1972 Colina Ct RERF21-0262 Shingle (,,c,-,b,r-,--, REROOF SHINGLE PERMIT PERMIT NUMBER
;_, CITY OF ATLANTIC BEACH RERF21-0262
K'' j ISSUED: 11/8/2021
800 SEMINOLE ROAD
01119r ATLANTIC BEACH. FL 32233 EXPIRES: 5/7/2022
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: I DESCRIPTION: VALUE OF WORK:
1972 COLINA CT REROOF SHINGLE Shingle: FL10674R15,
FL15216R7 $13840.00
,
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169506 1056 SELVA NORTE UNIT 01
COMPANY: ADDRESS: CITY: STATE: ZIP:
SUNRISE ROOFING
COMPANY 762 7TH AVE S JACKSONVILLE FL 32250
OWNER: I ADDRESS: CITY: STATE: ZIP:
LORIN OLIVIER F 1972 COLINA CT ATLANTIC BEACH FL 32233-4530
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT If\
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.
DESCRIPTION7ACCOUNT QUANTITY PAID AMOUNT
$120.00
BUILDING PERMIT 455 0000 322-1000 0
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: 11/8/2021 1 of 2
Ilitr '`''''��
REROOF SHINGLE PERMIT PERMIT NUMBER
- J S t i
CITY OF ATLANTIC BEACH RERF21-0262
800 SEMINOLE ROAD ISSUED: 11/8/2021
\--:-to''ls) ATLANTIC BEACH, FL 32233 EXPIRES: 5/7/2022
Issued Date: 11/8/2021 2 of 2
-S '`'• Building Permit Application
J Updoted 10/9/18
City of Atlantic Beach Building Department
**ALL INFORMATION
;;;=J:} r 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 1 -1 ')Q2 Cot I(`Cc C ,, A}I *c.`?tO4 ( 3 27Permit Number: 1 E F ZI —0 2—(07
Legal Description 3 9—C(y • e9 —2-S -2 SCLV A, troit= up(rON) RE# I(a q50 (o -- 1 Oclo
Valuation of Work(Replacement Cost Lor zY'
$ ��' IJL`D.O Heated/Cooled SF a 1 10 Non-Heated/Cooled S(.0 S"...
• Class of Work: ❑New DAddition Iteration DRepair OMove ODemo DPool ❑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? DYes(must submit separate Tree Removal Permit) Vlo
Describe in detail the type of work to be performed:
� 12e —foo c_.. 'Wl�'l�t�W-�ci S C� n v� PL.),.... .�
1P�c.4nr1 c,Nec1u11-4 S V\k; kp s
Florida Product Approval# ill--00 L4 l21 S F LI 52 I (D— for multipleproducts useproduct
/ �' P approval form
Property Owner Information
Name t tk 1-Q.. Lo(i Address 191 a c v'..Gc C�'.
1&
City Pc )P\c _Gl State FL 3 2233 Zip Phone �o�'-a33 0 ^1
E-Mail e i a ec ID_ 0 V is , J
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company 5 y;-5_e m
� C �"_ "c�"'ualifying Agent Thres„ i v S I�j�(k�
City,A((SD(lvlFL.-\(ekrcttate FZip 3
Address �,p Cut S. Z, S�
Office Phone 913 t,.( —• 2. s— 1ci Z_CC Job Site Contact Number ca-.1 --(-"(X75-1 e2-,c7—
State Certification/Registration# C$_(hi 132,6 E-Mail \P.511) LkLI (0 St 1 Vi1`. i1` .��. ,.�w1I
Architect Name&Phone# 1v 1 toc-
Engineer's Name&Phone# \Jlv?r
Workers Compensation Insurer OR Exempts Expiration Date I J ( '2.0'1-2--
Application is hereby made to obtain a permit to do the work and installations as indicat d.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
RECD1W,YON't NrCE OF COMMENCEMENT.
(Signature of Owner or Agent) loi,
(Signature of Con or)
Signed and sworn to(or affirmed)before me this/2-day of Signed and sworn to(or affirmed)before me this day of
fJ4 .r 121 b, - NOV 2021 ,by lrav'•s_ :4,
, �t G ��% �i
COLLEENA.K LING 3a-�i A,
.,::.; :!4.,r,. b: Commissiotri GG 165631 (Signat ire of Notary)
::.'�'a= Expires December 7,2021 (Signature of Notary)
•:°F�0 '' Bonded Thru Troy Fain Insurance 800.385.7019
1 ]Personally Known OR [ ]P rsonally Known OR .`
CHRISTIAN GILES
Produced Identification [ Produced Identification '': MY COMMISSION#HH 117153 I
ype of Identification: �\� �u
Type of Identification: _ i
�,+�,E'.'�oPi�• EXPIRES:April 1 Z 2025 I
� ^ pF n Bonded Thru Notary Pub' n�
Doc # 2021277222 , OR BK 19969 Page 1538, Number Pages: 1 ,
Recorded 10/21/2021 08 :31 AM, JODY PHILLIPS CLERK CIRCUIT COURT DWAL COUNTY
RECORDING $10. 00
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. 1 69506 1056
State of Ronda --------_ 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: 39-94 09-2S-29E SELVA NORTE UNIT ONE LOT 28
Address of property being improved; 1972 COLINA CT., ATLANTIC BEACH, FL 32233
General description of Improvements: Re-roof
Owner ELIETTE LORIN
Address 1972 COLINAATLANTIC BEACH.FL 32233
Owners interest in site of the improvement owner
Fee Simple Titleholder(if other than owner) N/A
Name
Address
Contractor Sunrise Roofing Company
Address 762 7th.Ave.S,Jacksonville Beach,FL 32250
Phone No.9c4 495-1835 —
N/A Fax No.
Surety(if any) -
Address
__Amount of bond S
Phone No.
Fax No.
Name end 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 tc himself.owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06 l2)(b).Florida Statutes. (Fill in at Owners 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 ONLY gi±
yJr' 4` y
Yf/ DER -
S ned �(/( �t��I "� � n
Before me this
�Y rit.Ts��Y f in the 3 ` r
C° `t1•.P1ouva�lI S r Ronda.has rsonali �ppearao Ft - m
himsei rwfspf 8rid - �5 herrrn by 7 w , i
is that a'.statements and declarations bereft, 2g.
ate Sue and accurate ` t�
C) . r'
Notary si at Large.Stale of County of
• k>y commission expires._ \',� '�1\
Personally Kno.-n M
Produced 1derraOcdlronI C.54.1•YV t'Co" Orr4-64.(0, k__'
Q ^vet, 0,0#tct"I ,Nc110-1.