1026 Big Pine Key RERF19-0084 Shingle REROOF SHINGLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RERF19-0084
800 SEMINOLE ROAD ISSUED: 6/13/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 12/10/2019
MUST CALL INSPECTION PHONE • 14) 247-5814 BY 4 PM FOR • •
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • '
CODE, ' OF BEACH CODEOF 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:
1026 BIG PINE KEY REROOF SHINGLE shingle re-roof FL10124.1, $7500.00
19948, 16160.1
TYPE OF
• • GROUP:
172027 5060 SELVA LAKES
COMPANY: ADDRESS:
JACK C. WILSON ROOFING 4522 ST AUGUSTINE RD JACKSONVILLE FL 32207
CO.
• ADDRESS:
STEGALL KATHRYN STEECE 1026 BIG PINE KY ATLANTIC BEACH FL 32233
GINN
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 . . •
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $90.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$94.00
Issued Date:6/13/2019 1 of 2
REROOF SHINGLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RERF19-0084
Y V~ 800 SEMINOLE ROAD ISSUED: 6/13/2019
j ATLANTIC BEACH. FL 32233 EXPIRES: 12/10/2019
Issued Date: 6/13/2019 2 of 2
Building Permit Application
City of Atlantic Beach
G!ursl� 800 Seminole Road,Atlantic Beach,FL 32233
Phone:(9"247.5826 Fax:(904)247-5845
Job Address: �)
/' -� C ,bra Permit Number:_ C
Legal Description ,
C l
Valuation of Work(Replacement Cost)$ C7u�,�
Heated/Cooled SF
pNon-Heated/Cooled
• Class of Work(Circle one); New Addition Alteration Reair Move D
gMg Pool Window/Door(,f
• Use of existing/proposed
structure(s)(Circle one): Commercial Residenti0lt
• If an existing structure,is a fire sprinkler system installed?(Circle one ; r
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of Tree Removal
Describe in detail the type of work to be performed:
Florida Product Approval# U C
-(�• for multiple products use product a
Property Ow er Information P approval form
Name: ;�6�i `�G����k�1L ?
City �� Address:
- State_ �/ Zip_ '�„ ���_Phon
E-Mail �� ..�-
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Informatio
Name of Cl.mpan
Address �� •� ( • ualifying gent:
Cain
Office Phone t �t I(, - _City ,t tate i_-Zip
State Certification/Registration# --Job Site Contact Nu ber l p -
E-Mail �-�'�Y��-----
Architect Name&Phone q ” Cw'� � �J Zed Oh
Engineer's Name&Phone#
Workers Compensation
Exempt/Insurer/Lease Employees/Expiration Date st
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 re Ila I ong
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.
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 EFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent including Contract r)
S gned and sworn to(or affirmed)before me this. ,tJ'� (Signature of Contractor)
t` dayy of Signed and sworn to(or affirmed) for a this day of
by �C.A �[�1ca� � t� �—
by c 1uf�
(Signature of Notary)
Ignature ary)
S•irt.., KYLE VOS$ A 04
[v]Personally Known _'S *i MyCOMMISS10N#GG 248184 ,� Or Notary Public State of Florida
[ )Produced Identifi ( Personally Known OR +P Nathan S Fiore
EXPIRES:August 13,2{122 [ ]Produced Identification
lm
Type of Identificatio gpr p +�� My Commission GG 929ea7
Type of Identification: 'lar Expires 05/012023