2167 sS FAIRWAY VILLAS LN RERF23-0014 Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department I **ALL INFORMATION
800 Seminole Road, Atlantic--Beach;FL 32233 i HIGHLIGHTED IN GRAY
"•cup IS REWIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us --_- - — -
Job Address:12167 FAIRWAY VILLAS gyri S 1 Permit Number: ' ,I
Legal Description{39-22 08-2S-29E FAIERWAY VILLAS LOT 28 i RE#{169398-1056 fi
Valuation of Work(Replacement Cost)$17.963560- — Heated/Cooled SF 1050 Non-Heated/Cooled 232
• Class of Work: ONew DAddition DAlteration ®Repair ❑Move ❑Demo DPool DWindow/Door
• Use of existing/proposed structure(s): ❑Commercial II Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes •No
• Will tree(s)be removed in association with proposed proiect? ❑Yes(must submit separate Tree Removal,Permit) IP No
Describe in detail the type of work to be performed:
ROOF REPLACEMENT rc y5-33 ..re IZ SJ;4"c t I2 5qs. I Skye-
leeFlFlorida
orida Product Approval#FL 10674.1 for multiple products use product approval form
Property Owner Information
Name 1 OLLEEN M MCGREADY Address 12167 FAIRWAY VILLAS LN S
City[ATLANTIC BEACH State[FL Zip 132233 j Phone 1(904)315-3770 I
E-Mail1N/A - - 1
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company[ 1G FISH ROOFING AND WATERPROOFING,LLC i Qualifying_Agent(STEVEN M SCOATES
Address;
6821 SOUTHPOINT DR N,SUITE 114 ,+City,JACKSONVILLE I State[FL i Zip132216
Office Phone 1(904)685-8334 I Job Site Contact Number JACOB(904)547-9368
State Certification/Registration#iCCC1330441 I E-Mail[STACY@BIGFISHROOFING COM --1
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer IFRSA 1 OR Exempt o Expiration Date 112-31-2023 1
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 ad`dition to thqulrements of thi
oermlt,there may be additional restrictions applicable
,:t is,property that maybe found nat�he publici cords of this county,
there be additional permlts)required from Othw
er governmental entities such as ater'managernent;distnets;state agen6g qr.
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 AN ATTR.• NEY BEFORE
RECORDING YOURJJOTICE OF COMMENCEMENT.
(Signature of Oiler or Agent) (Signature of Contractor)
Si ned and sworn to(or affirmed)before me this 7.3 day of Signed and sworn to(or affirmed)before me this 2 3 day of
►t4a4A) , 2o 1-3 ,by C011 fen Wt• V .6 ri d •�hkA•-� , 20-2--)by_4eu-`n S c04
NAM: (S n NST SIMMONS-)
Commission#HH 234904 :. Ai
1�'.F to,,T March 3,2026 a._,�`:;� #HH 234904
"t(ri s�P' March 3,
[ ]Personally Known OR ersonally Known OR 2026
[ 94roduced Identification [ ]Produced Identification
Type of Identification: Type of Identification:
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. 169398-1056
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: 39-22 08-2S-29E
FAIRWAY VILLAS
LOT 28
Address of property being improved: 2167 S FAIRWAY VILLAS LN
ATLANTIC BEACH,FL 32233
General description of improvements: ROOF REPLACEMENT
Owner COLLEEN M MCGREADY •
Address 2167 FAIRWAY VILLAS LN S
Owner's interest in site of the improvement _
Fee Simple Titleholder(if other than owner)
Name
Address •
Contractor BIG FISH ROOFING
Address 6821 SOUTHPOINT DR N,SUITE 114,JACKSONVILLE,FL 32216
Phone No. (904)685-8334 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 ? k;..
different date is specified): �o ?:
THIS SPACE FOR RECORDER'S USE ONLY OWNER "� ($r1 co .
•
Signed: L! '1y] DATE lI/x3123
Doc##2023014821,OR BK 20561 Page 1526, Before me this day of ras 'Lo 2d In the 7X 0:
Count�of Dwal,State of Flo�ic�a, as pgrsonaaaaattff�Illly appeared
Number Pages:1 ('O ik"e,- fM. IY C. l�L+�u1 herein by
Recorded 01/24/2023 01:07 PM, himself/herself and affirms that all s ements and eclarations herein q
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL are true and accurate §e
COUNTY
RECORDING $10.00
• Notary Public at Large,State ofCounty of
My commission expires:�• 3—3- 2.-07A0
Personally Knownor
Produced Identification