2341 W OCEANWALK DR RERF23-0030 (.;,----Th,11...Alt.„?j
REROOF SHINGLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RERF23-0030
800 SEMINOLE ROAD
ISSUED: 2/21/2023
ATLANTIC BEACH. FL 32233 EXPIRES: 8/20/2023
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:
2341 W OCEANWALK DR REROOF SHINGLE PRIVATE PROVIDER $34177.00
SHINGLE ROOF
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169463 1066 OCEANWALK UNIT 03
COMPANY: ADDRESS: CITY: STATE: ZIP:
GALAXY BUILDERS INC 5544 DOVER CREST LN JACKSONVILLE FL 32258
OWNER: ADDRESS: CITY: STATE: ZIP:
SMITH JOHN GREGORY 2341 W OCEANWALK DR ATLANTIC BEACH FL 32233
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 /1111.11111111111111/111111111111 I
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $168.75
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.53
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $173.28
Issued Date:2/21/2023 1 of 2
4411�`"V' Building Permit Application Updated 12/8/17
City of Atlantic Beach
\.,�v;l,, 800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845 2
Job Address: 2341 Oceanwalk Drive West Permit Number: ?ERE Z3`�3
Legal Description 42-74 37-2S-29E Oceanwalk Unit 3 Lot 33 RE# 169463-1066
Valuation of Work(Replacement Cost)$'b4 t ►1-1.4c Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one) ,ddition Alteration Repair Move Dg i Pool Window/Door
• Use of existing/proposed structure(s) (Circle one): Commercia Residentia _
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes N N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed: t
Replace Roof C t rk ( e
Florida Product Approval#FL10674.1-R16 f 172Q6 _j2.1 for multiple products use product approval form
Property Owner Information
Name: John Gregory Smith and/or Susan Smith Address: 2341 Oceanwalk Drive West
City Atlantic Beach state Fla zip 32233 Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) OWner(s)
Contractor Information
Name of Company: Galaxy Builders, Inc. Qualifying Agent: Michael A Sundberg
Address 6684 Columbia Park Drive South, Suite 6 City Jacksonville state Fla zip 32258
Office Phone 904-503-4164 Job Site/Contact Number 904-503-4164
State Certification/Registration# CCC 1329195 E-Mail admin@galaxyfla.com
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Builders Mutual Insurance 107/31/2023
Exempt/Insurer/Lease Employees/Expiration Date
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 regulationg
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 YOUR NOTICE OF COMMENCEMENT.
• ---- Ni had S idbell
John C,Smith(Feb 17,202314:33 EST) Michael Sandberg(Feb 17,2023 1S 0 EST) -0 ,
(Signature of Owner or Agent) (Signature of Contractor) LL.
(including contractor) o Cl-
a,t0rt
Sig ed and sworn to(or affirmed)before me this I 1 day of Signed and sworn to(or affirmed)before me this l—1 da og 1 N
, a6 % by
John G SmithT i 6.AL,. by Michael Sundberg �. j LD H N
i‘PriteW—1110-. •:f','
a
ignature ota ') (Signature • . o w r a
�yf P44, Notary,-ubffc State ofIona z co w
Barbara L Gudith Petit
[ ]Personally pw R. My Commission GG 331343 Personally Known OR , '%
/
h(,j Produced I •nPMF n Expires 05/27/2023 [ ]Produced Identification a
Type of Identi - . .0A,AN.l6w,4►+► 1.��?• Type of Identification: `0,,.,
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. 169463-1066
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 desorption of property being improved: 42-74 37-2S-29E Oceanwalk Unit 3 Lot 33
Address of property being improved: 2341 West Oceanwalk Drive,Atlantic Beach, Florida 32233
General description of improvements: Replace Roof
Owner John Gregory Smith and/or Susan Smith
Address 2341 Oceanwalk Drive West,Atlantic Beach, Florida 32233
Owner's interest in site of the improvement Property Owner(s)
Fee Simple Titleholder(if other than owner) N/A
Name N/A
Address N/A
Contractor Galaxy Builders, Inc.
Address 6684 Columbia Park Drive South,Suite 6,Jacksonville, Florida 32258
Phone No. (904)503-4164 Fax No. (904) 503-4166
Surety(if any) N/A
Address N/A Amount of bond$N/A
Phone No. N/A Fax No. N/A
Name and address of any person making a loan for the construction of the improvements.
Name N/A
Address N/A
Phone No. N/A Fax No. N/A
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 N/A
Phone No. N/A Fax No.N/A
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 N/A
Phone No. N/A Fax No. N/A
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a
different date is specified): •
r
orM
THIS SPACE FOR RECORDER'S USE ONLY OWNER u-y(7,
75 a�
Signed: - � .,,.,. DATE Feb17,2023 .0m
Before me this 1'-1 day of t....)/j)., r7��i 2) in the 2 a (o
Doc#2023033520,OR BK 20587 Page 1453, County of Duval.State of Florida.has personally appeared ci t j N
Number Pages. 1 John G Smith herein by a rsi
himself,'herself and affirms that all st Cements and declarations herein E E
Recorded 02/21/2023 09:24 AM, E
are true and accurate;by means of physical presence or_online notarization. ,ip oy
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL 3-Gv a
COUNTY / z° w
RECORDING $10.00
N. yc'vQ4b
No TyPub is a Large.St a of F a bounty Duval • •t��
` d.
My commiss' expires: 7�
Person yKno.: '
n or P.
Produced Identification Driver's License
I .
Form #9B-3.053-2002-01
Notice to Building Official of
Use of Private Provider
Effective January 20,2003
Project Name: 2341 Oceanwalk Drive West Roof Replacement
Parcel Tax ID: 169463-1006
Services to be provided: Plans Review Inspections X
Note: If the notice applies to either private plan review or private inspection services the Building
Official may require, at his or her discretion, the private provider be used for both services pursuant to
Section 553.791(2)Florida Statute.
I Galaxy Builders, Inc. , the fee
owner, affirm I have entered into a contract with the Private Provider indicated below to conduct the services
indicated above.
Private Provider Firm: Legacy Engineering, Inc.
Private Provider: John E. Ellis III PE
Address: 6415 Greenland Road, Jacksonville, FL 32258
Telephone: 904-320-0408 Fax:
Email Address(Optional): ppidept@legacyengineering.com
Florida License, Registration or Certificate#: 81349
I have elected to use one or more private providers to provide building code plans review and/or inspection
services on the building that is the subject of the enclosed permit application, as authorized by s. 553.791, Florida
Statutes. I understand that the local building official may not review the plans submitted or perform the required
building inspections to determine compliance with the applicable codes, except to the extent specified in said law.
Instead, plans review and/or required building inspections will be performed by licensed or certified personnel
identified in the application. The law requires minimum insurance requirements for such personnel, but I
understand that I may require more insurance to protect my interests. By executing this form, I acknowledge that I
have made inquiry regarding the competence of the licensed or certified personnel and the level of their insurance
and am satisfied that my interests are adequately protected. I agree to indemnify, defend, and hold harmless the
local government, the local building official, and their building code enforcement personnel from any and all
claims arising from my use of these licensed or certified personnel to perform building code inspection services
with respect to the building that is the subject of the enclosed permit application.
I understand the Building Official retains authority to review plans, make required inspections, and enforce the
applicable codes within his or her charge pursuant to the standards established by s. 553.791, Florida Statutes. If I
make any changes to the listed private providers or the services to be provided by those private providers, I shall,
within 1 business day after any change, update this notice to reflect such changes. The building plans review
and/or inspection services provided by the private provider is limited to building code compliance and does not
include review for fire code, land use, environmental or other codes.
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I ,
The following attachments are provided as required:
1. Qualification statements and/or resumes of the private provider and all duly authorized representatives.
2. Proof of insurance for professional and comprehensive liability in the amount of$1 million per
occurrence relating to all services performed as a private provider, including tail coverage for a minimum
of 5 years subsequent to the performance of building code inspection services.
Individual Corporation Partnership
Gala Builders Inc.
Print Corporation Name Print Partnership Name
By: filir By:
(signature) (sign.'ie) (signature)
Print Print Print
Name: Name:Michael A Sundberg Name:
Address: Its:President Its:
Address:6684 Columbia Park Dr S#6 Address:
Telephone Jacksonville, Florida 32258
No.:
Telephone Telephone
No.904-503-4164 No.:
Please use appropriate notary block.
STATE OF Florida
COUNTY OF Duval
Individual Corporation Partnership
Before me,this day of fore me,this 610 day of Before me,this day
,20 ,personally f O.0.5 ed ,20a9? of 20
appeared ersonally appear personally appeared
who executed the foregoing instrument, O1tJC VPkt?:) qof
and acknowledged before me that same C�0,1,MI 1J, 1j i 1 X71` C'.. ,a partner/agent on behalf of
was executed for the purposes therein J corporation,on ,
expressed. behalf of the state corporation,who a partnership,who executed the
executed the foregoing instrument and foregoing instrument and
acknowledged before me that same was acknowledged before me that same
executed for the purposes therein was executed for the purposes therein
expressed. expressed.
Personally known ;or Produced identification Type of identification produced
Signatureo Notary IWik C\ LI�� ,141' Print Name Barbara L Gudith Petit
Notary Public:NOTARY STAMP BELOW
My commission expires:
dost Pty, Notary Public State of Florida
`h Barbara L Gudith Petit r
M;_ _ o My Commission GG 331343
'4 op* Expires 05/27/2023
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