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1021 Atlantic Blvd ROOF19-0072 Mod ROOF NON SHINGLE PERMIT PERMIT NUMBER ROOF19-0072 CITY OF ATLANTIC BEACH n 800 SEMINOLE ROAD ISSUED: 9/19/2019 ATLANTIC BEACH. FL 32233 EXPIRES: 3/17/2020 MUST CALL INSPECTION • 914 247-S814 BY , PM FORDAY INSPECTION. ALL •RK MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • ' D + 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: 1021 ATLANTIC BLVD 953- ROOF NON SHINGLE RIGID ROOF INSULATION $170780.00 975 AND 2 PLY MOD. BIT SYSTEM TYPE OF • • GROUP: 177602 0040 SECTION LAND COMPANY:-- - DD ROOF CONTROL SERVICES 11748 OSPREY POINT BLVD CLERMONT FL 34711 OWNER: ADDRESS: EQUITY ONE ATLANTIC 1600 NE MIAMI GARDENS DR NORTH MIAMI FL 33179 VILLAGE INC BEACH 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. FEES DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT BUILDING PERMIT 455-0000-322-1000 0 $693.00 BUILDING PLAN CHECK 455-0000-322-1001 0 $346.50 STATE DBPR SURCHARGE 455-0000-208-0700 0 $15.59 STATE DCA SURCHARGE 455-0000-208-0600 0 $10.40 TOTAL:$1,065.49 Issued Date:9/19/2019 1 of 2 ROOF NON SHINGLE PERMIT PERMIT NUMBER JS " CITY OF ATLANTIC BEACH ROOF19-0072 800 SEMINOLE ROAD ISSUED: 9/19/2019 "-.c:: 9i ATLANTIC BEACH. FL 32233 EXPIRES: 3/17/2020 Issued Date: 9/19/2019 2 of 2 City of Atlantic Beach APPLICATION NUMBER r Building Department (To be assigned by the Building Department.) t J 800 Seminole Road © � Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM r n Property Address: IC) Department review required No �� ��L IN�"�(1 (.y t J Building Ye Applicant: �O�� g &Zoning Tree Administrator Project: R t c� , n hN S I )l,Pr 7 ti Public Works ___�> Public Utilities 2 G Public Safety i Fire Services Review fee $ _ Dept Signature Other Agency Review or Permit Required Review or Receipt Date & of Permit Verified B C� Florida Dept. of Environmental Protection Florida Dept. of Transportation P1 St. Johns River Water Management District V`Army Corps of Engineers `C Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: proved. ❑Denied. ❑Not applicable (C' e.) Comments: �� EBULDING / PLANNING &ZONING Reviewed by: Date: l7�` of TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 OFFICE COPY ys x Building Permit Application Updated 12/8/17 City of Atlantic Beach 800 Seminole Road,Atlantic Beach,FL 32233 Phone:(904)247-5826 Fax:(904)247-5845 �!F Job Address: 1021 ATLANTIC BLVD Permit Number: ' ` Legal Description 38-2S-29E CASTRO Y FERRER GRANT PT RECD O/R 8130-2297 RE# R-177602-0040 Valuation of Work(Replacement Cost)$ 170.780.00 Heated/Cooled SF 11,265 Non-Heated/Cooled ASA • Class of Work(Circle one): New Addition Iteratio Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial Residential • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No ED • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: Recover Roof Replacement: Install new rigid roof insulation over existing roof. Install new 2-ply modified bitumen roof system. Install new flashing at all penetrations and at perimeter walls. Florida Product Approval# 3915-1327 for multiple products use product approval form Property Owner Information Name: Regency Centers, LP Address: One Independent Drive Suite 114 City Jacksonville, State F1 zip 32202-5019 Phone 904-598-7630 E-Mail georgewhetstone@regencycenters . com Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) George Whetstone Contractor Information NameofCompany: Roof Control Services Qualifying Agent: Todd Griffin Address 6900 Phillips HWY Suite 42 city Jacksonville State FL zip 32216 Office Phone 904-527-8052 Job Site/Contact Number James Byram(904)-527-8052 State Certification/Registration# CC-C057884 E-Mail jbyram roofcontrol.com Architect Name&Phone# N/A Engineer's Name&Phone# N/A Workers Compensation Bdd efield Employers Ins.Co. 12/31/2019 Exempt/Insurer/Lease Employees/Expiration Date Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or installatio9as commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulatia*g= J Z construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNVJ U Z O WELLS,POOLS, FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc.NOTICE:In addition to the requirements o ici 0 permit,there may be additional restrictions applicable to this property that may be found in the public records of this county, dm F- z H there may be additional permits required from other governmental entities such as water management districts,state agencie�pr O Q Q federal agencies. U C3 V p W II.- Q D OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with ag Z CC % CC applicable laws regulating construction and zoning. U N F— N F- WARNING TO OWNER:YOUR FAILURE TO RECORD A NOTICE OF COM MEN ENT MAYO Q w RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PRO E . IF YOU INTEI O W WCL m TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN A O EY BEFORE w >._ W o RECO DING YOUR NOTICE OF COMMENCEMENT. , w W w wUcnw 3 e"Ic __ � � W E (signature of Owner or Agent) I (Si ature of Contractor) (including contractor) Aigned and sworn to(or affirmed)before me this day of Signed and sworn to(or ffi ed)before this day o g p cr,IQ 6 `Zo lr1 .by L7G O �}�.t.-�S-�o4�t ��[1 2 D/ ,by (Signature of Notary) / jr• BETH CHURCH �sonall Known OR ttA!p�e WENDI HILL L]'p '!Y• U�' Nota Public-State of Florida Y t ersonally Known OR Notary ••' '�'�Q o` Commission GG 253550 [ ]Produced Identification t� * * Commission#GG 240468 [ ]Produced Identification '�o�,�: My Comm.Expires Sep 13,2022 Type of Identifications �_��l a Q� Ex iresNovember20.2022TypeofIdentification: Fp'F Fto Bonied Thru tkdget Notary Servlaa OFFICE COPY PRODUCT DATA SHEET PDS-181 a SOPREMA Rev 11/12 SOPREMA #14 MP FASTENERS Soprema#14 MP Fasteners - Package Quantities Below Order No. -See Below DESCRIPTION Soprema #14 MP fastener is engineered to provide exceptional performance in a variety of substrates and applications for Soprema Mechanically Fastened SBS Membrane Systems. Fasteners are designed for the attachment of insulation and membrane to steel (18- 22 ga.), wood, and structural concrete. To meet FM requirements, the fastener must penetrate the steel deck three-quarter(3/4")inch. Minimum penetration is one(1")inch into wood,three-quarter(3/4")inch through wood that is less than three-quarter(3/4")inch thick and one and one-quarter (1 '/4") inch into concrete. When installing in concrete, pre-drill using a seven-thirty-second(7/32")inch drill bit and drill pilot hole one-half('/i') inch deeper than the required embedment. Install the fastener using a clutch-driven drill motor with a maximum 1500 RPM. The#14 MP Fastener offers these advantages: • Superior pullout performance and ease of application • Specific designed thread for increased back-out resistance • FM Approvals, ICC/ES, Miami-Dade County, Florida State-Wide Approval • Approved for steel, wood and concrete decks • Soprema's flexibility to supply warranted fasteners based on the authorized Soprema roofing applicator's preferred fastener request or applicator tools used • Used with Soprafix and UNILAY Mechanically Fastened Systems COMPOSITION & PACKAGING Soprema supplied#14 MP Fastener is case hardened carbon steel and use specific head,shank and thread diam- eters, point types and head styles meeting FM Approvals corrosion and simulated wind uplift criteria requirements. #14 MP Fastener #14 MP Fastener Fastener Size Part Number Qty./Pail** Fastener Size Part Number Qty./Pail** 1-1/4" F1011 1000 5" F1019 1000 1-1/2" F1012 1000 6" F1020 1000 2" F1013 1000 7" F1021 500 2-1/2" F1014 1000 8" F1022 500 3" F1015 1000 9" F1023 250 3-1/2" F1016 1000 10" F1024 250 4" F1017 1000 12" F1025 250 4-1/2" F1018 1000 "Each pail contains one(1)#3 Phillips Head drive bit WARRANTY Soprema supplies Soprafix#14 MP Fasteners to authorized Soprema roofing applicators and are included in Soprema Project Warranty Agreement offerings. 310 QUADRAL DRIVE • WADSWORTH,OHIO 44281 • TEL.:(330)334-0066 • TOLL FREE:(800)356-3521 • FAX:(330)334-4289 General product information is provided on this Product Data Sheet The physical property values reported here are based on testing conducted under controlled laboratory conditions according to accepted test standards. OFFICE COPY PRODUCT DATA SHEET PDS-185a 16SOPREMA Rev 11/12 SOPRAFIX 2.4-INCH SEAM PLATE Soprema 2.4-Inch Seam plate - 1000 / Pail Order No. F1059 DESCRIPTION Soprafix Membrane 2.4-inch Seam Plates are engineered to provide exceptional performance when used in specific Soprafix or Unilay mechanically fastened SBS Roof - Assemblies. The Soprafix 2.4-inch seam plate has engineered'scoops'that allow the plate to get excellent grip of the membrane without cutting into it with sharp barbs. It is the installer's responsibility to know the Soprafix • system being installed, which Soprafix fastening components are required, where and how often these parts are placed within the System. Unless otherwise noted in the Soprafix Approved Details, the installer must center the required Soprafix Seam Plate down the middle of the mechanically fastened side lap of the specified Soprafix membrane. Soprema #15 or #14 Fasteners (or other approved)are installed into the Soprafix Stress Plate according to the applicable Fastening Pattern(s). The 2.4-Inch Soprafix Seam Plate offers these advantages: • Labor savings with increased membrane rupture performance and resistance (pull-over) • Included in Soprema Project Warranty Agreement offerings • Soprema's flexibility to supply warranted fasteners and stress plates based on authorized Soprema roofing applicator's preferred requests • See current FM Approvals, ICC/ES, Florida State Wide Product Approval and Miami-Dade County Product Approval for Approved Roof Assembly combinations COMPOSITION & PACKAGING Soprema supplied Soprafix Plates are manufactured from heavy gauge galvalume with special designed reinforcing ribs. All Soprafix Plates meet building code and FM Approvals corrosion and simulated wind uplift criteria requirements. WARRANTY Soprema supplies Soprafix Stress Plates to authorized Soprema roofing applicators and are included in Soprema Project Warranty Agreement offerings. Increased Soprafix Stress Plate and fastener layout densities may be required for Wind Warranty Riders or when elevated roof velocity pressures are encountered on specific projects. 310 QUADRAL DRIVE • WADSWORTH,OHIO 44281 • TEL.:(330)334-0066 • TOLL FREE:(800)356-3521 • FAX:(330)334-4239 General product information is provided on this Product Data Sheet The physical property values reported here are based on testing conducted under controlled laboratory conditions according to accepted test standards soPRA�Ix MECHANICALLY FASTENED TWO-PLY SBS MODIFIED BITUMEN MEMBRANE SYSTEM OFFICE COPY F OFFICE COPY SOPRALENEO - - FLAM 188 FR GR DESCRIPTION & FEATURES SOPRALENE Flam 180 FR GR(fire retardant, granulated)is an SBS-modified bitumen cap ply for use in approved multi-ply membrane and flashing assemblies. SOPRALENE Flam 180 FR GR is composed of a proprietary formulation of elastomeric styrene-butadiene- styrene(SBS) polymer modified bitumen and is reinforced with a tough, dimensionally stable non-woven polyester mat. The topside is surfaced with ceramic coated granules and underside is surfaced with polyolefin burn-off film to optimize heat welding. SOPRALENE Flam 180 FR GR includes the standard white granules.Contact SOPREMA®Customer i Service or your sales representative for other granule color options and special order requirements. STORAGE & HANDLING Store rolls on end and maintain in an upright position to prevent damage. Store rolls ;:- in a clean dry location and cover as necessary to protect rolls from environmental damage such as extreme cold, heat, or moisture. Monitor varying environmental conditions during storage, handling and application of SOPRALENE Flam 180 FR GR. APPLICATION Prior to installation, unroll SOPRALENE Flam 180 FR GR onto the roof surface and allow to relax. Position SOPRALENE Flam 180 FR GR in desired position and back roll the product. SOPRALENE Flam 180 FR GR is then heat welded to approved substrates. Refer to the SOPREMA SBS Roofing Installation Guide for additional application guidelines. 20111113 '• • a Rf.. SOPRALENE Flam 180 FR GR 0.27 0.24 0.87 0.90 27 234 Standard white granules(WH) initial 3 year initial 3 year initial 3 year - SOPRALENE Flam 180 FR GR 0.66 0.62' 0.91 0.91 81 75 Highly reflective white granules(SG) initial 3 year initial 3 year initial 3 year HEAT-WELDED SOPRALENE Flam 180 FR GR 0.10 N/A 0.89 N/A 6 N/A Smog reducing granules(EC03) initial" initial" initial" 'CRRC Rapid Ratings.Refer to Cool Roof Ratings Council(CRRC). "Calculated using internal testing 32.8 39.4 97.9 160 118 25 1.Grade G 1�i_0 m (1.0 m) (9-1 M-) (4.0 mm) ('51 kg) ( ,361 Ib, 176164 1,361 kg) Coverage rate as reported assumes installation using side and end lap recommendations. www.soprema.us SOPREMA� 310 Quadral Drive,Wadsworth, Ohio 44281 Is � Toll Free: (800)356-35211 Tel: (330)334-0066 OPRAFIX ""'t' O OFFICE COPY d,nr�a ' BASE 612 DESCRIPTION & FEATURES SOPRAFIX Base 612 is an SBS-modified bitumen base ply for use in approved , multi-ply membrane and flashing assemblies and is designed specifically for mechanical attachment to approved substrates. SOPRAFIX Base 612 is composed of a proprietary formulation of elastomeric styrene-butadiene-styrene(SBS) polymer , modified bitumen and is reinforced with a tough, dimensionally stable non-woven , ;_`, polyester mat engineered for mechanical attachment. The topside and underside are surfaced with polyolefin burn-off film to optimize heat welding. STORAGE & HANDLING Store rolls on end and maintain in an upright position to prevent damage. Store rolls in a clean dry location and cover as necessary to protect rolls from environmental damage such as extreme cold, heat, or moisture. Monitor varying environmental conditions during storage, handling and application of SOPRAFIX Base 612. APPLICATION Prior to installation, unroll SOPRAFI) ,Base 612 onto the roof surface and allow to relax. Place SOPRAFIX Base 612 in desired position. SOPRAFIX Base 612 is mechanically fastened through the 4 inch or 5 inch side laps using the 2 inch or 2.4 inch plates respectively following the details for the required uplift pressure. Subsequent approved _ inter-pty or cap ply membranes are applied to SOPRAFIX Base 612 via heat welding. Refer to the SOPREMA®SBS Roofing Manual for additional application guidelines. mg • MECHANICALLY FASTENED 66164 32.8 39.4 4- 95.2 (8.8 m-) 118 82 30 Type 1.Grade X10.0 m 11.0 111) (3.0 mm) (37.2 kg) (2.510 lbs/ 5- 92.5 (8.6 m= 1.139 kg) Coverage rate as reported assumes installation using side and end lap recommendations.Coverage reported reflects 4 and 5 inch side laps respectively. //l t SOPREWW www.soprema.us 310 Quaduad rat Drive,Wadsworth,Ohio 44281 Toll Free: (800)356-3521 1 Tel: (330)334-0066 NNEMO etc. TABLE 2E: STEEL DECKS-NEW CONSTRUCTION,REROOF(TEAR-OFF)OR RECOVER SYSTEM TYPE D-2: INSULATED,MECHANICALLY ATTACHED SOPRAFIX,BONDED ROOF COVER System Deck Insulation and/or Base Membrane Roof Cover(Note 1S) MDP No. (Note 1) Thermal Barrier Base Fasteners Spacing Ply Cap (psf) Min.22 ga.,type B,Grade Min.1.5-inch,One or Trufast#15 EHD with Trufast 2.4 in. 33 steel at max.6 ft spans SOPRAFIX Base 610,611,612, 12-inch o.c.within 4-inch 5-228. more layers,any Scoop Seam Plates or Soprema#15 HD (Optional)SBS-TA-F SBS-TA-F -75.0 attached 6-inch o.c.with combination 614 or 622 with Soprema 2.4"Seam Plate wide,heat-welded laps TRAXX/5 screws Min.1.5-inch,One or SOPRTrufast#14 HD with Trufast 2.4 in. Elastophene SP or SP 3.0 5-229. Min.22 ga.,type B,Grade more layers,any 614 or 622 IX Base 610,611,612, Scoop Seam Plates or Soprema#14 MP wide, o.c.within 4-inch or 5opralene 180 5P or SBS-CA1 -75.0 80 steel combination 614 or with Soprema 2.4"Seam Plate ,heat-welded laps 180 SP 3.5,torch-applied Min.1.5-inch,One or Trufast#14 HD with Trufast 2.4 in. 5-230. Min.Z2 ga.,type 8,Grade more layers,any 614 or 622 IX Base 610,611,612, 12-inch o.c.within 4-inch Scoop Seam Plates or Soprema#14 MP (Optional)585-TA-F SBS-TA-F -75.0 80 steel combination 614 or with Soprema 2.4"Seam Plate wide,heat-welded laps Min.1.5-inch,One or Min.22 ga.,type B, Soprema#15 EL with SOPRAFIX 2 3/8 12-inch o.c.within 5-inch 5-231. Grade 80 steel more layers,any Unilay in.SB Stress Plates wide heat-welded laps None None 82.5 combination Min.1.5-inch,One or Trufast#15 EHD with Trufast 2.4 in. 5-232. Min.22 ga.,type B, more layers,any SOPRAFIX Base 621 or 622 Scoop Seam Plates or Soprema#15 HD 12-inch o.c.within laps lNone 585-CAI -97.5 Grade 80 steel combination with Soprema 2.4"Seam Plate wide,heat-welded laps Min.1.5-inch,One or Trufast#15 EHD with Trufast 2.4 in. Elastophene SP or SP 3.0 l Grade 80 steel wideheat-welded laps 5-233. Min.22 ga.,type B, more layers,any SOPRAFIX Base 614 Scoop Seam Plates or Soprema#15 HD 12-inch o.c.within laps or 5opralene 180 SP or SBS-CAl -97.5 combination with Soprema 2.4"Seam Plate , 180 SP 3.5,torch-applied Min.1.5-inch,One or Trufast#15 EHD with Trufast 2.4 in. Min.22 ga.,type B, 12-inch o.c.within 4-inch 5-234. more layers,any SOPRAFIX Base 614 Scoop Seam Plates or Soprema#15 HD (Optional)SBS-TA-F SBS-TA-F -97.5 Grade 80 steel combination with Soprema 2.4"Seam Plate wide,heat-welded laps Trufast#15 EHD with Trufast 2 in. Min.1.5-inch,One or Barbed Metal Seam Plates or Trufast 5-235. Min.22 ga.,type B, more layers,any SOPRAFIX Base 621 or 622 2.4 in.Scoop Seam Plates or Soprema 6-inch wewithin 4-inch wide, heat-weld None SBS-CAi -112.5 Grade 33 steel combination #15 HD with Soprema 2"Seam Plate or heat-welded laps Soprema 2.4"Seam Plate Trufast#15 EHD with Trufast 2 in. type B Min.22 ga., , Min.1.5-inch,One or. Barbed Metal Seam Plates or Trufast Elastophene SP or SP 3.0 5-236. more layers,any SOPRAFIX Base 610,611,612, 6-inch o.c.within 4-inch wide,2.4 in.Scoop Seam Plates or Soprema or Sopralene 180 SP or SBS-CAi -112.5 Grade 33 steel combination 614 or 62Z #15 HD with Soprema 2"Seam Plate or heat-welded laps 180 SP 3.5,torch-applied Soprema 2.4"Seam Plate Trufast#15 EHD with Trufast 2 in. Min.22 ga.,type B, Min.1.5-inch,One or SOPRAFIX Base 610,611,612, Barbed Metal Seam Plates or Trufast 6-inch o.c.within 4-inch wide, 5-237. more layers,any 2.4 in.Scoop Seam Plates or Soprema (Optional)SBS-TA-F SBS-TA-F -112.5 Grade 33 steel combination 614 or 622 #15 HD with Soprema 2"Seam Plate or heat-welded laps Soprema 2.4"Seam Plate Min.1.5-inch,One or Trufast#14 HD or#15 EHD with 5-238. Min.22 ga.,type B, more layers,any SOPRAFIX Base 621 or 622 Trufast 2 in.Barbed Metal Seam Plates 6-inch o.c.within 4-inch wide, None SBS-CA1 -120.0 Grade 80 steel or Soprema#14 or#15 HD with heat-welded laps combination Soprema 2"Seam Plate NEMO ETC,LLC Appendix ation Report 535000.12.10-R25 for FL3915-R27 Certificate of Authorization#32455 6TH EDITION(2017)FBC NON-HVHZ EVALUATION I C E COPY Revision 25:02/12/2019 Prepared by: Robert Nieminen,PE-59166 Soprema Modified Bitumen Roof Systems;(800)356-352 1,Page 53 of 117 NOTICE OF COMMENCEMENT State of Florida Tax Folio No. County of Duval To Whom It May Concern: The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT. Legal Description of property being improved: 38-2S-29E CASTRO Y FERRER GRANT PT RECD O/R 8130-2297 Address of property being Improved: 1021 ATLANTIC BOULEVARD 953-975,ATLANTIC BEACH,FLORIDA General description of improvements: Roof Replacement, Units 1-9b Owner: REGENCY CENTERS Address: ONE INDEPENDENT DRIVE,SUITE 114,JACKSONVILLE,FL 32202 Owner's interest in site of the improvement: Fee Simple Titleholder(if other than owner): Name: ontractor: ROOF CONTROL SERVICES,INC Address: 6900 PHILIPS HIGHWAY,SUITE 42,JACKSONVILLE,FLORIDA 32216 Telephone No.: (904)527-8052 Fax No: (904)551-4944 Surety(if any) Address: Amount of Bond$ Telephone No: Fax No: Name and address of any person making a loan for the construction of the improvements Name: Address: Phone No: Fax No: Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may be served:Name: Address: Telephone No: Fax No: In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.06(2)(b), Florida Statues. (Fill in at Owner's option) Name: Address: Telephone No: Fax No: Expiration date of Notice of Commencement(the expiration date is one(1)year from the dat, ecording u�"R�ifferent date is specified): 4ZI tit+ rommisclon GG MOO Expires November 20,2022 THIS SPACE FOR RECORDER'S USE ONLY OWNER EOFF>�Po' BondodTluuDidpNMollarpSw4m Doc#2019217001,OR BK 18937 Page 1580, Signed'' `�/� �'-`�— Date: lot Number Pages: 1 Before me thK 4 '" day of �' p{t��. in the Count of Duval,State Recorded 09/19/2019 08:31 AM, Of Florida,has personally appeared RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Notary Public at Large,State of F orida,County of Duval. COUNTY My c fires: L l RECORDING $10.00 ersonally Known: or roduce ion: ,�