114 SEMINOLE RD RERF21-0245 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
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us [� (�
Job Address: 114 Seminole Road Atlantic Beach, FL 32233 Permit Number: ERF Z ( - 024 5
Legal Description 10-8 20-2S-29E .066 SALTAIR SEC 1 S1/2 LOT 623,E 15FT OF S1/2 LOT 607 RE# 170602-0100
Valuation of Work(Replacement Cost)$6350.00 Heated/Cooled SF 1700 Non-Heated/Cooled412
• Class of Work: ❑New ❑Addition •Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial •Residential
• 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) •No
Describe in detail the type of work to be performed:
Re-Roof /16 Sqs/ 7/12 pitch Owens Corning Shingles FL10674R13
Florida Product Approval#FL10674R13 for multiple products use product approval form
Property Owner Information
Name Kathryn Chaplin Address 114 Seminole Road
City Atlantic Beach State FL Zip 32233 Phone 904-524-3423
E-Mail k_champs29@yahoo.com
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company TURNKEY ROOFING OF FLORIDA Qualifying Agent RUBEN LAVARIAS
Address9521 SHELLIE ROAD SUITE 1 CityJACKSONVILLE State FL Zip32257
Office Phone 904-900-1069 Job Site Contact Number 703-964-7723 JOE CAUCCI
State Certification/Registration# CCC1331925 E-maiiViolet@chooseturnkey.com
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer Brown&Brown of Florida, Inc. OR Exempt ❑ Expiration Date 5/6/22
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) (Signature of Contractor)
Signed and sworn to(or affirmed) before me this I`1 day of Signed and sworn to (or affirmed) before me this 11 day of
(^j' r r) ) I , by itiG,IN''X-, ({11 , l 2( , by L014,' LwiV;4f
(Signature of Notary) ature of Notary)
A.r , JUAN tORR€S
[ ]Personally Known OR [ Personally Known OR �1 . ) y A�AfAflA6lNVI/Rcc s
[ Produced Identification , [ ] Produced Identification �N (fAb 88
Type of Identification: !r ( Type of Identification: M. Merch 27,2p23
ouggc Notary'gorvkN
Tax Folio No. 170602-0100
Permit No.
NOTICE OF COMMENCEMENT
State of FLORIDA
County of DUVAL
The undersigned hereby gives notice that Improvement will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes,the following information is provided in this Notice of Commencement.
1. Description of property: (legal description of the property, and street address if available):
10-8 20-2S-29E.066 SALTAIR SEC 1 S1/2 LOT 623,E 15FT OF S1/2 LOT 607
114 SEMINOLE RD Atlantic Beach FL 32233
2. General description of improvement: RE-ROOF
3. Owner (name and address): Kathryn Chaplin 114 Seminole Road
Atlantic Beach FL 32233
a. Owner's Interest in property: FEE SIMPLE
b. Name and address of fee simple titleholder (if other than Owner):
4. Contractor: (name and address): TURNKEY ROOFING OF FLORIDA, INC.
9521 SHELLIE ROAD, UNIT 1, JACKSONVILLE, FL 32257
a. Contractor's phone number: (904)900 1069
5. Surety (name and address):
a. Surety phone number: Doc#2021269937,OR BK 19958 Page 189,
b. Amount of bond: $ Number Pages 1
Recorded 10/14/2021 10.24 AM,
6. a. Lender: (name and address): JODY PHILLIPS CLERK CIRCUIT COURT DUVAL
b. Lender's phone number: COUNTY
RECORDING $10.00
7. a. Persons within the State of Florida designated by Owner upon whorl-
Section 713.13(1)(a) 7., Florida Statutes: (nameandaddress)
b. Phone numbers of designated persons:
8. a. In addition to himself or herself, Owner designates of to receive a copy of the Lienor's
Notice as provided in Section 713.13(1)(b), Florida Statutes.
b. Phone number of person or entity designated by owner:
9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different date is
specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA
STATUTES, AND CAN 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 COMMENCING WORK OR RECORDING YOUR
NOTICE OF COMMENCEMENT.
Owner's Signature:
Print Name: Kathryn Chaplin
Title/Office: r
The foregoing instrument was acknowledged before me this `( day of Oa tr , 20 Zr( , by h�.4-hr./ �"1qI•1
as(type of authority, e.g. officer, trustee, attorney in fact) for (name of party on behglf of whom instrument was
executed) who (check one)_ is personally known to me or who produced p i-, as identification.
The signer personally appeared before the Notary at the time of the notarization by physical presence or by means of audio-video
communication technology and who affirmed that all the above statements are true and co ct.
Signature of Notary:
ow(pt,,, JUAN TORRES My Commission Expires: 3
Commission#GG 316888
`u v Expires March 27,2023 Location of the Notary at the time of notarization
itefop* BondedThn Budget Notary Silvia,