234 Poinsettia St RERF22-0001 Shingle REROOF SHINGLE PERMIT PERMIT NUMBER
^�s i J- ' RERF22-0001
11 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 1/4/2022
<1-__•01119'1,_; ATLANTIC BEACH, FL 32233 EXPIRES: 7/3/2022
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:
234 POINSETTIA ST REROOF SHINGLE Shingle: FL10124 R26, $4500.00
Underlayment: FL18686-R4
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170572 0000 SALTAIR SEC 03
COMPANY: ADDRESS: CITY: STATE: ZIP:
MONAHAN ROOFING 2050 S KING CIR NEPTUNE BEACH FL 32266
OWNER: ADDRESS: CITY: STATE: ZIP:
SMITH DAVID 234 POINSETTIA STREET ATLANTIC BEACH FL 32233
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.
_ FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $75.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$79.00
Issued Date: 1/4/2022 1 of 2
REROOF SHINGLE PERMIT PERMIT NUMBER
\\ CITY OF ATLANTIC BEACH RERF22-0001
ISSUED: 1/4/2022
800 SEMINOLE ROAD
"401: ATLANTIC BEACH, FL 32233 EXPIRES: 7/3/2022
Issued Date: 1/4/2022 2 of 2
Building Permit Application Updated 10/9/18
rM City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
yr IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Li Pa,r1,3-e_tit CN .S I- Permit Number:
r\ue•- LLA y S`{ 4% SZt } tel. .-
Legal
Legal Description s `t- 6, c, f,<, .__ t RE# / 7 0 S? R - CSG G c
Valuation of Work(Replacement Cost)$ LIrSC>C) Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration DRepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial l idential
• If an existing structure,is a fire sprinkler system installed?: DYes 0'No
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) -KINo
Describe in detail the type of work to be performed: I I a� ,11`4-11< 'r1 cue
re.01W2 C3lCl .3'rwIst2 r‘Q.) 1 P ywU�
1c`Aitfnc.t , /0 /-ate Li Ft.._ f`by, t Ar�hr fc 4w1 ShinSj.a'
r',or d.a Product Approval# 0foi multiple products use product approval form
Property Owner Information �'b usFc r /d'G 2' cr
Name i ,sqvr z ( S rn I Address 27e, Po,,, J ef-. -. -1 I-- _
City A! State I-/ Zip Phone
E-Mail -
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company 1(Y)drlahcrn (In Qualifying Agent / O M i-no Ac /h -,
Address' 2 0 53 1c;0-5 u G1 r'c(Q S City ep hurt-c_ Qch State Rg Zip 2 2Z G g
Office Phone 5d124-) Job Site Contact Number S(v 8 -
State Certification/Registration# E-Mail T1--Mar h4r1 c CorfQ- oe_1—
Architect Name&Phone# N
Engineer's Name&Phone# N I fa-
Workers Compensation Insurer OR Exempt/Expiration Date el-J_
23
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
RECORDFJVG YOUR NOTICE OF4IMMENCEMENT.
(Signature of Owner or Agent) (Signature of Con actor)
Signed and sworn to(or affirmed)before m this 3 day of Si ned and sworn to(or affirmed)before me this day of
, LO Z by 1. ✓n ,l va( , 20a- ,by l owt" Mond
'r• 'Y)
ASHETON DOUD -
� Commission#GG 366354
,., MY COMMISSION*HH 203966 Expires August 15,2023
[ ]Personally Known OR EXPIRES:December 2,2025 [ )Personally Known OR aR.' '' Bonded ThruTroy Fain Insurance 800.3857019
?o•i�oPP Bonded Tlxu Notary Public UndenwI1Ms
NI Produced Identification 1-Produced Identification �.
Type of Identification: (2 - L Type of Identification: f(r U L
• NOTICE OF COMMENCEMENT
Permit No. Parcel ID/Tax Folio No.
State of Florida, County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713, Florida Statutes,the followinginformation is provided in this Notice of Commencement.
0 Description of property(legal description of property and address if available):
Ajor/4 `z SW. vCLtio•l _? p/c,< bc,.. & / v pG c 1(-
2.
(2. General Description of improvements:
mete' e g_ erocF
3. Owner Information:
a)Name and Address: L Ar' J/''t , 23'7 , - J- f l�-� <// C
b)Interest in property: 0 u.n e,-
c)Name and address of simple titleholder(if other than owner):
4. Contractor Information:
a)Name and Address: Mcact hF S Ccn f rcac..lori, �'N C 20Sa S a ce��
b)Phone Number: 22/ -00 Si' ,t er `4
5. Surety Information: ?22 GG
a)Name and Address:
b)Phone Number:
c)Amount of Bond: $
6. Lender Information:
a)Name and Address: N f (3
b)Phone Number:
7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13 (1)(a) 7,Florida Statutes:
a)Name and Address: M / fl
b)Phone Numbers of Designated Person:
8. In addition to himself/herself, Owner designates of to receive a
copy of the Lienor's Notice as provided in Section 713.13 (1) (b), Florida Statutes.
a)Name and Address: /,�j
b) Phone Number of person or entity designated by owner:
9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction
and final payment to the contractor,but will be one(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.
Under penalty of perjury, I declare that I have read the foregoing notice of commencement and that the facts stated
therei s . - l e to the best of my ledge and belief.
c \ c a.—
ignature of Owner or Owner's Authorized Officer/Director/Partner/Manager 'Signatory's Printed Name&Title/Office
The foregoing instrumentjwas acknowledged before me this _ day of TJ - L. -� - , 20 2..1,.
by A r Lv}i^ (/ud as WcAvh_ti for Lc,.ore-- s th
(Name of Person) (Type of Ai�t ority,i.e.Officer/Attorney) (Name of Party Instrument was Executed for)
ASHETON DOUG VLt
141 , t+ MY COMMISSION/HH 2O3 NOTARY PUB IC STATE OF FLORIDA
:"•'.-�� EXPIRES:December 2,2025 Print Name: i sn aved
Bonded MuNeter/Public 1k enders
❑ Personally.Known
Doc#2022001614,OR BK 20080 Page 2243, [I Identification'Type: Or RFs L
Number Pages: 1
Recorded 01/04/2022 10:19 AM,
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL Revised 1/18/18
COUNTY
RECORDING $10.00