780 Triton Rd RERF20-0091 Permit PacketOWNER:ADDRESS:CITY:STATE:ZIP:
LYLE NELLY ET AL 780 CAMELIA ST ATLANTIC BEACH FL 32233-2522
COMPANY:ADDRESS:CITY:STATE:ZIP:
FIRST COAST HOMES LLC 1719 10TH STREET NORTH JACKSONVILLE
BEACH FL 32250
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
170933 0000 ATLANTIC BEACH SEC H
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
780 CAMELIA ST REROOF SHINGLE SHINGLE ROOF $7700.00
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
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
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.
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.
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.
1 of 2Issued Date: 10/1/2020
PERMIT NUMBER
RERF20-0091
ISSUED: 10/1/2020
EXPIRES: 3/30/2021
REROOF SHINGLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 10/1/2020
PERMIT NUMBER
RERF20-0091
ISSUED: 10/1/2020
EXPIRES: 3/30/2021
REROOF SHINGLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $94.00
RERF20-0091 Address: 780 CAMELIA ST APN: 170933 0000 $94.00
BUILDING $90.00
BUILDING PERMIT 455-0000-322-1000 0 $90.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R13586 $94.00
Printed: Thursday, October 1, 2020 10:13 AM
Date Paid: Thursday, October 01, 2020
Paid By: FIRST COAST HOMES LLC
Pay Method: CREDIT CARD 382901667
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R13586
Building Permit Application
City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904} 247-5845 Email: Building-Dept@coab.us
Updated 10/9/18
**ALL INFORMATION
HIGHLIGHTED IN GRAY
IS REQUIRED.
Job Address: '780 GCLM el .'g 5-J-tee.'t-Permit Number: __________ _
Legal Description )?-31/ ?R:-1 S -)9 £ .). 3 $EC )I Aflc,.1'/2c &�.-c4 L,..,fs,.p; i&/i<IL!{f_# J 7093' 5,,. occO
Valuation of Work (Replacement Cost)$7,700.00______ Heated/Cooled SF ____ Non- Heated/Cooled ____ _
•Class of Work: �ew □Addition □Alteration □Repair □Move □Demo □Pool □Window/Door
•Use of existing/proposed structure(s): □Commercial )(Residential•If an existing structure, is a fire sprinkler system installed?: □Yes □No oN/ A•Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describeindetailthe typeof workto be perforrned: /) J/J I L I LL ,,, 1 '/le.le/ (l-<EY"lOUC ;tr::eria.ce. a�ph c._{""["" 7h 1 1 J ;;,
Florida Product Approval # __ ';2e_e_·=_Q.f!J'2.�C1la ( s 1-ier:-t
Property Owner Information
for multiple products use product approval form
Name tve ( lv L vie---·-···-·--. ·-·-···· ___ Address�{)_J(....,a=:1.L:,,ri:...'..!::e::...,l_,_1 a,,:::,.1 --==s-'+:_,,_-s·-=t;'-=C-'T-+--,-----.,.,-;-.,.,_,..,.---7' 1 Phone yC-f ·-L/ }tf -76) Y City _iL .. fJ.?2i.!1...'}L �---f?s e_0"{:,f:::! ·-----·--·· -·-· .S1:at2 __ EJ_ ___ Zip .3 r). 2_? '3E-Mail ___________ _ -Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) ___________________ _
Contractor Information
Name of Company F/,5 t Cac:i. s--f /-f or1 es:J--l�C-Qual�ing Agent . Uou5h:s C, Dae,, c.['-t;
Address_J_ � I q JO+,-, s-h-c.c,..+ /1.Jo;�'ti.-,_City .JC!s.K [Sc.J.-, State FL Zi p 3 )_J. S-o
Office Phone 9: OL/-S-C 9 -J.. S-I If _ Job Site Contact Number 9cL/-SB '? -
�
'/ 9?
State Certification/Registration# CCC / 3 3 / 5' �C ···-F.-Mail c,ed/..o et�--'-I u-f @ CLO f, Co M
Architect Name & Phone# _,/'J,c...c. ,<-,½,-.<.'A�-------------------------------Engineer's Name & Phone# N/A
Workers Compensation Insurer I OR Exemp�¼' Expiration Date S -) if --')...o�.J__ ·
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 add ition 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 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 ATTOR NEY BEFORE
:J� . �t: .. RECORDING�OTICE OF COMMENCEMENT. �� �
(Signature of Owner or Agent) �ture of Contractor)
Signed and sworn to (or affirmed) before me this -1.."b day of r1:,..v )oJ o , bv. M If.. 7
Signed and sworn to (or affirmed) before me this /;;;_day of
1'1a.,1 20).,0 I b 7
�• •� Commission # GG 178343
,,���V'J}, ( igAtttf\'ISO NoOOE RR
��0tit-'� State of Florida-Notary Public
-,,_?.'I' 0�,;,:� My Commission Expires [X' Personally Known R'',,m,','i,1'' January 24, 2022 [ ] Produced ldentifi Type of Identification: _____________ _
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7
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7
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1
8