604 MAIN ST REROOF SHINGLE PERMIT PERMIT NUMBER
�� RERF22-0047
CITY OF ATLANTIC BEACH ISSUED: 3/3/2022
• 800 SEMINOLE ROAD
EXPIRES: 8/30/2022
':,1,-u1119)7ATLANTIC BEACH, FL 32233
MUST CA " NP f• '+ .; i 1 ; _ , .,, . . • . � � �_,.., �:; •
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILD!'
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
dOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property
hat may be found in the public records of this county, and there may be additional permits required from other
;overnmental entities such as water management districts, state agencies, or federal agencies.
ry' :JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
604 MAIN ST REROOF SHINGLE SHINGLE ROOF $8750.00
r TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170915 2000 ATLANTIC BEACH SEC H
L:E` `s•COMPANY: ADDRESS: CITY: STATE: ZIP:
ROMANO BROTHERS
ROOFING, INC 155 E. Levy Road Atlantic Beach FL 32233
OWNER: ADDRESS: CITY: STATE: ZIP:
WILLIAMS SAMUEL 604 MAIN ST ATLANTIC BEACH FL 32233
NARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
N YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
;OMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
NSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
toll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $95.00
STATE DBPR SURCHARGE 455 0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$99.00
Issued Date: 3/3/2022 1 of 2
,;:&-•0y Building Permit Application Updated 10/9,18
r ; City of Atlantic Beach Building Department **ALL INFORMATION
"�. 7` 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
l-v'; IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
RGRF 2.-Z-0047
Job Address: �.c, q 11�--A(}.1n :4 - Permit NumbQtsr „e-('E
1 l 1 C•
Letd-t4 gal Description)$.... --1 ITh -DS- k. •MS N-V)be 1( h RE#� 41_ �
Valuation of Work(Replacement Cost)$R---i ( Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑AdditionAlteration DRepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Residential
• If an existing structure,is a fire sprinkler system installed?: DYes ❑No
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ❑No
D tribe in tail the type of work to be performed:
Q__/ CC)c' TheLc-- ,t6kno
c
Florida Product Approval# k 1 .)1z . ` 1S1 l.4 for multiple products use product approval form
Property Owner Information ,
` II4
Name 4\ �i C; �1, Addr-ss V -1 \ Q 'I.Z .
City aR V 1 • ► M- • ` State 1 I Zip ..�iii Phone l - I • - C
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor nforma ion
Name of Co a 41111101..._. ti jib - S Quali t Y'1✓1
Address�� sQ - • City State Zip" 5
Office Phon _ _,- ,,L Job Site Contact Number I nn`� q[�' (x,t1 C> -t-j... ✓,r"
State Certifica n/Registration# I •0 til E-Mail 1
Architect Name& Phone#
s
Engineer's Name&Phone# 1 �- 'JT
Workers Compensation Insurer `� OR Exempt 0 Expiration Date�c c ::%)'"
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or inst Ilation 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 OBT a IN FIIIANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECO h,a ING Y U NOTI _ OF CO MENCEMENT.
(Signature of Owner or nt) (Signature of Contractor)
Signed an swor to(or affirm d)before - this 2 day of Si ed and sworn to(or affir -.)before m- this 2 day of
(Signature of Notary) •na ryes fiOjaryl
t " ,,JY��-., NICHOLAS JOSHUA 3ROWER
dry:.; .. 7iIC;HOLAS JOSHUA 3ROWER 0 r°• t': Notary Public-State of Florida
;? `r:. notary Public State of Florida ®" Commission HH 186068
[ ]Personally Known OR � Personally Known OR
:� Commission.4 HH 186068 f ' ''or c.. My Comm.Expires Feb 1,2026
pd)Produced Identificati n ( I Produced Identification Bonded through National Notary Assn.
%7 CF F� My Comm.Expires Feb 1,2026 [ ]
Type of Identification: , 4 Soncec through National Notary Assn. 0 Type of Identification:
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.# 170915-2000
State of FL 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 17-2S-29E.085 ATLANTIC BEACH SEC H S(OFT LOT 5,N 26.25F7
LOT 6 BLK 132
Address of property being improved:604 MAIN ST ATLANTIC BEACH,FL 32233
General description of improvements: REROOF
Owner Samuel Williams
Address 604 MAIN ST ATLANTIC BEACH,FL 32233
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor ROMANO BROTHERS ROOFING INC
Address PO BOX 330337 ATLANTIC BEACH FL 32233
Phone No. 904-246.5649 Fax No. 904-246-4810
Surety(if any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
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 DANNY ROMANO
Address 155 LEVY RD SUITE E ATLANTIC BEACH FL 32233
Phone No. 904-610-0476 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 Statutes.(Fill in at Owner's option).
Name
Address
Phone Na Fax No
Expiration date of Notice of Commencement(the expiration date is% e(1)year from the date of recording unless a
different date is specified):
LY O•N •
;i0"iii• NICHOLAS JOSHUA BROWER f Signed - ATE Z
t` Notary Public•State of Florida Before day. U! _ me
Commission x HH 186068u..,! ► ate F••• s °�appe�ar�gd
'' orn My Comm.Expires Feb 1,2026 � + herein by
Bonded through National NotaryAssn. imselt -rse a affirms hat a state ruts and dec orations herein
are true and accurate
Doc# OR BK 20168 Page 1903,
Number Pages: 1 v v ! 1
Recorded 03/03/2022 08:40 AM, ary Public at Large.Stat-o �/ , County of JI
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL My commission expires: b 17Irfr13r �!
Personally Knov:n or
COUNTY Produced Identification
RECORDING $10.00 -