1580 Beach Ave RERF19-0125 Shingle rtl.:LJf,', REROOF SHINGLE PERMIT PERMIT NUMBER
r CITY OF ATLANTIC BEACH RERF19-0125
800 SEMINOLE ROAD ISSUED: 9/9/2019
.�^91 ATLANTIC BEACH, FL 32233 EXPIRES: 3/7/2020
MUST CALL INSPECTION • • • 1 BY 4 PM FORiINSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • '
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF APPLY, PLEASE
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:
1580 BEACH AVE REROOF SHINGLE SHINGLE ROOF $31000.00
TYPE OF
• • GROUP:
171875 0000 MANDALAY
COMPANY: ADDRESS:
HAMMER TIME ROOFING 14286 Beach Blvd JACKSONVILLE FL 32250
• ADDRESS:
MARCH DIANE 1580 BEACH AVE ATLANTIC BEACH [ i_ 32233
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.
'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 $210.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.15
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.10
TOTAL: $215.25
Issued Date: 9/9/2019 1 of 1
/ 1.
- Building Permit Application Updored1019118
v City of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: 3uild.ing-Dept@coab.us IS REQUIRED.
Job Address: / S 8 Q ��0 4 �v Permit Number: RLKF Z J
Legal Description/0 a - 5 L �� �. �� /O all< 6 3 RE#_17le 7S -
Valuation of Work(Replacement Cost)$ I i C%o Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial J�sidential
• If an existing structure, is a fire sprinkler system installed?: Dyes _R;,1Go
• Will trees be removed in association with Proposed rooect? ❑Yes must submit separate Tree Removal Permit C�No
Describe in detail the type of work to be performed: 12 e _ R,.,o /
Florida Product Approval# 1067Lf, f 7-7-7 -�e I for multiple products use product approval form
Pro ert Owner Information�`�''^�4 t-
Name i G n L /V(� c Address (t
City ; -,r- . !n%. {'i State in t4 Zip �� G Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company f/ 1 Qualifying Agent j{
r1 6 L-. �1y e:-_r_Q
Address /y,t �G ( y c",., Lf. State F Zi
—---P�-���11-�.1' S� l� � ��'� Cit �. p d
Office Phone ('V) / Job Site Contact Number
State Certification/Registration# CCC_/_3a S Q Y E-Mail
Architect Name& Phone# ��-- C,�
Engineer's Name& Phone#
Workers Compensation Insurer , OR Exempt❑ Expiration Date 2
Application is hereby made to obtain a permit to do the work and ' stallations 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 RECORDOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEME TSTOYOUR P PERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LE . DE OR A Y BEFORE
IN YOU TICE OF OMMENCEMENT.'
ignature of Owner or Agent)
(Signature of Contractor)
Signed and sworn to(or affirmo) before me this Zdlay of ned a sworn to or ffir ed)be e is da of
Q c�
(Sign " re�&N.tary) gn�p
Personally Known OR Personally Known OR :ey'•., TONIGINDL GER
]Produced Identification
i J Produced Identification e. ':.": MYCOMMISSI0N#FF924951
ype of Identification: �- EXPIRES:October 6,2019
Type of Identification: ruNctaryPubacundewnters
X 0 TIT CB OF �QMMBN CBM M.ETA
Fir.--ii i`.°o. Tax Folio Ido 0000
jici8n4 G'-
ccuntti of
To;Vhonl it iTtay Concern:
Till undersigned hereb;r informs you Thai improvements will be made to Certain real property,and in
accordance.viih Section 713 of the Florida Statutes,i'rs f011ovring information is stated in this NOTICE OF
CDi;ii ENCEidi=P1 T. ) �
Laoai dc5ri'uiion or%roLtiB't being improved: /Q`/I
- s c�sz-
i�IK <a
Address of proper;being impi ott�d: {` �`Q CS,- L Avt
PC a a 3
General dascrimicn of improve-me its:
in siva uftila
I idehiclder(if other iilaR vv!r!ei 1
anI_=
Addr es=
"oRr__c:or l20
jw ......raSS 28 S it I S - a s
=hone Pio.(1,041 7l -rl/Y " r=x Ni a.
Surety(if ar i;i
-mount o;bond S
uhona No. Fax No.
Name and address Ofan,v parson mafS:2no a loan fnr iR c ns:ruc-an v: le irnpro:' marts.
Plama
`dd*===
Z1(�xxz0
M O o ctDi a: c0i 01 na !C..
OCZO Z_Z- it
'<m � 1`fama Of 'o% .+..lin i e Staia of Florida.`.. - fi ^!!� n_ __-"'a`..=.d R�: t-
Z Ton. co
pe1 .•d5i n trio'then: `R v'a_i_:. C'anei ucen:�.han roticas ar cfF:,r
G) CCCLinianiS :leY Ge Set:'cd:
dr rn((ON V
m N I+lama
r W
S C7 rD o
r
m� ;U ?Mena Pfo•
XL_� W
N ro x
0 -U 8 in addition to himself'. :•onar dasicnatas`ha rMHO`:!inc person QO receive a Cep:'of the Lienor's Notice=s orovided in
Zon a Seciion 7 i3.06(?i(b),Flcdda Siaiuias_(Pili in az O:-ner's ootior.l.
c
C) to
o fD =.00FSss
c �
X rn ?hong IN 0. No.
0
c _
n =xpira;ion dais Of ldotica of COmr,lancanlant(ha=xeiration data Is one(i)y5ar from the dais of rscording unless a
r di:aranf date iS specified):
THIS SPACE FOF.FcCOr^,DEr.'S US.Oi�lLY tt E?
lu A A
--c.-nu C.,._:2!.:..a.v...-:�ilr3. as personally appear
�rNnrerrna4 =alt a l++-s:.._.Eli s_� leas enc 6e�! raiiDns n
A ere Ml=
' >
`, _
IGmbet C ens
Count v of
MY c"is*A' RM
1 d l_an(litca_::