130 Jackson Road RERF23-0063 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
FOX KARA M 130 Jackson Rd Atlantic Beach FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
K & D ROOFING &
CONSTRUCTION 74 6th St. S #104 JACKSONVILLE
BEACH FL 32250
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
172141 0000 DONNERS S/D PT LOT 2
17-
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
130 JACKSON RD REROOF SHINGLE Re-Roof Shingle $9125.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 BUILDING ROOF IN-PROGRESS INSPECTION REQUIRED INFORMATIONAL
Notes:
a.\tThe roof sheathing for all new construction must remain uncovered until the Roof Sheathing Inspection is approved.\r\r
b.\tAll roofing projects require an In-Progress Inspection.\r\r
c.\tSheathing installation and replacement guidelines per APA.\r\r
d.\tUnderlayment must conform to FBC-R Table 905.1.1\r\r
e.\tShingles must conform to ASTM D3161 G or H, or ASTM D7158 F\r\r
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: 4/24/2023
PERMIT NUMBER
RERF23-0063
ISSUED: 4/24/2023
EXPIRES: 10/21/2023
REROOF SHINGLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $100.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $104.00
2 of 2Issued Date: 4/24/2023
PERMIT NUMBER
RERF23-0063
ISSUED: 4/24/2023
EXPIRES: 10/21/2023
REROOF SHINGLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
r City of Atlantic Beach Building Department ALL INFORMATION
HIGHLIGHTED IN GRAY800SeminoleRoad, Atlantic Beach, FL 32233
y ufi r
Phone: (904)
90,
247-5826 Email: Building-Dept@coab.us
IS REQUIRED.
Job Address: /"30 Act S 1 ki . Perm ip_N mber: 1)W 73-0-0r 5
Legal Description 19-4 17- 5-??r rS t..--- RE# / 74! / -COCO
Valuation of Work(Replacement Cost)$ ci//25 Heated/Cooled SF Non-Heated/Cooled r
Class of Work: New Addition Alteration Repair Move Demo Pool Window/Door VAP:, roe
Use of existing/proposed structure(s): Commercial , Residential
l
If an existing structure,is a fire sprinkler system installed?: Yes No Uti 4
Will tree(s)be removed in association with proposed project? Yes(must submit separate Tree Removal Permit) IDIWo
Describe in detail the type of work to be performed: 3/i- /,7ubU/
FL- / Ytl c_ 0(064/ 4
Florida Product Approval# /4- IC/moi/ ti < 1/1PiO _6 r for multiple products use product approval form
Property ' ner Information
j 1, j
Name -,,I r
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X /)
g
Address 1.Ny i J 45{X,1 i 'thy- j
City Iv i) State_fes Zip 522,J! Phone 9a/L jilF p'"`J,d f 1
E-Mail r ih (a a .CrAitii
Owner or •gent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information_
Name of Cof ni Qualifyi99g Agen fc; Lep
Address 1 I
p
1rl,
i CV (, , /g City L State
V
Zip?
j
9 5.
Office Phone LC 1-1( Job Site Conta t Nu ber rjgi 3'
State Certification/Registration# Ir(r 13/s''' 'r/ V E-Mail lL t Y1• 1j/0 4 -1 0(_l',i
Architect Name&Phone#
Engineer's Name&Phone#y
Workers Compensation Insurer f)r1(, o. 1' w OR Exempt o Expiration Date g/ ,
Application is hereby made to obtain a peYmit 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 ATTOR E BEFORE
RECORDING YID)JR OTI E OF COMMENCEMENT.
Signature of wner or Agent) Signature of Contractor)
Syred swoiRto r affirm d)before my this 17!day of Si ned nd swore tQ r affirm )befor me, his day of
fit 'K, ,byY l rc ribyc j
Signa ge
o1 '
AIWA: /dilrl(hISZA
f Notary) Sign ure of Notary)
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Y'' PersonallyKnown ORPersonallyKnownORe,. SHERRI LYNN EMAHISER
rYProduced Identification e.;*..o` SHERRI LYNN E..4Ic ,RProducedIdentificati. Nota Public-State of Florida [ ]
v a`` Commission#HH 476 iNotary oub'ic-Slate of=:aridaL, 7"_.$,z
My Comm.Expires May 31,2024 Commissioc -H 47,3
Bonded through National Notary Assn.MY Comm.Expire;!1,: 2024
Bonded through Nador, NL i'l.Assn.
TOTICE OF COMMENCEIV1__NT
PREPARE IN DUPLICATE)
yy
Permit No. Tax Folio No. 0:0CM
State of FLORIDA County of GA I VAL-
To whom it may concern:
The undersigned hereby informs you that Improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF
COMMENCEMENT.
Legal d ription of property bein• proved /
C)r/ / /7 j5 r LJ}
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lionfn C r Ill 1 .5'
Address of grope rn Irilprove•: t, /
General description of improvements: RE ROOF/50 YR SHINGLES
Owner Y1"l
Addr 130 D7C VSCh Pt! - 4 V1'1 eo pZ 3?253
Owner's interest in site of the improvement OWNER
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor K&D ROOFING&CONSTRUCTION COMPANY,INC.
Address 74 6TH STREET SOUTH,SUITE 104 JACKSONVILLE BEACH,FL 32250
Phone No.904-541-1700/904-223-6068 Fax No. 904-369-3249 E-FAX
Surety(if any)
Address Amount of bond$
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 WNER
Signed: j TE Li(f 3-/Z 3BeforemetisWdayofZ4Ie ' in the
Doc#2023077145,OR BK 20649 Page 1760, yn of val. Florida.has•-rsonally appeared
Number Pages: 1 c-Fir
Recorded 04/19/2023 12:18 PM,
himself,'herself a affirms that all statements and de ati je Ingr lain SHERRI LYNN EMAHISER
are true and accurate
1 4.--s--,-.,,-: Notary Public-State of FloridaJODYPHILLIPSCLERKCIRCUITCOURTDUVALPsCommission#HH 476
COUNTY
Y A`4J•
0,,,,,!;,''dMy Comm.Expires May 31,2024RECORDING $10.00 fJ 1
Bonded through National Notary Assn. 0
NoMy sii n
L ,Stator Coygty -
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NAL
My commission expires:
tt11
ll'' o(} j
Personally Known
0._
or
Produced Identification