1660 Beach Ave Unit 2 RERF22-0096 Roof Pernit & NOC REROOF SHINGLE PERMIT PERMIT NUMBER
'�' RERF22-0096
err CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 4/28/2022
~.1•- ''fir ATLANTIC BEACH. FL 32233. EXPIRES: 10/25/2022
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: 1 PERMIT TYPE: 1 DESCRIPTION: VALUE OF WORK
1660 BEACH AVE 2 REROOF SHINGLE SHINGLE ROOF $11511.00
TYPE OF CONSTRUCTION: REAL NUMBER:E ZO"NING:. BUILDING USE SUBDIVISION:
169575 0010 OCEAN GROVE UNIT 01
COMPANY: I ADDRESS: CITY: t STATE: I ZIP':
J & M RESIDENTIAL 6020 PARKWAY DRIVE NORTH CUMMING GA 30040
SERVICES, LLC
OWNER: 1 _ ADDRESS: CITY: I STATE: ZIP:
BARDUSCH MARK C 1660 BEACH AVE #2 ATLANTIC BEACH FL 32233-5807
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.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $110.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$114.00
Issued Date:4/28/2022 1 of 2
1,,� Building Permit Application Updated 10/9/18
1 - : City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address:111-40o 13eaCh Prve. Unit 2. Rilantic afijdfermit Number: i C
Leal Description 5 0' 2 9 E ."04.U �} h Grove,Uhi+ RE#,1 le q 51 S -000 -
r? LaTS e, d0 CD 01 S ._-32-- BLS
Valuation of Work(Replacement Cost)$ 11 i 5 t l Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New DAddition ❑Alteration tepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial lthtesidential
• If an existing structure,is a fire sprinkler system installed?: DYes ❑No
• Will tree(s)be removed in association with proposed proiect? ❑Yes(must submit separate Tree Removal Permit) 1:KNo
Describe in detail the type of work to be performed:
S1iviNo,1e e- ROCS. Remo !e:icsSfino.,i Shy r,g cats o:�nol Q4:00 ce LA1t�, vt2-c k
Shin 9itc • 22 .S • 81-Iz e►
Florida Product Approval#-FL 1012-LI-R21 � _\tloBlo 2H for multiple products use product approval form
Property Owner Information
Name 1601V-C1 UtSCI'1 'Address1L96O '�C ch
city'P!�' 01111'1 Bei) h State FL P ,;22.33 'Phoned 104- 33 7- 056 t
; Zi
E-Mail. r - 1932x00 Yahe CGr_n
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company'. and 1-1 Q S c.1 G.S Qualifying Agent T►i1�'rcrn Q�`
Address'l;aOZ1 ?�e,Wy t4Dr.�r City Curhmin_43 'State 6th Zip '1J()(31()
Office Phone16 7 92- 90 ;Job Site Contact Number
State Certification/Registration# CCC1,33Ig51 E-Mail Ahs( Oil. �yi n @ and-Iva0A . C,0('
Architect Name&Phone# J
Engineer's Name&Phone#
Workers Compensation Insurer'fACY1P.Y)concon1nOcuSi(3rke., -OR Exempt❑ 1
Expiration Date G(o 30 202/2
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 OTICE addition requirements of thi-
o l additional restrictions pplicable to this property that maybe found$iI gb?public records dana county,and
l$:62BlilTikg additional permits,rea uired.from other governmental entities OttigidgtfOrynanagement districts„talinaggatA.@11
ederal: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
R.ING YO R N TICE OF COMMENCEMENT.
REC __ _ __
-kW
J (Signature o ner or Agent) (Signature of Contractor)
Signed and sworn to(or .•• ed)before me this,._day of Signed and sworn to(or aff ed)b:'ore me this y of
hl , I by ,k,44Oti\ evi Art , 2022, • i ( h -ah iskaq
V `- y (`gRa'�bltt'9fNoti�PyYSON ALBRIGHT.
�ei; o�tar� i is ee of Florida orida :V X41.Notary Public-State of Florida
-./.: ' * Commission # GG 954739 _.`111*- Commission# GG 954739
y, or My Commission Expires • 1.1'')4'1"'F`D?,: My Commission Expires
[ ]Personally Known •• ''�%%%%%"` February 04, 2024 [ ]Personally Kno OR ���„����` February 04, 2024
(Produced Identifi .tion 36:1.1Produced Identification • " '
Type of Identification:-V(\ Type of Identification: �*ste)(S\VegAL C,
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. I
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. 2 Oct- /�
Legal description of property being improved:t5 - 1- 2.s- 1(�E. .d�Q °
Q;rbvc Univ 1 1)z LOTS 9, io gecb 012. os--151 - 32
Address of property being improved: \t9 'leac,In Ave. V1t)A- 2
Air1c r c �-FL 32133
l)
General description of improvements: hI rgu„ Re.-gocc
Owner ‘AQrk g o,rd u sc h
Address 1[O(Q 0 B Q L'kl c\vt. un u i- 1, ti Di��l. on. �L—
Owner's interest in site of the improvement Owner
Fee Simple Titleholder(if other than owner) N/A
Name
Address
Contractor J&M RESIDENTIAL SERVICES LLC
Address 6020 PARKWAY NORTH SUITE 500,CUMMING,GA,30040
Phone No.904-337-0509 Fax No.
Surety(if any) N/A
Address Amount of bond$
Phone 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 wA
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 N/A
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 h= m
different date is specified): N a
THIS SPACE FOR RECORDER'S USE ONLY /SOWN '• / y n aG m c`�'
/ DATE / J o v
Signed: ► /.� J N�',o
Before me this �'aay of gt• / n the <u)* T
Doc#2022108668,OR BK 20246 Page 573, ty• D a •-de of Flo'da,ri•s personally appeared Z..79,•E
Number Pages:1 I V'\ i• �'ctu CC�A herein by pE
Recorded 04/28/202210:05 AM, him >,herself an.a that all statem4nts and declarations herein <n a.E v
a- e and acture r.
LL
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL U
COUNTY / Z
RECORDING $10.00 /// j441 c Alb fi 9 m' ,,,�
Public at Large.State of ' Coun K/K.v� +-.
/7r commission expires:
-ersonally Known
Produced Identification