795 Main St Recd NOC & ReRoof Applc -5- 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
'1 5 '3 Y Q Ahc„, 2zer 3
Job Address: p M(,L,�(� � fij }lu ` �� I--3 Permit Number:
Legal Description l$ "34 3e o,0'14 5-EC. 14 Af Atoci3ei S RES 1 1 mot k -Cc
£ OFr L-Cr bLK c1
Valuation of Work(Replacement Cost)$ l j C{y�,O`: Heated/Cooled SF 259 Non-Heated/Cooled r6
• Class of Work: []New ❑Addition •Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ,esidential
• If an existing structure, is a fire sprinkler system installed?: L'es ❑No
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) to
Describe in detail the type of work to be performed: Re_QcF w+1- 0, JQY1.5 C0O+`D
Y0(1\ ed\A-&••151�1� s
Florida Product Approval# 'L. \ ~7� ^ ‘5 for multiple products use product approval form
Property Owner Information
Name NI 0.)0(2v Address S m Ct-•
City .>v1[�.It'\- L �u CY 1 State_Et`Zip 37233 Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company I I _ • �I;,� qualifying Agent ' �S �:.ig,
Address 1 (C 1 ,Q . 5 , City •. ` i:to Zip 3 Z Z�
Office Phone 9 04 r 323 • t ri 2C1 Job Site Contact Number Ot-t (I '
State Certification/Registration# CCC ',3 t?J .R E-Mail 1 e S1 e ‘,\.‘,-1 6 5 c S. CC,Y1,1
Architect Name& Phone#
Engineer's Name&Phone# 1\i‘ 1,c
Workers Compensation Insurer OR Exemp, Expiration Date IJ' If)
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
RECORDIN . YOUR NOT E OF CO ENCEMENT.
(Signature .f 0 er or Agent) // (Signature of Contractor)
Signed and sworn to(or affirm_ d)before me this `� day of Signed and sworn to(or affirmed)before me this II day of
�.— — iCSiateexFJarl�� bpi/ /020 / F-cortAC,l1,, �1�•� by t(& x( 24 e�
IR Kim A Scharfenstine 1/ �� �_ MIL
My Commission ��
HH 180776 ( ignature . ,ta s�' 1nyppl�rr
(III Exp. 9/30/2025 ry) '•. :# � Itt�J� NSTON
4 • ,., • MY COMMISSION#HH 057579
���.P:' EXPIRES:October 27,2024
VPersonally Known OR [ ]Personally Known OR •:rfors�� BoodedTtvuNotary polio underwriters
[ ]Produced Identification [J,Produced Identificatio
Type of Identification: Type of Identification: L 1)
NOTICE OF COMMENCEMENT
State of FLORIDA Tax Folio No. 170944-0040
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: 18-34 38-2S-29E 0.094 SEC H ATLANTIC BEACH S 40FT LOT 6 BLK 151_
Address of property being improved: 795 MAIN ST_ATI ANTIC REACH Ft 32233
ancr::.! pc imprv.—rrtent• RF-ROOF
Owner: JANET GRIMES Address: 795 MAIN ST.,ATLANTIC BEACH,FL 32233
Owner's interest in site of the improvement: OWNER
Fee Simple Titleholder(if other than owner): NIA
Name:
Contractor: SUNRISE ROOFING COMPANY —
Address: 762 7TH AVE.S.,JACKSONVILLE BEACH,FL 32250
Telephone No.: (SO4)495-1835 Fax No:
Surety(if any) N/A —
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name: NIA
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: N/A
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name: NIA
Address:
Telephone 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):
—
Notary Public State of Florida
Kim A Scharfanstine
THIS SPACE FOR RECORDER'S USE ONLY OWNER • Nil My C 107768s on
Exp. 9/30/2•
Signed: (ç,&,(.,vY4_
Doc#2022014729,OR BK 20102 Page 375, Before me his day of 1 /ePm I i ..- in h;C. o Duval, ate
Number Pages:1Of Florida,has personally appeared . i� AI&r /I ! Gc+=
Recorded 01/19/2022 03:55 PM,
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL Notary Public at Large,State of Ion ,C. my of Duval.
COUNTY My commission expires: q�.0 ..20a c
RECORDING $10.00 Personally Known: or
Produced Identification:
6,1 w'e.6c vl S ac 151'0,4 5,%Ccui on l 1n e