371 3rd St RERF21-0215 REROOF SHINGLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RERF21-0215
800 SEMINOLE ROAD ISSUED: 9/7/2021
1.0'119~ ATLANTIC BEACH, FL 32233 EXPIRES: 3/6/2022
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: 3 DESCRIPTION: VALUE OF WORK:
371 3RD ST REROOF SHINGLE SHINGLE ROOF ON PORCH $1600.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: I GROUP:
169823 9000 ATLANTIC BEACH
COMPANY: _ ADDRESS: CITY: STATE: t ZIP:
HAMMER TIME ROOFING 14286 Beach Blvd JACKSONVILLE FL 32250
OWNER: ADDRESS: j CITY: STATE: ZIP:
EILERS ELIZABETH A 371 3RD ST ATLANTIC BEACH FL 32233-5231
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT I(`
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.
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 $60.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$64.00
Issued Date:9/7/2021 1 of 1
�� BuildingMa les o at- va�2
iiiik Permit Application I�cat�on Updated 10/9/18
;''';'y —1111111s:? City of Atlantic Beach Building Department
ily
**ALL INFORMATION
x.119,' 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Buildin[5-Deptffcoab.uc IS REQUIRED.
Job Address: ?j1 I �(d J77e� V �T Permit Number: �1` 2 r- £)
Legal Description 5--69 /6-a5-.11'E 0.tg9 /4-4-bol c &G c� 4,/3 7.r a/a
- 5 RE#
Valuation of Work(Replacement Cost)$ /, LO u. az" Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New L'ddition EAlteration ❑Repair ElMove ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ENo
• Will tree(s) be removed in association with proposed proiect? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed:
54:1‘5(e(e tiAdJi•itrO 'ef0 SG f-->�-
Florida Product Approval# Opf)41- g a$ VA' 5101R-3 for multiple products use product approval form
Property Owner Information
Name Cli2gl,G(i, Edei5 Address 37f eStcl stfe --F
City /4.4(c„1.};r I.5e.cwh - State tCY Zip 3'2 33 Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Rarnn.cl I;;•,•.e 120014:1"-S 41.--4 Qualifying Agent �iil k,..,4/ 0,. (tenc.au-cf
Address 110-%(.4cwh 41.4 )4. f -' ó(. City 3 iJ 5bA.,L Ile State r L Zip 3).) S?�
Office Phone ( dIoc•4 ) '7 L(,— 7t1-4 Oi Job Site Contact Number San-p
State Certification/Registration# Ccc I 'Se gS3 E-Mail 114,-)14-6._4., r<,.-J._V ra',/� L 4 /,(0.-&--1
Architect Name&Phone#
Engineer's Name& Phone#
Workers Compensation Insurer r3,,/j i-h.((6 6Ecc L� OR Exempt❑ Expiration Date &•2
2,2
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 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 OBT FINANC , CONSULT WITH YOUR LENDE ' $ • AN A •RNEY BEFORE
REC e •DI:, • 7. 47•TICE OF COMMENCEMENT. /
(Signatur ner or Agent) —, - (Signature of Contractor
ned a d sworn to(or affirm d)pefore me this V day-of S' ed and sworn to(or a 'rmed) before me thi i day of
/ `
i 4 by '��`I h,(I' �i , i./�. b i.Lui/�'/I IA _
l ,. - MY' - - -- - -- - .14 /. � ��. i . /
:�Yf ; {Y CARMEN E PEE T �;r P< CARM N E PEET
J'....•::',...:, IY COML.IS,.IO,'' ._ . ;'2 ' MY COMMISSION#GG 956962
]Personally Known OR :•;•1—Aw EXPIRE::!. . rsonall Known OR
-i:-....-4,0...,,,.., EXPIRES:June 1C,2024
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[ ]Produced Identification `'EPF;• B:,nded Thv Now•,i-_.: .- , 'F�� °' Bonded Tiro Notary Pt,Vic Underwriters
�J oduced Identification
Type of Identification: "~ Type of Identification: