551 Pelican Key RERF22-0008 ShingleOWNER:ADDRESS:CITY:STATE:ZIP:
DAVIDSON BRIAN S 551 PELICAN KY ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
Avenue Roofing 6251 Philips Hwy Ste 5 Atlantic Beach Fl 32233
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
172027 5578 SELVA LAKES UNIT 02
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
551 PELICAN KEY REROOF SHINGLE Shingle: FL10124.1,
Underlayment: 10626.1 $10123.40
FEES
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 BUILDING ROOF IN-PROGRESS INSPECTION REQUIRED INFORMATIONAL
Notes:
a. The roof sheathing for all new construction must remain uncovered until the Roof Sheathing Inspection is approved.
b. All roofing projects require an In-Progress Inspection.
c. Sheathing installation and replacement guidelines per APA.
d. Underlayment must conform to FBC-R Table 905.1.1
e. Shingles must conform to ASTM D3161 G or H, or ASTM D7158 F
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.
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.
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.
1 of 2Issued Date: 1/20/2022
PERMIT NUMBER
RERF22-0008
ISSUED: 1/20/2022
EXPIRES: 7/19/2022
REROOF SHINGLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $105.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $109.00
2 of 2Issued Date: 1/20/2022
PERMIT NUMBER
RERF22-0008
ISSUED: 1/20/2022
EXPIRES: 7/19/2022
REROOF SHINGLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $109.00
RERF22-0008 Address: 551 PELICAN KEY APN: 172027 5578 $109.00
BUILDING $105.00
BUILDING PERMIT 455-0000-322-1000 0 $105.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R18530 $109.00
Printed: Thursday, January 20, 2022 9:40 AM
Date Paid: Thursday, January 20, 2022
Paid By: Avenue Roofing
Pay Method: CREDIT CARD 576676952
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R18530
Final Plumbing
Final Electrical
Final HVAC
CC Final
Final Building*
Swimming Pool Steel
Swimming Pool Safety
Electrical Grounding & Bonding
Swimming Pool Final (Bldg)
Swimming Pool Final (PW)
Formed Columns/ Beams*
Masonry Cell Fill
Structural Steel*
OTHER:
OTHER:
OTHER:
OTHER:
OTHER:
Power Pole
Silt Fence
Piers/ Stem Walls
Underground Plumbing
Underground Electric
Foundation/ Footing
Slab**
Retaining Wall Footing
Driveway
Sewer (Building Dept)
Sewer Tap (Utilities Dept)
Rough Electric*
Rough Plumbing/ Top Out*
Rough Mechanical*
House Wrap
Wall Sheathing
Roof Sheathing
Tie-down Framing Connections
Rough Framing
Roofing In Progress
Window/Door In-Progress
Insulation Ceiling
Insulation Wall
Exterior Lath
Stucco Scratch Coat
Exterior Siding In-Progress
Brick Flashing & Ties
Early Power
Gas Rough
Gas Final*
* When all rough electric, plumbing, mechanical are complete but before any work is
covered up.
* When all gas piping is complete and wallboard is installed but before gas is
attached to any appliance. All outlets must be capped and pipe pressurized at a
minimum of 15 lbs.
* For new living space: When all construction work including electrical, plumbing,
mechanical, exterior finish, grading, required paving and landscaping is complete
and the building is ready for occupancy, but before being occupied
Additional inspections may apply to your project if your project
contains these elements:
INSPECTIONS REQUIRED FOR BUILDING PERMITS
To verify compliance with building codes, inspections of the work authorized are required at various points of the construction.
The following inspections are typically required for residential projects:
Date: Initial: Date: Initial:
_____________________________________________________
Permit Type
____________________________________________________
Permit No.
__________________________________________________________
Job Address
____________________________________________________
Contractor
POST THIS CARD WITH PERMITS AND PERMIT
DOCUMENTATION IN FRONT OF BUILDING
Construction Hours per City Code: 7am—7pm Weekdays; 9am—7pm Weekends
Building Department Public Works/Utilities Fire Department
Phone: 904-247-5826 Phone: 904-247-5834 Phone: 904-630-4789
Fax: 904-247-5845 Fax: 904-247-5843 Fax: 904-630-4203
* When forms and reinforcing steel, anchor bolts, sleeves and inserts, and all
electrical, plumbing and mechanical work is in place, but before concrete is poured.
* When all structural steel members are in place and all connections are complete,
but before such work is covered or concealed.
** FORM BOARD ELEVATION CERTIFICATE MUST BE ON-SITE FOR SLAB INSPECTION
Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: _______________________________________________________ Permit Number: ____________________________
Legal Description ________________________________________________________________ RE# _________________________
Valuation of Work (Replacement Cost) $_________________ Heated/Cooled SF ___________ Non- Heated/Cooled_____________
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:
Florida Product Approval #______________________________________________ for multiple products use product approval form
Property Owner Information
Name ______________________________________________ Address _________________________________________________
City ____________________________________ State _______ Zip _______________ Phone ________________________________
E-Mail ______________________________________________________________________________________________________
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) _________________________________________________
Contractor Information
Name of Company _______________________________________ Qualifying Agent _______________________________________
Address________________________________________________ City___________________ State ________ Zip_______________
Office Phone ____________________________________ Job Site Contact Number _______________________________________
State Certification/Registration # ____________________ E-Mail_______________________________________________________
Architect Name & Phone # ______________________________________________________________________________________
Engineer’s Name & Phone # _____________________________________________________________________________________
Workers Compensation Insurer _____________________________________ OR Exempt □ Expiration Date ___________________
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)
Signed and sworn to (or affirmed) before me this ____ day of
___________, ________, by ____________________________
________________________________
(Signature of Notary)
[ ] Personally Known OR
[ ] Produced Identification
Type of Identification: ______________________________________
___________________________________________________
(Signature of Contractor)
Signed and sworn to (or affirmed) before me this ____ day of
___________, ________, by ____________________________
________________________________
(Signature of Notary)
[ ] Personally Known OR
[ ] Produced Identification
Type of Identification: ______________________________________
**ALL INFORMATION
HIGHLIGHTED IN GRAY
IS REQUIRED.
551 Pelican Key Jacksonville, FL 32233
1 43-11 17-2S-29E SELVA LAKES UNIT 2 LOT 91 172027-5578
10123.40
Full Roof Replacement
x
X
X
x
DAVIDSON BRIAN S 551 Pelican Key
Jacksonville FL 32233 (214) 316-9294
brian.davidson81@gmail.com
AVENUE ROOFING LLC MICHAEL JOSEPH SHOUVLIN
9526 Argyle Forest Ste B2 #512 Jacksonville FL 32222
904-712-3494
CCC1332649 ADMIN@AVENUEROOFING.COM
Frank Winston Crum Insurance Company 01/01/2023
X
FL Driver License
January
10th
2022 Brian S Davidson
State of Florida County of Pinellas
See Notarize.com Attached Certificate
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DESCRIPTION OF ATTACHED DOCUMENT
Title or Type of Document: ____________________________________________________
Document Date: ________________________________
Number of Pages (including notarial certificate): _____________
On __________________, before me, _________________________________________ ,
the foregoing instrument was subscribed and sworn (or affirmed) before me by:
________________________________________________________________________.
Name of Affiant(s)
JURAT
State/Commonwealth of _____________________
City County of ______________________
Notary NameDate
Personally known to me -- OR --
Proved to me on the basis of the oath of _____________________________ -- OR --
Proved to me on the basis of satisfactory evidence: ________________________________
Type of ID Presented
Name of Credible Witness
WITNESS my hand and official seal.
Notary Public Signature: _________________________
Notary Name:__________________________________
Notary Commission Number:______________________
Notary Commission Expires:______________________
Notarized online using audio-video communication
Pinellas
FL Driver License
2
10/11/2024
HH 52334
William Wallace Schrimpf Jr
William Wallace Schrimpf Jr01/10/2022
Florida
Brian S Davidson
City of Atlantic Beach - BUILDING PERMIT APPLICATION
01/10/2022
FLORIDA PRODUCT APPROVAL SHEET - STATE OF FLORIDA COUNTIES
*Project Address: _________________________________________________________________________
*Permit #: __________________________*Owner/Project Name: __________________________________
As required by Florida Statute 553.842 and Florida Administrative Code Rule 61G20-3, please provide the
information and product approval number(s) for the building components listed below as applicable to the
building construction project for the permit number listed above. You should contact your product supplier if
you do not know the product approval number for any of the applicable listed products. Information
regarding statewide product approval may be obtained at: www.floridabuilding.org.
ROOFING PRODUCTS
1.Asphalt shingles
2.Underlayments
3.Roofing fasteners
4.Nonstructural metal
roof
5.Built-up roofing
6.Modified bitumen
7.Single ply roofing
8.Roofing tiles
9.Roofing insulation
10.Waterproofing
11.Wood shingles/shakes
12.Roofing slate
13.Liquid applied roofing
14.Cement-adhesive
coats
15.Roof tile adhesive
16.Spray applied
polyurethane roof
17.Other
Category/Subcategory Manufacturer Product Description FL Approval #
18.Other
19.Other
20.Other
STRUCTURAL
COMPONENTS
1.Wood
connector/anchor
2.Truss plates
3.Engineered lumber
4.Railing
5.Coolers-freezers
6.Concrete admixtures
7.Material
8.Insulation forms
9.Plastics
10.Deck-roof
11.Wall
12.Sheds
13.Other
SKYLIGHTS
1.Skylight
2.Other
In addition to completing the above list of manufacturers, product description and State
approval number for the products used on this project, the Contractor shall maintain on
the job site and available to the Inspector, a legible copy of each manufacturer's
printed specifications and installation instructions along with this Product Approval Sheet. I certify
that this product approval list is true and correct to the best of my knowledge. I further certify
that use of different components other than the ones listed in this document must be approved
by the Building Official.
*Contractor Name (Print Name):________________________________________________________
*Contractor Signature: ________________________________________________________________
*Company Name: ____________________________________________________________________
*Mailing Address: _____________________________________________________________________
*City: _______________________________________________ *State: _________________________
*Zip Code: ____________________________________________
*Telephone Number: _________________________ E-Mail Address: ____________________________
*Cell Phone Number: _________________________ Fax Number: ______________________________
Manufacturer Product Description FL Approval #
Manufacturer Product Description FL Approval #
NOTICE OF COMMENCEMENT Permit No . _________ _
Tax Folio No . ________ _
T HE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in a ccord ance with
Chapter 713, Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT.
I. Description of property (legal · 2.. Lo-f Cf!
a) Street (job) Address :_....,,,,,_,'---4.Ll.Lu.,,.,=------j""-'"\-__,[1.1.IQ,,(!!.L!l,'----.Qt~L.JO--+---L....\,,e___.e::_--=-.,~~-----
2. General description ofimprovement(s): RE-ROOF ---=-=-==--=-c ______________________ _
3. Owner or Lessee mfo rmatlon .(L essee as owner on ly ,f contracte i:J fo r improvem ent s)
a . Name: l3r e,I\ ~,cl5M _l S ~r~o..v 1d1;ep,
b. Address ,SS\ pi-Ro...; NJ Jff\d,;Afr, tieD-Ch. 1FL 32'L3 3
c. Interest in property : OWNED/PRIMARY RESIDENCE
d. Name and address of fee simple titleholder (if other than owner):. _________________ _
4. Contractor Information
a. Name and address : AVENUE ROOFING LLC 9526 Argyle Forest Ste 82 #512 Jacksonville, FL 32222
b. Phone number: 904-712-3494 Fax No . (Opt.)_
5. Surety Information
a. Name and address: b. Amount of bond$-----------------
c. Phone number: ______________ Fax No . (Opt .).
6. Lender
Do c # 202 131 3632 , OR BK 20030 Pag e 502,
Number Pages : 1
Reco rded 11/24/20 2 1 04:14 PM ,
JODY PHI LLIPS CLERK CIRCUIT COU RT DUVA L
CO UN TY
RE COR DING $10 .00 a. Name and address : ________________ _
b. Phone number. ________________________________ _
7. Persons within the State of Florida designated by Owner upon who notices or other docum en ts may be served as prov id ed by
Section 713 .13(1)(a)7 ., Florida Statutes:
~:me and tddress: _______________________________ _
. one num er: -=-=---------=----:-----:---:--:-:----:--------------,----,-------,---,-----,:--:-:--------:--:---:-:---
8 . In addition to himself, Owner designates the following person(s) to recei ve a copy of th e Lienor's Notic e as pro vided in
Section 71 3. IJ(l )(b ), Florida Statutes :
a. Name and address: _______________________________ _
b . Phone number:-=---=-----------,---------=--:------:------:--,-------:,---:---,-------::-------:-:-------:---=--Expiratioo date of notice of commencement (the expiration date is I year from the date of recording unl ess a di1Te1 ·en t
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 1, SECTION 713.13, FLORIDA STAT UES , AND
CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A
NOTICE OF COMMENCEME NT MUST BE RECORDED AND POSTED O N THE JO B SITE
BEFORE THE FIRS T INSPEC TION. IF YOU INTEND TO OBTAIN FINANCI NG, CONSULT
WITH YOUR LE NDER OR AN AT TORN EY BEF OR E COMMENCIN G WOR K OR
RECORDIN G YO UR NOTICE OF COMM EN T. xi~u
Si gnatory 's T
State of Fl orid a
The foregoin g instrum en t wa s ac k nowledged before m e by m e ans of 9(physica l presence trr-B-online
nota n zatwn, th1 s'Z, ~ay of D Q-.0 be< _ , 201:...!._ by Jsc ~r,.,n J)o-.,1,0.":>1;:,o , w ho is persona!,!y known to m e or has produced
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