370 Garden Ln RERF21-0236 Shingle -.0...A,,-4-,---,,, REROOF SHINGLE PERMIT PERMIT NUMBER
1-i''
s, RERF21-0236
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 10/8/2021
< <r EXPIRES: 4/6/2022
-';i'� ATLANTIC BEACH, FL 32233
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:
370 GARDEN LN REROOF SHINGLE SHINGLE ROOF $9000.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172020 5025 SELVA MARINA GARDEN
COMPANY: ADDRESS: CITY: STATE: ZIP:
SUNBELT HOMES AND 450-106 STATE ROAD 13 NORTH, 14409 ST. JOHNS FL 32259
ROOFING, LLC
OWNER: ADDRESS: CITY: STATE: ZIP:
GRANDY FRANCES H 370 GARDEN LN ATLANTIC BEACH FL 32233-4522
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.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $100.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$104.00
Issued Date: 10/8/2021 1 of 2
�' ''''r REROOF SHINGLE PERMIT PERMIT NUMBER
• CITY OF ATLANTIC BEACH RERF21-0236
800 SEMINOLE ROAD ISSUED: 10/8/2021
EXPIRES: 4/6/2022
ATLANTIC BEACH. FL 32233
Issued Date: 10/8/2021 2 of 2
Building Permit Application
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
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p
Job Address: 310 1✓:..,1y n G 1I . /, �. Permit Number: E1<FZ`/
-O7 3(z.)
Legal Description j?- OH-DS-)1 -;,15i -/vk/1laikr^u 64v,;& f//Uf. 5/ ik-e REff 2Y/$-177.1-
p cr
Valuation of Work(Replacement Cost)$ �000 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair DMove ❑Demo ❑Pool DWindow/Door
• Use of existing/proposed structure(s): ❑Commercial DResidential
• If an existing structure,is a fire sprinkler system installed?: [Nes ❑No
• Will tree(s)be removed in association with proposed project?I:Wes must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed: } \AA 1\C)
12�lZUt
,( Florida Product Approval# ran,AO /n' /J7./sf, f/i.6',. o /5..//C for multiple products use product approval form
Property Owner Information
Name (ftANCES H &PPANo'7 Address 31c) 4l/4-t.,21/ n
City /(4nf.121c+:r.1 State -FL Zip 3.2.233 Phone 90 Y- QZ '/ -?Sid'
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company .c(,.,A}Get( I4 u,nL P&L) Ra t!:.✓G Qualifying Agent 1 4Orngs (3 Sa,VJA
Address t-1 SJ - 106 S 11- I1 n/ rrtitli City SA!./( 7ON/v, State (( Zip 3 z-t 55
Office Phone Job Site Contact Number
State Certification/Registration# C CC ( 31.1 6,91 E-Mail SUN r36t1 eANOlfomG S A o'..
Architect Name&Phone#
Engineer's Name&Phone# _ ��
Workers Compensation Insurer OR ExemptXExpiration Date ✓l 2-3
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 OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
- - -
(Signature of Owner or Agent (Sign ure of Contractor)
n 44�
Signed and sworn to(or affirmed)before me this Zl day of Si ned nd sw�(or affirme,) •e sre this0!✓ u .y of
SC-Pi , 100 ,b Fivw(cs NGn1 fri _ , •7' Se-- .i
(Siinature of Notarvl (Signature of Notary)
THOMAS B.SMITH
.;Et°f� / M� KATHERINE KARR-GARCIA
MY COMMISSIoi4 fl l*i 029415 (/J Personal) Known OR
Personally Kno �3R;�; _ � Y ��` Commission i GG 260954
��•;: EXPIRES: 2024 [ ]Produced Identification
[ ]Produced)dent o*; BondedNoisyft, puWeUrdenrdlr� Mow Expires October 3,2022
Type of Identificati " Type of Identification: jc &MEITea 16J,;nNm4yS•rrkas
NOTICE OF COMMENCEMENT
State of F L v rt i OA Tax Folio No. 111..0 1.V - 5'01f
County of rJ( vAL
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: 11 - 0841 oq -is- 2q C _SCUM
(11A ittivA GARD& Pr Lo'TS °► IC) Rrcr) olrt Gs 1` 0 - 117r
Address of property being improved: 3-10 GAR DEA/ CN R TlAN11 C 13L/ (t, rt. 3 2133
General description of improvements: RC R U V
Owner: r(IANCtS N GRAND/ Address: 310 GAr11E,tJ LA/ /a1t,N1:( bCh (L
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: 51..,ft) 13 CC-( !I u/n E S /a,/O R t ci C Lc< _
Address: NSU" !c.)6 S (3 n./ X 110 1 SANT u{iNS FL 3 2 ts5
Telephone No.: 904- 341- 0 410 Fax No:
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 date of recording unless a different date is
specified): —
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Doc#2021259219,OR BK 19940 Page 1850, ted: 1-1I • . Date: er
Number Pages:1 re me this Z 1- day of S t P i tut,f in -C. a • val,State
Recorded 10/04/2021 11:48 AM, lorida,has personallya
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL pp' —.nascuul3fl�grls`l�T:��
ary Public at Large,State o Ig .'o•:.nty_p 9 - . 1 HN 029115
COUNTY
RECORDING $10.00 ...u' sion -x.ires: 1.7.E " .,.
zonally Known: I • , _or
r ... . cation:
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