202 Pine St ROOF19-0093 TPO Roof . r,,,,, ROOF NON SHINGLE PERMIT PERMIT NUMBER
it CITY OF ATLANTIC BEACH ROOF19-0093
V 800 SEMINOLE ROAD ISSUED: 12/13/2019
°1;"~ ATLANTIC BEACH. FL 32233 EXPIRES: 6/10/2020
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:
202 PINE ST ROOF NON SHINGLE TPO ROOF $2300.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170558 0000 SALTAIR SEC 03
COMPANY: ADDRESS: CITY: STATE: ZIP:
ROMANO BROTHERS
ROOFING, INC 155 E. Levy Road Atlantic Beach FL 32233
OWNER: ADDRESS: CITY: STATE: ZIP:
OBANION JACQUALINE K 202 PINE ST ATLANTIC BEACH FL 32233-4014
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.
s...
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000 322-1000 0 $65.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $32.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $101.50
Issued Date: 12/13/2019 1 of 2
ROOF NON SHINGLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH ROOF19-0093
800 SEMINOLE ROAD
ISSUED: 12/13/2019
°rsl)' ATLANTIC BEACH. FL 32233 EXPIRES: 6/10/2020
Issued Date: 12/13/2019 2 of 2
% _�',,, Building Permit Application Updated 10/9/18
J :?.
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
e1 Phone: (904)247-5826 Fax: (904)247-5845 Email: Building-Dept@coab.us IS REQUIRED.
LL l'o� I
Job Address: frr^e T Permit Number: a9 3
Legal Description /0 "/t'o A '"o?S-a9F Sad/44f SPc 3 /c./ So25— RE# iyo..5s8 -Oov0
Valuation of Work(Replacement Cost)$ SIC-- Heated/Cooled SF 0 Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo OPool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ✓iResidential
• If an existing structure,is a fire sprinkler system installed?: ✓❑YeNo
• Will tree(s)be removed in association with proposed project?LJYes(must submit separate Tree Removal Permit) INo
Describe in detail the type of work to be performed: Sm.n .90 ('c...e o✓e l /ocrch
Florida Product Approval# 5-gin e for multiple products use product approval form
Property Owner Information
Name 7 ie Q 'rj 4J I u i �J Address :D. ve
Fie 1•k_ S )--, -7
City / ,r C'• - State if-l-, /Zip 34a.3..1) Phone 90'4-ys Ci? • 5d L
E-Mail 1.LF�' 0(-6 ) 1 lei Cr.Mill / . Cv^I
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) n/a
Contractor Information
Romano Brother Roofing Inc. Daniel Romano
Name of Company Qualifying Agent
Address 155 E Levy Hd. City Atlantic Beach State FL Zip 32233
Office Phone (90�j246 569 Job Site Contact Number
State Certification/Registration# CU:1328893 E-Mail romanobrothersrooting(cc.gmail.com
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer WBS WC 90-00-818-06 OR Exempt❑ Expiration Date Exp. 12/311
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
a•p cable laws regulating construction and zoning.
2 3 m W RNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
om`°R*-ULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
N to 6, n
in H 8TO OBTAIN FINANCING, CONSULT WITH YOUR LEND AN ATTORNEY BEFORE a
E/ORDING YOUR N• ICE OF COMMENCEMENT. s 0N
o o a _
z z'w • Signature of Owner or Agent) (Signature of Contractor) H. o
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it•. • •ned nd sworn to(or affirmed)before me this I day of Sigag and sworn to(or affirm,•)before m-this 13 day of $z a
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iij .J •.Mbe. 20/9 ,by."UC G a. *A r ��ei,by a .. .a
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_ 4111'111.1.7-n-a ture of Not, ) :
[ ]Personally Known OR personally Known OR
(,. Produced Identificationf \ [ ]Produced Identification
Type of Identification: di) Type of Identification: