Permit ❑No
Describe in detail the type of work to be performed: FL, t0&'74 - (2)
00 .k, Lr I ��•Z 16, - R Z -u rtc� l OL4t—n
Florida Product Approval# for multiple products use product approval form
Property Owner(Information r�
Name 91�At a n LS Ce 40 ,12fld'c� CLC Address �oQ2 I�,�tu+YFV _ ZJ 32Z;.�
City ;K State V�,L Zip32Z i Phone
E-Mail � SFS ��E�'yc SZC�� . 6irvAc ( Ccrv1
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company f1i P5 1lkic- Qualifying Agent
Address 1933 1 i(l' Oq_(y' Cit IQ >C- State i"(- Zip 322`t
Office Phone c() -It Job Site Contact Nu er 090`1 X0`"2 - 21$�
State Certification/Registration# C CS$ Z� E-Mail _Irs u-7 G C;J 10
Architect Name&Phone# ILIA
Engineer's Name&Phone# 0A
Workers Compensation Insurer e- OR Exempt❑ Expiration Date t( S l91
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 regulating
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 YXATTORNEY
--PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR BEFORE
RECORDING OUR NOTICE OF COMMENCEMENT.
natu of Owne r Agent) (Sigp}tge of Contractor)
PNNO�`''•,
Signed and sworn to(or affirmed) before me this day of Signg(d and swo(A*Qioryrrri ), tAfore a this day of
t4k,4n J JI:Aq by �00 Ili . C- 0y r 10 1-' 'C1 b •�sSV'r'r YA J` "
- ¢ Z `
- � �y BAXLEY
� re of Notary)
.: MY COMMISSION t FF 897525
P
EXPIRES:November 8,2019
d;
[ ] Personally Known OR �R;;1• 8ondedThruNotaryPublcUnderwrte< [ ]Personally Knowi'QRSTATE C)
QTProduced Identification [ ]
Produced Identification
Type of Identification: oR Lb(-- Type of Identification: