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800 SEMINOLE RD RERF22-0085 91 e�, REROOF SHINGLE PERMIT PERMIT NUMBER k CITY OF ATLANTIC BEACH RERF22-0085 aw AV 800 SEMINOLE ROAD ISSUED: ATLANTIC BEACH, FL 32233 EXPIRES: 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: 800 SEMINOLE RD REROOF SHINGLE SHINGLE ROOF $60707.00 TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION: CONSTRUCTION: NUMBER: GROUP: 170389 0000 SALTAIR SEC 02 COMPANY: ADDRESS: CITY: STATE: ZIP: LEWIS WALKER ROOFING P 0 BOX 554 LAKE BUTLER FL 32054 OWNER: ADDRESS: CITY: STATE: ZIP: CITY OF ATLANTIC BEACH 800 SEMINOLE RD ATLANTIC BEACH FL 32233-5444 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 $324.00 STATE DBPR SURCHARGE 455-0000-208-0700 0 $4.86 STATE DCA SURCHARGE 455-0000-208-0600 0 $3.24 TOTAL:$332.10 Issued Date: 1 of 1 Building Permit Application Updated 10/9/18 City of Atlantic Beach Building Department **ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED. Job Address: 800 SEMINOLE RD. ATLANTIC BEACH, FL 32233 Permit Number:h -RJ Z Z- COBS 10-15 16-2S-29E 12.900 SALTAIR SEC 2 LOTS 27 TO 66,103 TO 150,CLOSED Legal Description STREETS ADJACENT THEREOF,34-64 SALTAIR ACRES SECTION 02 PT TRACT A RECD 4094-1017 RE# 170389-0000 Valuation of Work(Replacement Cost)$ 60,707 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) XNo Describe in detail the type of work to be performed: 116 SQUARE SHINGLE REROOF 5/12 Florida Product Approval# ISL 1012-it) FL J d 6 2 6 for multiple products use product approval form Property Owner Information Name CITY OF ATLANTIC BEACH Address 800 SEMINOLE RD City ATLANTIC BEACH State FL zip 32233 Phone E-Mail Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company LEWIS WALKER Qualifying Agent AMY SKOWRON Address PO BOX 2147 City LAKE CITY state FL Zip 32056 Office Phone 866-959-7663 Job Site Contact Number State Certification/Registration # CCC1333551 E-Mail permit nq(a�Iewlswalkerroofinq.com Architect Name&Phone# N/A Engineer's Name& Phone# N/A a Workers Compensation Insurer BUILDERS MUTUAL INSURANCE COMPANY OR Exempt o Expiration Date 4i/it U /2-0 2.2., 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 YOIJR NOTICE OF COMMENCEMENT. -'- v (Signature of Owner or Agent) (Signature of Contractor) i Signed and sworn to(or affirmed)before me this 3t day of Si ned and sworn to(or affirmed) before me this 11 day of much , aoaa , by 64-I\ k<i n AM > \ ,20 Z2 , by L,wls WGtY+-✓ V ;d:o r (Signature o• ‘•t.ry) : •'.:: ,g l it'JY>�INSTON 6c1gYPrise BPABARA JOHNSTON 4 ..• MY COMMISSION#HH 057579 r .a ro;,• EXPIRES:October 27,2024 Commission a GG 306135 [ ersonally Known OR Eo.f�°P' ga µ p p [ Personally Known OR ' -OF =. `oma Expires May 6,2023 [ ]Produced Identification' 4 [ ] Produced Identification OFP..0 600dedTin Bute(NohrySerete$ Type of Identification: _ Type of Identification: PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA (*REQUIRED) *Project Address: 800 SEMINOLE RD, ATLANTIC BEACH, FL 32233 Permit#: *Owner/Project Name: CITY OF ATLANTIC BEACH 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. Category/Subcategory Manufacturer Product Description Limitation of Use State# Local# A.EXTERIOR DOORS 1. Swinging 2. Sliding 3.Sectional 4. Garage Roll-Up 5.Automatic 6. Other B.WINDOWS 1. Single hung 2. Horizontal slider 3. Casement 4. Double hung r-- 5. Fixed 6.Awning 7. Pass-through 8. Projected 9. Mullion 10. Wind breaker 11. Dual action 12. Other Page 1 of 4 Updated 06/21/21 Category/Subcategory Manufacturer Product Description Limitation of Use State# Local# C. PANEL WALL 1.Siding 2.Soffits 3. EIFS 4.Storefronts 5. Curtain walls 6. Wall louvers 7. Glass block 8. Membrane 9. Greenhouse 10. Synthetic stucco 11. Other D. ROOFING PRODUCTS 1.Asphalt shingles GAF TIMBERLINE FL10124 2. Underlayments y Giqf I,fesefher lvr41c.h l- 106 Z 6 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 Page 2 of 4 Updated 06/21/21 Category/Subcategory Manufacturer Product Description Limitation of Use State# Local# E.SHUTTERS 1.Accordion 2. Bahama 3.Storm panels 4. Colonial 5. Roll-up 6. Equipment 7. Other F.STRUCTURAL COMPONENTS 1. Wood -_- — — - ---connector/anchor _ 2.Truss plates 3. Engineered lumber 4. Railing --- - ----- _�.--- 5.Coolers-freezers 6.Concrete admixtures 7. Material S. Insulation forms 9. Plastics 10. Deck-roof 11. Wall 12. Sheds 13. Other G.SKYLIGHTS 1. Skylight 2. Other H. NEW EXTERIOR ENVELOPE PRODUCTS 1. 2. Page 3 of 4 Updated 06/21/21 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): Lewis Walker *Contractor Signatur---- *Company Name: Lewis Walker Roofing, INC *Mailing Address: Po Box 2147 *City: Lake City *State: FL *zip Code: 32056 *Telephone Number: 866-959-7663 *E-mail Address: permitting©Iewiswalkerroofing.com Cell Phone Number: Fax Number: 386-719-4472 Page 4 of 4 Updated 06/21/21 Florida Building Code Online https://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVX... FIOR{OA O4PARIMGNT OF '} !.P^'' , Business & Professional Regulation i HI •_< 1 rOBPR HOME ABOUT DBPR OOP*0ivis DNS CONTACTDent BCIS Home Log In User Registratbn Hot Topics Submit Surcharge Stats&Facts Publicatbns Contact Us BCIS Site Map Links Search d1:1'11C'-3 r $ ProductAPProvaIUSER:Public User Product Approval Menu>Product or ApplicationSearch>Application List>Application Detail 0 oFFicE of THE FL# FL10124-R31 SECRETARY Application Type Revision Code Version 2020 Application Status Approved Comments Archived Product Manufacturer GAF Address/Phone/Email 1 Campus Drive Parisppany, NJ 07054 (800)766-3411 mstieh@gaf.com Authorized Signature Robert Nieminen Ireith@nemoetc.com Technical Representative William Broussard Address/Phone/Email 1 Campus Drive Parsippany, NJ 07054 (800)766-3411 TechnicalQuestionsGAF@gaf.com Quality Assurance Representative Address/Phone/Email Category Roofing Subcategory Asphalt Shingles Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida Professional Engineer Evaluation Report- Hardcopy Received Florida Engineer or Architect Name who developed Robert Nieminen the Evaluation Report Florida License PE-59166 Quality Assurance Entity UL LLC Quality Assurance Contract Expiration Date 12/16/2022 Validated By John W. Knezevich, PE Validation Checklist- Hardcopy Received Certificate of Independence FL10124 R31 COI 2021 01 COI NIEMINEN.pdf Referenced Standard and Year(of Standard) Standard Year ASTM D1970 2015 ASTM D3161 2016 ASTM D3462 2010 ASTM D7158 2019 TAS 107 2020 Equivalence of Product Standards Certified By 1 of 2 4/19/2022, 10:47 AM Florida Building Code Online https://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVX... Sections from the Code Product Approval Method Method 1 Option D Date Submitted 08/12/2021 Date Validated 08/16/2021 Date Pending FBC Approval 08/22/2021 Date Approved 10/12/2021 Summary of Products FL# Model,Number or Name Description 10124.1 GAF Asphalt Roof Shingles Fiberglass reinforced 3-tab, laminated, 5-tab and hip/ridge asphalt shingles Limits of Use Installation Instructions Approved for use in HVHZ: No FL10124_R31_II_2021_08_04_FINAL ERGAF_ASPHALT Approved for use outside HVHZ:Yes SHINGLES_FL10124-R31.pdf Impact Resistant: N/A Verified By: Robert Nieminen PE-59166 Design Pressure: N/A Created by Independent Third Party: Yes Other: Refer to ER,Section 5. Evaluation Reports FL10124R31AE20210804FINAL_ER_GAF_ASPHALT SHINGLES_FL10124-R31.pdf Created by Independent Third Party: Yes Bads Next Contact Us::2601 Blair Stone Road,Tallahassee FL 32399 Phone:850-487-1824 The State of Florida is an AA/EE0 employer.CoQyripht 2007-2013 State of Florida ::Privacy Statement::Accessibility Statement::Refund Statement Under Florida law,email addresses are public records.If you do not want your e-mail address released in response to a public-records request,do not send electronic mail to this entity.Instead,contact the office by phone or by traditional mail.If you have any questions,please contact 850.487.1395.*Pursuant to Section 455.275(1),Florida Statutes,effective October 1,2012,licensees licensed under Chapter 455,F.S.must provide the Department with an email address if they have one.The emails provided may be used for official communication with the licensee.However email addresses are public record.If you do not wish to supply a personal address,please provide the Department with an email address which can be made available to the public.To determine if you area licensee under Chapter 455,F.S., please click tea_ Product Approval Accepts: ® ® ® Credit Card Safe 2 of 2 4/19/2022, 10:47 MV Florida Building Code Online https://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVX... FLORIDA CIlPAATMSNT OF Business & Professional Regulation . _. rDBPR NOME ABOUT DBPA OBRA DIVISIONS CONTACT NPR BCIS Home Log In User Regstration Hot Topics Submit Surcharge Stats&Facts Publications Contact Us BCIS Site Map Links Search d ,or i Product Approval USER:Public User Product Appr_oval Menu>Product or Application Search>Application Let>Appl_icatgn History>Application Detail R OFFICE OF THE FL# FL10626-R22 SECRETARY Application Type Revision Code Version 2020 Application Status Approved Comments Archived Product Manufacturer GAF Address/Phone/Email 1 Campus Drive Parisppany, NJ 07054 (800) 766-3411 mstieh@gaf.com Authorized Signature Robert Nieminen Ireith@nemoetc.com Technical Representative William Broussard Address/Phone/Email 1 Campus Drive Parsippany, NJ 07054 (800)766-3411 TechnicalQuestionsGAF@gaf.com Quality Assurance Representative Address/Phone/Email Category Roofing Subcategory Underlayments Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida Professional Engineer Evaluation Report-Hardcopy Received Florida Engineer or Architect Name who developed Robert Nieminen the Evaluation Report Florida License PE-59166 Quality Assurance Entity UL LLC Quality Assurance Contract Expiration Date 12/31/2024 Validated By John W. Knezevich, PE Validation Checklist- Hardcopy Received Certificate of Independence FL10626_R22_COI_2021OS_COI_NIEMINEN.pdf Referenced Standard and Year(of Standard) Standard Year ASTM D1970 2015 ASTM D4533(tear) 2015 ASTM D4798(weathering) 2011 ASTM D4869(water transmission) 2016 ASTM D5035(tensile) 2011 ASTM D6164 2011 ASTM D6757 2016 FM 4474 2011 1 of 2 4/19/2022,3:27 PN Florida Building Code Online https://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVX... FRSA/TRI,6th Edition 2018 Equivalence of Product Standards Certified By Sections from the Code • Product Approval Method Method 1 Option D Date Submitted 06/09/2021 Date Validated 06/11/2021 Date Pending FBC Approval 06/17/2021 Date Approved 08/10/2021 Date Revised 12/16/2021 Summary of Products FL# Model,Number or Name Description 10626.1 GAF Roof Underlayments Roofing Underlayments for use in sloped roof systems for use in FBC non-HVHZ jurisdictions Limits of Use Installation Instructions Approved for use in HVHZ: No FL10626_R22_II_2021_06_09_FINAL_ER_GAF_UNDERLAYMENTS_FL10626- Approved for use outside HVHZ:Yes R22.pdf Impact Resistant: N/A Verified By: Robert Niemien 59166 Design Pressure: +N/A/-442.5 Created by Independent Third Party: Yes Other: 1.)The design pressure noted in this Evaluation Reports application relates to one particular FL10626R22AE20210609 FINAL ERGAF UNDERLAYMENTSFL10626- underlayment system. Refer to ER Section R22.pdf 5.8.3 for details. 2.) Refer to ER Section 5 for Created by Independent Third Party: Yes other Limits of Use. lea* fit' Contact Us::2601 Blair Stone Road,Tallahassee FL 32399 Phone:850-487-1824 The State of Florida is an ANEEO employer.Copylight 2007-2013 State of Florida ::Privacy Statement::Accessibility Statement::Refund Statement Under Florida law,email addresses are public records.If you do not want your e-mail address released in response to a public-records request,do not send electronic mail to this entity.Instead,contact the office by phone or by traditional mat.If you have any questions,please contact 850.487.1395.*Pursuant to Section 455.275(1),Florida Statutes,effective October 1,2012,licensees licensed under Chapter 455,F.S.must provide the Department with an email address if they have one.The emai5 provided may be used for officlal communication with the licensee.However email addresses are public record.If you do not wish to supply a personal address,please provide the Department with an email address which can be made available to the public.To determine If you are a licensee under Chapter 455,F.S., please click hem._. Product Approval Accepts: Credit Card Safe 2 of 2 4/19/2022,3:27 PM Doc # 2022099204 , OR BK 20231 Page 1830, Number Pages : 1 , Recorded 04/20/2022 09 : 49 AM, JODY PHILLIPS CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10 . 00 NOTICE OF COMMENCEMENT State of FLORIDA Tax Folio No. 170389-0000 County of DUVAL To Whom It May Concern: The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT. Legal Description of property being improved:10-15 16-2S-29E 12.900 SALTAIR SEC 2 LOTS 27 TO 66. 103 TO 150,CLOSED STREETS ADJACENT THEREOF, 34-64 SALTAIR ACRES SECTION 02 PT TRACT A RECD 4094-1017 Address of property being improved: 800 SEMINOLE RD, ATLANTIC BEACH, FL 32233 General description of improvements: SHINGLE RE ROOF Owner: CITY OF ATLANTIC BEACH Address: 800 SEMINOLE RD,ATLANTIC BEACH, FL 32233 Owner's interest in site of the improvement: OWNER Fee Simple Titleholder(if other than owner): N/A Name: Contractor: LEWIS WALKER Address: PO BOX 2147, LAKE CITY, FL 32056 Telephone No.: 866-959-7663 Fax No: Surety(if any) N/A Address: Amount of Bond$ Telephone No: Fax No: Name and address of any person making a loan for the construction of the improvements Name: 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: 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: N/A 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): THIS SPACE FOR RECORDER'S USE ONLY OWNER Signed: 1-t , if 1. j Date: S 3 I ��� Before me this 3'l day of )A(.•f(J,.' a- in the County of Duval, tate Of Florida,has personally appeared p t� �(li n•'t�!1 ______ Notary Public at Large,Sta Florida,Count C.va N ' JENNIFER JOHNSTO My commission expires: 7579 Personally Known: _, ,,,,,, .:1624 Produced Identification: `lie R ti • • '‘' 44#417 LEWIS WALKER ROOFING INC 1 -4136.15-WLW-ROOF Letter of Authorization/Power of Attorney Date: 4/19/2022 I, Lewis Walker , qualifier of Lewis Walker Roofing, Inc. , do this date 4/19/2022 grant unto Amy Skowron authorization to sign for any and all documents necessary to secure permits at CITY OF ATLANTIC BEACH BUILDING DEPARTMENT . I understand and acknowledge that I, as the License Holder, am fully responsible for any act carried ut under this Letter of Authorization. Lewis Walker //� (Print License Holder Name) (Sig ature of License Holder) State of Florida County of C&Uv1 The foregoing instrument was acknowledged before me by means of physical presence or online notarization this )9 day of Aefi l , 20 as ,by (printed name of contractor) Are personally known to me Has produced current drivers license Has produced as identification. \ - atiA \� �PHOUSTp���i�/i Notary Signature ,(� `0-.<01` 025 SEAL = :z cp.• �. - •Of? 8ondSU..d • 4.,\ i P ubtic F