443 Osprey Key RERF20-0040 Shingle REROOF SHINGLE PERMIT PERMIT NUMBER
*41014,
CITY OF ATLANTIC BEACH RERF20-0040
800 SEMINOLE ROAD ISSUED: 2/28/2020
x v ATLANTIC BEACH. FL 32233 EXPIRES: 8/26/2020
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:
443 OSPREY KEY REROOF SHINGLE SHINGLE ROOF $2500.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172027 5086 SELVA LAKES
COMPANY: ADDRESS: CITY: STATE: ZIP:
A & 0 Builders LLC 7384 Hawks Cliff Drive W Jacksonville Fl 32222
OWNER: ADDRESS: CITY: STATE: ZIP:
KERSEY RONALD L 443 OSPREY KEY ATLANTIC BEACH FL 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.
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 $65.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.60
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.40
WORK WITHOUT PERMIT 455-0000-322-1000 0 $175.00
TOTAL:$246.00
Issued Date:2/28/2020 1 of 2
"'''`'r REROOF SHINGLE PERMIT PERMIT NUMBER
J� p?' CITY OF ATLANTIC BEACH RERF20-0040
800 SEMINOLE ROAD
ISSUED: 2/28/2020
''v0;i}'r ATLANTIC BEACH. FL 32233 EXPIRES: 8/26/2020
Issued Date: 2/28/2020 2 of 2
,_
el-A,,p, Building Permit Application Updated 10/9/18+rt'1
City of Atlantic Beach Building Department **ALL INFORMATION
,_, r, V 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN CRAY
��:�� IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: `� O7 C y k Permit Number: �'\ 4- -C C.A-"(1 O
Legal Description t l r ,J EI.._V R L P KE Lo+ 4z._ RE# I-7 Z(2.;2_,7 — 0((-)..,�>
Valuation of Work(Replacement Cost)$ 25e10 Heated/Cooled SF Me` "f Non-Heated/Cooled
• Class of Work: ONew Addition ❑Alteration epaiir ❑ ve ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑CommercialRB esidential
• If an existing structure,is a fire sprinkler system installed?: EYes Bk‘
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) 1Cd1�o
Describe in detail the type of work to be perfor ed: )
Leak 1 n j reel re/Ya C. t'e/. i^\1 A.c")- (--d c- -
Florida Product Approval# FL..-.iielzy 612 Zr I j e) +it Eijfor multiple products use product approval form
Pro ert Owner Information
Name _et-F -(-se j Address 4/V3 a.5/Vt /`e Li
City e 4--t. C State Z Zip 32 •3 3 Phone 90 -S
/ AS 3
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information ,fp� �p J (,Q
Name of C mpany 11.- )Q f_? �.S Qualifying Agent Z/C r4 L /�A ` i\1 f 1
Address f ?S HtJL'kJ LA1rp 19 vi City J4 State ft Zip 32'Z22
Office Phone ( o 4 ) 3 8? • F,..6 L Job Site Contact NumberbState Certification/Registration# . 2 7c2 >�-S,5 E-Mail A C ttt20944' ee,_„1rk_46((Q 's IJ L'HA1 L. CF tuf
Architect Name&Phone# •J j f{
Engineer's Name&Phone# ' NM
Workers Compensation Insurer OR Exempt V Expiration Date_______:_2_02_2122,/
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 th,,t 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
RECO'DI YOUR NOTICE
/ Of COMMENCEMENT. tkiriAstikSignat�of Owner or Agent) (Signal re of C tractor)
Signed and sworn to(or affirmed)before me this `"'I day of Si ned and sworn to(or affirmed)before me this day of
, 220_ , by C(th4 J . t r in- y am,by ; �f,1 1j�
He eras—Loon
x` "0.4. State of Florida (Signature of Notary) ;:N•'ASjg,Kf1)1MB13Mw1QgwARTH
My Commission Expires 02/0112021 •, Commission#GG 291049
Commission No.GG 68713 -•• r;` Expires January 14,2023
"*.f.........;°; Bonded Nu Troy Fain Insurance 800-3857019
[ ]Personally Known OR [ ]Personally Known OR _
No6oduced Identification ['vf Produced Identification__� ``1D L^r.
Type of Identification: f lDI'I G(C1 O(I�(P(S L1 Gen}� Type of Identification: _
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