1843 Seminole Rd RERF21-0227 Shingle rt' L r REROOF SHINGLE PERMIT PERMIT NUMBER
JS S„
CITY OF ATLANTIC BEACH RERF21-0227
V~ ISSUED: 9/21/2021
J {f 800 SEMINOLE ROAD
°1119%' ATLANTIC BEACH, FL 32233 EXPIRES: 3/20/2022
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: DESCRIPTION: VALUE OF WORK:
1843 SEMINOLE RD REROOF SHINGLE Shingle: FL10124 $13950.00
TYPE OF REAL ESTATE ZONING: - BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169630 0000 OCEAN GROVE UNIT 02
COMPANY: f ADDRESS: CITY: STATE: ZIP:
EXCEL ROOFING 5722 DUNN AVE MIDDLEBURG FL 32068
CONTRACTING
OWNER: ADDRESS: CITY: STATE: ZIP:
JEFFERY DAVID L 1843 SEMINOLE RD ATLANTIC BEACH FL 32233-5915
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.
1 BUILDING ROOF IN-PROGRESS INSPECTION REQUIRED INFORMATIONAL
Notes:
a.The roof sheathing for all new construction must remain uncovered until the Roof Sheathing Inspection is approved.
b.All roofing projects require an In-Progress Inspection.
c.Sheathing installation and replacement guidelines per APA.
d.Underlayment must conform to FBC-R Table 905.1.1
e.Shingles must conform to ASTM D3161 G or H,or ASTM D7158 F
FEES
Issued Date:9/21/2021 1 of 2
0LAj'' REROOF SHINGLE PERMIT PERMIT NUMBER
�3 � � RERF21-0227
if, XCITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 9/21/2021
x � y� EXPIRES: 3/20/2022
ATLANTIC BEACH. FL 32233
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $120.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$124.00
Issued Date:9/21/2021 2 of 2
Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: ''IIlilding-DPptPcoA.uC IS REQUIRED.
Job Address: is 11/3St./111I-)PLE'- RL 6-14,)1,c ,J-2 3i A33 Permit Number:
Legal Description U-av cg-v/5.-:,2,!4 O2egiJGrove. an,/- 9 1d7" 31 RE# /b9 ,36) -OC '
Valuation of Work(Replacement Cost)$ 13`, Vs-0c Cl Heated/Cooled SF Non-Heated/Cooled
• Class of Work: .I:rew ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Ntesidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ISINo
Describe in detail the type of work to be performed: I?lily/Gii� G,Iti t`r '/A'C.e, Ai iii/eS
Florida Product Approval#/-47-'/0/4.(5' for multiple products use product approval form
Property Owner Information
Name Yic 4 PrASCi%/ mace/y Address A- _-.3.__ _-2,7)-1,00/7..._-_ Rc
City � r1T/yper
State )L Zip 3j,x;23 Phone 9Z)41-',4/6 -845-4;
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company e.:el �t2A4ri eath eict5 LNG; Qualifying Agent t/ef7Py/ o .. Jj`
,57,":2S
Address ,57,":2 k& City ,)acJ/ 7M y;/ /State /T Zip '3,;2j/E.
Office Phone yz,l-4'3/- 7/6Job Site Contact Number LLQ/' /- L/ 3 3931
State Certification/Registration# �3 81/434 E-Mail ecL:.jqi(4oI/A,.'
Architect Name& Phone# 4/14
Engineer's Name& Phone# 1J;_'
Workers Compensation Insurer OR Exempt❑ Expiration Date
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 OBTAIN FINANCING, CONSULT WITH YOUR �LENDER 9R A ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT. '// (
��1 � J/Tii� i
(Signature of Owner:or/ ' nt) (Signature of Contractor)
(7
Signed and sworn to(or affirmed)before me this /3 day of Signed and sworn to(or affirmed)before me this /. day of
. .2o 21 by • / `t5•• :J/, Je�i� . `- X0,21 ,by ''D,iL. 9i,r:.e.t a/
111-(747 / ,f -8,,c ��- _
(Signature of Notary) (Signature of Notary)
iso?g' ., ;o DENISE L.TAIT
q. �,�.: DENISE L.TAIT •r.••
ersonall Known OR ��� MY COMMISSION#GG 973828 Jersonall Known OR =�` ;,; MY COMMISSION#GG 973828
Y ' a n' Y r„v ..
[ ]Produced Identificati ;;��� EXPIRES:July 27,2024 [ 1 Produced Identification +;E'*o�,Ar' EXPIRES:July 27,2024 ,
Type of Identification: ''°`,F:°' Bonded Thru Notary Public Underwriters Type of Identification: Bonded Thru Notary Public Underwriters
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Doc # 2021245604 , OR BK 19919 Page 1773, Number Pages: 1 ,
Recorded 09/20/2021 11 : 13 AM, JODY PHILLIPS CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10. 00
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. 169630-0000
State of FLORIDA 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: 20-20 09-2S-29E OCEAN GROVE UNIT 2 LOT 36
Address of property being improved: 1843 SEMiNOLE RD Atlantic Beach FL 32233
General description of improvements:Re-roof
owner JEFFERY,DAVID L and JEFFERY PRISCILLA S
Address 1843 SEMINOLE RD Atlantic Beach FL 32233
Owners interest in site of the improvement OWNER
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor SCOTT SORENSEN - EXCEL ROOFING CONTRACTORS INC
Address 5722 DUNN AVE JACKSONVILLE FL 32218
Phone No,904-631-7663 Fax No.904-214.0004
Surety(if any)N/A
Address Amount of bond S
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name N/A
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 NIA
Address
Phone No. Fax No.
in addition to himself,owner designates the following person to receive a copy of the Lienors Notice as provided in
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option).
Name N/A
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLYOWNER
a
• Signed: . ,�`,-�c'.e,. �.ii n DATE ;1„�2�j
Before me this /..gUair of -.. .4 / 11n MeiCo ty of O al,Slate of Florida.. _+�J,' .-... •d
twelfth,/
rrmsev herself and attrms that all stat ns and declarations herein
are true and accurate
DENISE L.TAJT
d_i4� :.: MY COA MISSION#GG 973828
Not brat Large,Stated . - at July 27,2024
exptres: tt►� r ..,., Undene e,s
- sonaBy Kna..m --- -.. -'