10 10TH ST #65 RES17-0070 door permit Yt1
? CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL -ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0070
Description: replace sliding-glass door
Estimated Value: 0
Issue Date: 6/30/2017 '..
Expiration Date: 12/27/2017
PROPERTY ADDRESS:
Address: 10 10TH ST 65
RE Number: 170237 0142
PROPERTY OWNER:
Name: CAMPBELL HUGH D
Address: 1622 ROYAL OAK RD
DARIEN, IL 60561
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: RIVER CITY CONTRACTING LLC
Address: 44368 WOODLAND CIR CIA WILLIAM RUSSELL ELWOOD III
CALLAHAN, FL 32011
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.
* 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.
City of Atlantic Beach APPLICATION NUMBER
\. Building Department �(To be assigned by the Building Department.)
800 Seminole Road QI^T't� _'b
Atlantic Beach,Florida 32233-5445
Phone(904)247-5828 Fax(904)247-5845 Date routed: D�I I ✓I-t
1
E-mail: buildingdept(dcoab.us
-- Cityweb-site'. hftp:INv coab.us
APPLICATION REVIEWAND TRACKING FORM
. ��q(`� De rtmeM review required Yes No
Property Address: O 10 Building
Applicant: �t� � Cit j cboyuc, % Plannng&Zoning
1�n 1J 1 _'�-`/ Tree Administrator
�C
Project: � n3`V`II S,t QtlnG1� �Il k.� Public Works
Public Utilities
Public Safety
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verged 8
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
SL Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
t7lher:
APPLICATION STATUS
Reviewing Department First Review: IE4pprovedl. ❑Denied. . ❑Not applicable
(Circle one.) Comments:
UILDING
PLANNING&ZONING Reviewed by: al Date: 6
TREE ADMIN. Second Review: ❑Approved as revised. []Dem6/. [--]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. . ❑Not applicable
Comments:
Reviewed by: Date:
Revketl 05/1811017
OFFICE COPY1
Building Permit Application rJN 1 9 2011
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233 ..
Phone:(904)247-5826 Fax:(904)247-5845
Job Address: 10 104h S+ 411oF ; Aklarib r &aj:6, FL 372Permit Number: e�S I�--00-tD
Legal Descrlptionll -0P-79FTh flied/ r d E# 110247—h Iq2
Valuation of Work(Replacement Cost)511 600 00 Nested/Cooled SF 1.91en Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Poolindow oor
• Use of existing/proposed structure(s)(Grcle one): Commercial 1esidential
• If an existing structure,is afire sprinkler system installed?(Circle one): Yes 1,106D
• Submit a Tree Removal Permit Application H any trees are ttoi be removed or Affidavit of No Tree Removal
Describelndetailthetyeeolworktobeperformed: Insfalla110n o' PGT to Panel SI'IdinQ lass
Door on Second -Floor J
FloridaAcpr—II formuniple productsuse product approval form
Property Owner Info
Name: Address:
city Stated Zips Phone
E-Mail
Owner or Agent(IF Agent,Power of Attorney or Agency Letter Required) NWner
tractor rmation I / I 1\
Name of Copp t"f��TyLb.'rrnKsFwt � Qualifying
Agent:LJ`
Address rnf IZ QYw'e.� }T C— city Sol L ZIP3�-Z'IB
Office Phone PID ' 61L6- 12#1 Job SRe/Contact Nu�rlbar 90 '626
State Certification/Registration# E-Mal bel eod Ill
Architect Name&Phone# 14
Engineees Name&Phone# N'
Workers Compensation
Fula i/Imam/le eFmpigees/EapVa[fon Date
Application is hereby made to obtain a permit to do t e work and installations as indicated.l 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.
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 BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature of ar Agentinluding co in actor IsilNaure icon actor)
Signed and sworn to(or affirmed)before me tby of ii ed and sw'�a5����W����pKrm )b re n e th'. day of
March 2J-by (2bzLl_ �(7A iP_ 1 /"bY
• KflYSTAI KSALN 'G'"+s.. TONI GI PERG
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Type of Identification: L L - Typeof ldentihradon: J Y- �L
OFFICE COPY
A� CERTIFICATE OF LIABILITY INSURANCE 8/2912016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATWELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poliry(Ies)..at be endorsed. N SUBROGATION IS WAIVED,subject to
Me terms and conditions of the Policy,certain policies may require an endomamerd. A statement on Nis ceWllkale does not conhr ri9hb to Ula
cartKcale hostler in lieu of such endomemen s.
oxra T P n
PROWLER x
All Lines Insurance Agency,Inc. ONE 904-384-0783 FANNee gDd�B/-0530
4826 Blanding Blvd Suite 1 Erin Lis mlogan@alHines.com
JacksanNlle FL 32210.7390
Ixsu a AFIgmf10cW91ATE xAle•
plant.A'Southern-0elers Insurance Co 10190
INSURED INTEL-3 IxsuREN a:flamers Insurama Company 32700
Integrity Roofing Systems,Inc dba Pointer e:
Benton Integra Roofing Systems IxswERo:
5570 Flodda Mining BNd#310
Jacksonville FL 32257 IMMME0.E: - -
IxsUREaF:
COVERAGES CERTIFICATE NUMBER:15%741631 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWRHSTAHDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WINCH THIS
CERTFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERON IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IIIIRPOIILY Ri Pg ED Hese
L TYPEeFMBRNICE INS Pa11LY x1aBER
A X DgBFAPLLegrgML lyMgry mra0590 &tYNt6 WI3R017 EwCHOCCUWEIICE 51,000,000
o F a.000
LWLLiX/,CE OOCCUR PREMISE
MEDEW RRpRFxI 1110,300
PEReg4Kal➢YSMImY 11.000.000
GENLAWREt xlElYr/i1LE8Pgt GENEPALAamsem 112.000.030
Pouc,❑PaaCT LOB Paotualm-WIiaPACA (2.000.000
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OTHER
B Am0110aaElJxexlrY 6eN691230D W28rX116 9'23(2017 Fa aN4en1 51,030.300
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CERTIFICATE HOLDER CANCELLATION
SNWLO ANY OF TXE ABOVE DESCRIBED PoLWIEB BE LANOELLED 9EFORE
City Of Atlantic Beach WE EJIPIRATION DATE THEREOF. NOME WILL BE DELIVERED IN
Budding Dimment ACCORDANCE WITH THE POLICY PROVISIONS.
800 Seminole Rd
Atlantic Beach FL 322335446 atmKmED REPRESENrATNE `
C 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are regiater id marks of ACORD
-- STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
2601 BLAIR STONE ROAD
TALLAHASSEE FL 32399-0783
OFFICE COPY
ALBRITTON,JOHN FRANKLIN IV
BENTON INTEGRITY ROOFING 8 WINDOWS
5570 FLORIDA MINING BLVD S STE 310
JACKSONVILLE FL 32257
Congratulations! With this license you become one of me nearly
one million Floridians licensed by the Department of Business and STATE OF FLORIDA
Professional Regulation. Our professionals and businesses range
from architects to yacht brokers,from boxers to barbegue DEPARTMENT OF BUSINESS AND
restaurants,and they keep Florida's economy strong. PROFESSIONAL REGULATION
Every day we work to improve the way we do business in order CRC1331062 ISSUED: 08/1412016
to serve you better For information about our services,please
It onto vmw.myfloddallcenae.eom. There you Can find more CERTIFIED RESIDENTIAL CONTRACTOR
information about our divisions and the regulations that impact ALBRITTON,JOHN FRANKLIN IV
you,subscribe to department newsletters and learn more about BENTON INTEGRITY ROOFINq,$WINDOWS
the Department's initiatives.
Our mission at the Department is:License Efficiently, Regulate
Fairly.We constantly strive to serve you better so that you can IS CERTIFIED under the provlsipne a f CR 489 FS
Serve your customers. Thank you for doing business in Florida, .
e.wn�ae. wss ame usam.mwe.o
and congratulations on your new license!
DETACH HERE
RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD ;EN00 '
CRC1331062
The RESIDENTIAL CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31,2018
o a
ALBRITTON, JOHN FRANKLIN IV
BENTON INTEGRITY ROOFING 8 WINDOWS
5570 FLORIDA MINING BLVD.S STE 310
JACKSONVILLE FL 32257
ISSUED: D&14r2016 DISPLAY AS REQUIRED BY LAW SEOt 11608140004240
OFFICE COPY
Doc d 2017137092,. OR RIC 18014 Page 2371, Number Pagee: 1, Recorded
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