116 SEMINOLE RD RERF21-0246 • %:1��'"`fi Building Permit Application Updated 10/9/18
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City of Atlantic Beach Building Department **ALL INFORMATION
`` 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
`_!_/'citk IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us (�
Job Address: 116 Seminole Road Atlantic Beach,FL 32233 Permit Number: -\ E R E Li 5Z4
Legal Description 10-8 20-2S-29E .057 SALTAIR SEC 1 N1/2 LOT 623 RE# 170602-0150
Valuation of Work(Replacement Cost)$6350.00 Heated/Cooled SF 1836 Non-Heated/Cooled432
• 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?: DYes UNo
• Will tree(s) be removed in association with proposed project? DYes(must submit separate Tree Removal Permit) UNo
Describe in detail the type of work to be performed:
Re-Roof /16 Sqs/ 7/12 pitch Owens Corning Shingles FL10674R13
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name Katy Keene Address 116 Seminole Road
City Atlantic Beach State FL Zip 32233 Phone 904-343-4985
E-mail katykeene@outlook.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 _City JACKSONVILLE State FL Zip32257
Office Phone 904-900-1069 Job Site Contact Number 703-964-7723 JOE CAUCCI
State Certification/Registration# CCC1331925 E-Mail Violet@chooseturnkey.com
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer Brown&Brown of Florida. Inc. OR Exempt E Expiration Date 516/22
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
RECORD( G OU O//TICE OF COMMENCEMENT. 7
LWA_ -
gnature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed) before me this 14 day of Signed and sworn to (or affirmed) before me this 1.y day of
(X tnbii- , ?L 1 , by k(J„1� k- nc 6( kr - , 1L 1 ( , by ti��?e,i„ Calx,/ •LII
(Signature of Notary) (Signa irof Notary)
e.S.;.° ,,c, JUAN TORRES
* .$1, ,t . Commission#GG 316888
[ ]personally Known OR rKrsonally Known OR N�, w it\a< Expires March 27,2023
Produced IdentificationT\�l [ ] Produced Identification ForFaa 10PANThru Budget Notary Services
Type of Identification: J L_ Type of Identification:
Permit No. Tax Folio No. 170602-0150
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.057 SALTAIR SEC 1 N1/2 LOT 623
116 SEMINOLE RD Atlantic Beach FL 32233
2. General description of improvement: RE-ROOF
3. Owner(name and address): Katy Keene 116 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:
b. Amount of bond: $
6. a. Lender: (name and address):
b. Lender's phone number:
7. a. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by
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: e-Signed by Katy Keene
Print Name: Katy Keene
Title/Office: 1 ,�
The foregoing instrument was acknowledged before me this 13 day of��//'l JCfCX(, 20Z. I, by
as(type of authority, e.g. officer, trustee, attorney in fact) for(name of party on half,of whom instrument was
executed) who (check one) is personally known to me or_ who produced &Si 9('rt4 +i s identification.
The signer personally appear d 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 correct.
Signature of Notary:1 " l J.N.Az C Y
•
My Commission Expires: a— 7-11
Location of the Notary at the time of notarization
�a,1�r vuse� VIOLET FERRELL EDDY
Doc#2021269938,OR BK 19958 Page 190, Commission#HH 044301
Number Pages: 1 N °� Expires September 20,2024
Recorded 10/14/2021 10:24 AM, ''f o—� Bonded ThruBudgMNMerySenicec
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL °FFA
COUNTY
RECORDING $10.00