975 MAIN ST RERF22-0156 COAB Permit Form with Conditions Building Permit Application, ,, IL 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 C' 1� IS REQUIRED.
Job Address: 975 Main St,Atlantic Beach, FL 32233 Permit Number: • C-R I` 2 2 (DI Cc)
Legal Description 18-34 17-2S-29E/SEC H ATLANTIC BEACH/LOT 5(EX N1/2)BLK 185 RE# 170999-0000
Valuation of Work(Replacement Cost)$ 3,850.00 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ONew ❑Addition ❑Alteration ❑Repair ❑Move :Memo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial 6Z(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:
Remove existing roof, install new roof
Florida Product Approval#FL18355-R6 for multiple products use product approval form
Property Owner Information
Name Bonnie L and Troy D Sim Address 12680 Meadowsweet Ln
City Jacksonvillle State FL Zip 32225 Phone (904)237-3229
E-Mail ‘95 I(( 6 co rvic:Cr i t- .0-64-
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company White's Roofing Company,Inc Qualifying Agent Timothy White
Address 14676 Plumosa Dr City Jacksonville State FL Zip 32250
Office Phone (904)220-5546 Job Site Contact Number
State Certification/Registration# CCC 058017 E-Mail whitesroofing@att.net
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer FRSA OR Exempt❑ Expiration Date 12/31/2022
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 OBTAI) INANCING, •t-SULT WITH YOUR LE DER OR AN ATTORN Y BEFORE
RECORD! + 11.1 OTI - •F C•MMENCEMENT.
\,... ...
(Signature of Owner or Agent) "gnature of Contractor)
Signed and sworn to(or affirmed)before me this'� day of Signed and sworn to(or affirmed) before me this-30k(day of
L(X�t i , 2 22-, by Ig O lin n I e- -Ci r./1 J ON e- , Z022-, by '\ l tfv..0 W Vv.-% 1,-€.-
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. - • ,• .• -(C:LI.,t„.,111 LIR)
ANDREA J. LEPIANKA °PA'
ANDREA J. LEPIANKA
p;1,"1'..‘,,,U ? -=Notary Public-State of Florida
o %Notary Public-State of Florida "' = Commission # HH 28779
Irt E
[ ]Personally Known OR Commission # HH 28779 k]Personally Known OR ,,,, e: MyCommission Expires
N� ' My Commission Expires '%;o,«`.
()(]Produced Identificati, ---",';,p ,,,, August 05, 2024 [ ] Produced Identification August 05, 2024
Type of Identification: d = -• - Type of Identification: '
Doc # 2022172553, OR BK 20342 Page 643, Number Pages: 1,
Recorded 06/30/2022 10:13 AM, JODY PHILLIPS CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of Florida County of Duval
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: 18-34 17-2S-29E
SEC H ATLANTIC BEACH _
Lot 5(EX N1/2) BLK 185
Address of property being improved: 975 Main St,Atlantic Beach, FL 32233
General description of improvements: Complete roof replacement
Owner Bonnie L and Troy D Sim
Address 12680 Meadowsweet Ln,Jacksonville, FL 32225-3445
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor White's Roofing Company, Inc
Address 14676 Plumosa Dr, Jacksonville, FL 32250
Phone No. (904)220-5546 Fax No.
Surety(if any)
Address Amount of bond$
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
Address
Phone 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 Statutes.(Fill in at Owner's option).
Name
Address
Phone 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 OW�`
Signed: (I ar ( U '- ' DATE O(o/3D(Z2
Before me this 3Dtt-,day of , 2-02- in the
County of Duval,State of Floiiida,has personally appeared
hE StaL J1m herein by
himself/herself and affirms that all statements and declarations herein
are true an accurate °
•";:",, ANDREA J. LEPIANKA_
jp `,7i Notary Public-State of Florida
= Commission a HH 28779
,; My Commission Expires
-� �►l. I �.....v _ � August 05,2024
Notary Public at Large,State of Florida , oun y o p uva
My commission expires: August 5,2024
Personally Known or
Produced Identification Driver's License
PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA *RE UIRED
f Q )
*Project Address: 975 Main St, Atlantic Beach, FL 32233 Permit#:
*Owner/Project Name: Bonnie L & Troy D Sim
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
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 Tamko shingles FL18355-R6
2. Underlayments Carlisle ice and water shield FL6785-R10
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 Millenium off-ridge vents FL19567-R2
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
8. 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.
Timothy White
*Contractor Name (Print Name): *Contractor Signature:\ YIN*A,
*Company Name: White's Roofing Company, Inc
*Mailing Address: 14676 Plumosa Dr
*City: Jacksonville *State: FL *Zip Code: 32250
*Telephone Number: (904) 220-5546 *E-mail Address: whitesroofing@att.net
Cell Phone Number: (904) 333-6663 Fax Number:
Page 4 of 4 Updated 06/21/21
OWNER:ADDRESS:CITY:STATE:ZIP:
SIM BONNIE L 12680 MEADOWSWEET LN JACKSONVILLE FL 32225
COMPANY:ADDRESS:CITY:STATE:ZIP:
WHITE'S ROOFING
COMPANY, INC 14676 Plumosa Drive JACKSONVILLE FL 32250
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
170999 0000 ATLANTIC BEACH SEC H
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
975 MAIN ST REROOF SHINGLE SHINGLE ROOF $3850.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $70.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $74.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
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: 6/30/2022
PERMIT NUMBER
RERF22-0156
ISSUED: 6/30/2022
EXPIRES: 12/27/2022
REROOF SHINGLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 6/30/2022
PERMIT NUMBER
RERF22-0156
ISSUED: 6/30/2022
EXPIRES: 12/27/2022
REROOF SHINGLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233