65 W 5th St Units 65, 67 Destructive Roofing In ProDestructive Roofing In Progress Application
City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: _(.Q5 ancf (o-+ 03. C3 On Str-ex_� A7HnnH n f�eacA & 32233
Permit Number: - i tir GLI= �.i -C)132
ROOFING IN PROGRESS INSPECTIONS
Updated 01/13/2020
"ALL INFORMATION
HIGHLIGHTED IN GRAY
IS REQUIRED.
A roofing in progress inspection is a required inspection per the Florida Building Code -Existing Building (FBC-
EB). The purpose of the inspection is to confirm any required deck nailing has been completed and proper
installation of a secondary water barrier as required by Rule 9B-0475. This required inspection was not
requested by the contractor prior to completing the shingle installation for the above referenced permit,
and now a Destructive Roofing In Progress inspection must be performed by removing certain portions of
shingles and/or underlayment to insure compliance with state law. Not complying with this requirement
,-could affect your insurance coverage for storm damage.
_ OWNER AFFIRMATION
1 understand that the contractor, for the reason listed below, was unable to acquire a PASSED roofing in
progress inspection. I also understand the destructive roofing in progress inspection will require the
contractor to remove and replace shingles and/or underlayment as required by the City of Atlantic Beach
Building Department to verify work is in compliance with all state and local codes.
l
(Signature of Owner or Agent)
Si ned and sworn to qr affirmed) before me this cr 1- day of
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ignaturl of Notary)
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[]tj Personally Known OR Notary Public
f ) Produced Identification $tale of Floiflda
Type of Identification: ri
_ - CvmrnN HH059538
Expires IN2024
_ CONTRACTOR AFFIRMATION
COMPANY:_ i du—Ts �►'t l' Uo' C ti ` -- _ — - - -
ADDRESS OF PROJECT: LD6 and (D:+ s�t malf c, aA Fc
REQ -EST&D BY:-=e/tai ll✓lA/b!%Z1Z4,J - CCGJ3?�a----
REASON FOR REQUEST:�✓ln�t't�IJA-o�`T£� Z�L✓a( %ian�t,iacrtivcf-R;r.r„ P�zxFc�-/a1JlL
v-lrUJ A�,9 �}/ijl�,I/'.�.Lt� D�.�i-� %✓• �t0�17.d%llnldL 1/l✓C: /!J �f . Ln1N�Ul✓/37/�
I, si/r r�inQ /yiuoAJ understand City of Atlantic Beach Building Department procedures as
outlined in Bulletin ???. I also understand the destructive roofing in progress inspection is not part of those
procedures and is an exception to the procedure. In addition, I understand that any non -code compliant
work identified during this inspep. on may result in the assessment of additional re -inspection fees.
Signed: _ _ Date: �_ YrZOZ/ _
AN APPROVED COPY ar7HIS APPLICATION MUST BE ON SITE AT TIME OF DESTRUCTIVE ROOFING IN PROGRESS INSPECTION.