770 Amberjack Ln ROOF20-0068 Shingle, Mod RoofOWNER:ADDRESS:CITY:STATE:ZIP:
SELF LEWIE F 770 AMBERJACK LN ATLANTIC BEACH FL 32233-4205
COMPANY:ADDRESS:CITY:STATE:ZIP:
Triton Roofing &
Restoration LLC 480 State Rd 13 Ste 106-348 St Johns FL 32259
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171131 0000 ROYAL PALMS UNIT 01
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
770 AMBERJACK LN ROOF NON SHINGLE SHINGLE AND MOD. BIT
ROOF $12000.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $115.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $57.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.59
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $177.09
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: 11/18/2020
PERMIT NUMBER
ROOF20-0068
ISSUED: 11/18/2020
EXPIRES: 5/17/2021
ROOF NON SHINGLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 11/18/2020
PERMIT NUMBER
ROOF20-0068
ISSUED: 11/18/2020
EXPIRES: 5/17/2021
ROOF NON SHINGLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $177.09
ROOF20-0068 Address: 770 AMBERJACK LN APN: 171131 0000 $177.09
BUILDING $115.00
BUILDING PERMIT 455-0000-322-1000 0 $115.00
BUILDING PLAN REVIEW $57.50
BUILDING PLAN CHECK 455-0000-322-1001 0 $57.50
STATE SURCHARGES $4.59
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.59
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R14145 $177.09
Printed: Wednesday, November 18, 2020 4:12 PM
Date Paid: Wednesday, November 18, 2020
Paid By: Triton Roofing & Restoration LLC
Pay Method: CREDIT CARD 396293668
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R14145
~+; CENTRALSQUARE
ROOF20-0068
I
Building Permit Application
: City of Atlantic Beach Building Departme nt
.. ,-~ 800 Seminol e Road, Atlanti c Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Updated 10/9/18
**ALL INFORMATION
HIGHLIGHTED IN GRAY
IS REQUIRED.
Job Address: 7 '/ 0 O®YK [aN Permit Number: _________ _
Legal Description 3o-ht) l~-"28-ci9 £ /(o~()f fkrhr,4 (iJUt :t RE# Ir-JI 1al-OO()Q
Va luation of Work (Replacement Cost)$ J{1 1 00 0 Heated/Cooled SF Cf'? 5' Non-Heated/Cooled / /LfL/
• Class of Work: □New □Additio n !&Alteration □Repair □Move □Demo □Pool □Window/Door
• Use of existing/proposed structure(s): □Commercial l}s!Residential
• If an existing structure, is a fire sprinkler system installed?: □Yes Ga No
• Wi I tree ect? D Y s must submits val Permit No
Describe in detail the type of work to be performed: _ ,1 oc!.t h<."cf -re vooF sh i Y19 w tu s h, 1'9 Le OJl'Ju;t smdf m c S!Jct, JYJ
Florida Product Approval # FU 6 I ).I,/ I '12-~7 -sh, !'ff?6 fl,· R5.33 mV:.i 6r multiple products use product approval form
Property Owner Information
Name /,f,W~e If
city [U.£ c;;,,JJc, &cun
E-Mail _______________________________________ _
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) __________________ _
Contractor Information
Name of Company~~LJ.f-',':1-,+~'J:,,L,/--><l-:::,,+F.;;::..=::..:....::....-=...:.;n c..:o_,n..,;.,.::u ;:..c.::..Qualifying Agent_ Ro bert-12. l~I J
Address D 6 te I · City :st To hn.:!> State r-L Zip 92-2-s-c_>
Office Phone Ci · (p l ' 'SU~ Job Site Contact Number~--,,,,---....,,...,,-,-:,...,.,-,,..--.....,...,---,,.----
State Certification/Registration# CCC 183054-Cj E-Mail (Y);<.5'71 ~ -fr; fDrygCKSCY/1.JI /l e C..O]?J
Architect Name & Phone# _________________________________ _
Engineer's Name & Phone# .
Workers Compensation Insurer H7'.2 n k.CVLU11 W C-8..0f).CJCCOCO OR Exempt o Expiration Date O!IO l/2/
'1 ' Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or i nsta llation 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, t here may be additional restrictions applica ble to this property that may be fou nd 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.
:'),.t,il;';;::,·~~ I 1\3/lflll,1 ~ ry
i~ :·E MY COMM~# GG09 96
\ .~, ,, ' EXPIRES April 10, 20 1
[ ] Persona ly Known OR
~ Produced Identification
Type of Identification: _f~L-"'-1-J Du.-_________ _
tf'~':: ~ ~-,®( EXPIRES '10, 2021
r,-~ ~ersonall KndWli OR
[ ] Produced I enti icat1on
Type of Identification: _____________ _
ROOF20-0068
Doc# 2020248874, OR BK 19444 Page 2145, Number Pages: 1,
Recorded 11/08/2020 07:12 AM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10 .00
NOTICE OF COMMENCEMENT
PermltNo. • ,
state of r wr , cra
To wbom It may OOF1cern:
(PREPARE IN DUPUc.\TE)
Tax Folio No /'7 / 13/--000 ()
County of . {]C,CvcL/
'
The undersigned hereby Informs you Ul_at Improvements will be made to certain real propeny, anc1 ln
aecordance with Sectloo 713 of th.e Florida statutes, the following information Is stated In tills NOTICE OF
COMMENCEMENT,
Legal~on ofprope_i_fy being !ml)l'O\'.ecl: .,?'.)~O /'! -JiS-2 . .cJ £
J<C"fll /?Llms {UU f L /,of 7 PJM
OWner's Interest in site of the !mprovem_,·,._....pc.:....:.;.__..::.;;;;,'-?",l--'-"'!-...._.=--"'--4..=..:a==----------
Fee SlmpleTrtleho!der(ifo!herthan OWl'ler} ___________________ _
Name _____________________________ _
Address=...,....,---....,,..._..,...,__-,....,..,_--:--=----:----:cc:---,---:::---------
Conwctor..J...4-~:f---1~~~~*~~"'2~"'-'-::~~~-:;t;;-'"':::::-~:--"":"-:r--:;--~=rr=;"!l;"-
Address_~~~~:;:::!-:,1':;!~-;::-t.::......;;.;&..l'l..,__-=."-""--...:::.."--'""-"':;.:...:c..;....a-=....-__,;::c---".;;;;....:;--
Phon1, No. _____ -=--=-....._ ......... .;__ __ ,-__
SUFety(lfaey) ___________________________ _
Address _________________ Amountofbond $'--------
Phone N-o. ____________ Fex No . .,..._ ____________ _
Name and address of any pe!'SOn ITillkirig a loan for the construction of the Improvements. Name _____________________________ _
Addrass ____________________________ _
Phone No. ____________ Fax No. _____________ _
Nama of per.son Within the State of Florida, other than himself. designated by O'MW" upon whom notices or other
documents may be served: Name _____________________________ _
Address ____________________________ _
PhoneNo. ____________ FaxNo •. _____________ _
!n addttlOn io himself, owner designates the following person to recelve a copy of the Ueno!'$ Notice as provided In
Section 713.06(2) (b), Florlda Statutes. (Fill In at owner's option). Name _____________________________ _
Address ____________________________ _
PhoneNo. ___________ FaxNo. ______________ _
Expiration date of Notice of Commencement (the expfratlon date Is one {1) year from the date of recording unless e
different date isspeclfled): ----------:::-----------------
THIS SPACE FOR RECORDER'S use ONLY ' ~ . ;;J---~it , .
Sign~ ~ • . , •• tJe-Tc ll<{r9.D
seroreme~dayl>f ~191TI(,, In
County of Dtl\lal. state OfFlol1cla, flu~ appeared by
l>Jmaelfl ~ lhot"'MI08'f'ff'~ONl!9-
are true • ~ MY COMMIS&ON # GG09259&
ff. • E~IAES Ap,110, 2021
V
BCIS Home Log In User Registration Hot Topics Submit Surcharge Stats & Facts Publications Contact Us BCIS Site Map Links Search
Product Approval
USER: Public User
Product Approval Menu > Product or Application Search > Application List > Application Detail
FL #FL2533-R23
Application Type Revision
Code Version 2017
Application Status Approved
Comments
Archived
Product Manufacturer CertainTeed, LLC (Roofing)
Address/Phone/Email 20 Moores Road
Malvern, PA 19355
(610) 893-5400
mark.d.harner@saint-gobain.com
Authorized Signature Mark Harner
mark.d.harner@saint-gobain.com
Technical Representative Mark D. Harner
Address/Phone/Email 18 Moores Road
Malvern, PA 19355
(610) 651-5847
Mark.D.Harner@saint-gobain.com
Quality Assurance Representative
Address/Phone/Email
Category Roofing
Subcategory Modified Bitumen Roof System
Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida
Professional Engineer
Evaluation Report - Hardcopy Received
Florida Engineer or Architect Name who developed the
Evaluation Report
Robert Nieminen
Florida License PE-59166
Quality Assurance Entity UL LLC
Quality Assurance Contract Expiration Date 11/13/2022
Validated By John W. Knezevich, PE
Validation Checklist - Hardcopy Received
Certificate of Independence FL2533_R23_COI_2019_01_COI_NIEMINEN.pdf
Referenced Standard and Year (of Standard)Standard Year
ASTM D6162 2008
ASTM D6163 2008
ASTM D6164 2011
ASTM D6222 2011
ASTM D6509 2009
FM 4470 2012
FM 4474 2011
Equivalence of Product Standards
Certified By
ROOF20-0068
D
D
Sections from the Code
Product Approval Method Method 1 Option D
Date Submitted 06/20/2019
Date Validated 06/20/2019
Date Pending FBC Approval 06/22/2019
Date Approved 08/13/2019
Date Revised 07/30/2020
Summary of Products
FL #Model, Number or Name Description
2533.1 Flintlastic Modified Bitumen
Roof Systems
Modified Bitumen Roof Systems
Limits of Use
Approved for use in HVHZ: No
Approved for use outside HVHZ: Yes
Impact Resistant: N/A
Design Pressure: +N/A/-635
Other: 1.) Refer to ER Section 5 for Limits of Use.
2.) The design pressure noted in this application
relates to one specific system. Refer to the ER
Appendix for all systems and max design pressures.
Installation Instructions
FL2533_R23_II_2019_06_FINAL_A1_ER_CERTAINTEED_MODBIT_FL2533-
R23.pdf
Verified By: Robert Nieminen, PE PE-59166
Created by Independent Third Party: Yes
Evaluation Reports
FL2533_R23_AE_2019_06_FINAL_ER_CERTAINTEED_MODBIT_FL2533-
R23.pdf
Created by Independent Third Party: Yes
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Contact Us :: 2601 Blair Stone Road, Tallahassee FL 32399 Phone: 850-487-1824
The State of Florida is an AA/EEO employer. Copyright 2007-2013 State of Florida. :: Privacy Statement :: Accessibility Statement :: Refund Statement
Under Florida law, email addresses are public records. If you do not want your e-mail address released in response to a public-records request, do not send electronic
mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact 850.487.1395. *Pursuant to Section 455.275(1),
Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department with an email address if they have one. The emails
provided may be used for official communication with the licensee. However email addresses are public record. If you do not wish to supply a personal address, please
provide the Department with an email address which can be made available to the public. To determine if you are a licensee under Chapter 455, F.S., please click here .
Product Approval Accepts:
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Credit Card
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securit) J\I~ rn.1cs
ROOF20-0068
Revision Request/Correction to Comments
City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
**All INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: _______ _
0 Revision to Issued Permit OR D Corrections to Comments Date: 11/13/2020
Project Address: 770 Amberjack Lane
Contractor/Contact Name: Triton Roofing & Restoration, LLC/Robert Russell
Contact Phone: (904) 330-6037 Email: Ryan@Tritonjacksonville.com -------------
Description of Proposed Revision / Corrections:
additional product approval and installation documents
I_TrilM_· _Roo_fi_ng_&_Res1_0 ra_1ion_.L_LCJR_o1>ert_R_us_se_u ___ affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• Will proposed revision/corrections add additional square footage to original submittal?
0No D Yes (additional s.f. to be added: ____________ )
•~ill proposed revision~~orrec~ions ad~ add'.ti~nal increase in building value to o r igina l submittal?
~No O•ves (add1t1onal increase in b uilding value:$ (Contractor must sign if increase in valuation)
(Office Use Only)
~pproved D Denied D Not Applicable to Department Permit Fee Due S -------
Revision/Plan Review Comments ______________________________ _
Department Review Required:
Building
Planning & Zoning
Tree Administrator
Public Works
Public Utilities
Public Safety
Fire Services
Reviewed By
Date
Updated 10/17 /18
ROOF20-0068
Revision Request/Correction to Comments
City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
**All INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: _______ _
0 Revision to Issued Permit OR D Corrections to Comments Date: 11/13/2020
Project Address: 770 Amberjack Lane
Contractor/Contact Name: Triton Roofing & Restoration, LLC/Robert Russell
Contact Phone: (904) 330-6037 Email: Ryan@Tritonjacksonville.com -------------
Description of Proposed Revision / Corrections:
additional product approval and installation documents
I_TrilM_· _Roo_fi_ng_&_Res1_0 ra_1ion_.L_LCJR_o1>ert_R_us_se_u ___ affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• Will proposed revision/corrections add additional square footage to original submittal?
0No D Yes (additional s.f. to be added: ____________ )
•~ill proposed revision~~orrec~ions ad~ add'.ti~nal increase in building value to o r igina l submittal?
~No O•ves (add1t1onal increase in b uilding value:$ (Contractor must sign if increase in valuation)
(Office Use Only)
~pproved D Denied D Not Applicable to Department Permit Fee Due S -------
Revision/Plan Review Comments ______________________________ _
Department Review Required:
Building
Planning & Zoning
Tree Administrator
Public Works
Public Utilities
Public Safety
Fire Services
Reviewed By
Date
Updated 10/17 /18