319 1st St RERF23-0110 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
BLYTHE ROBERT D 319 FIRST ST ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
SHORE ROOFING
COMPANY 929 12TH AVE S JACKSONVILLE
BEACH FL 32250
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
169761 0050 ATLANTIC BEACH
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
319 1ST ST REROOF SHINGLE Re-Roof Shingle $12500.00
FEES
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: 7/11/2023
PERMIT NUMBER
RERF23-0110
ISSUED: 7/11/2023
EXPIRES: 1/7/2024
REROOF SHINGLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $115.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $119.00
2 of 2Issued Date: 7/11/2023
PERMIT NUMBER
RERF23-0110
ISSUED: 7/11/2023
EXPIRES: 1/7/2024
REROOF SHINGLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
rs' BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
Cityof Atlantic Beach BuildingDepartmentP PERMIT# —F23 _-Oi
800 Seminole Road, Atlantic Beach, FL 32233 A ALL information required to process
D';"` Phone: (904) 247-5826 Email: Huilding-Dept@coab.us
Job Address 3 I ct 1S i, S+.
2
RE# /6,?7 —O 7SC
6a 1LegalDescriptionS.i 6, --IS'-M e , O7 1 /}f ,1f!AC 3t J 1 VA r3/i(3
cv
rValuationofWork(Replacement Cost) . SiJ ,Heated/Cooled SF Non-Heated/Cooled SF
Class of Work: New Addition Alteration Repair Move Demo Pool Window/Door
Use of existing/proposed structure(s): Commercial Residential
If an existing structure,is a fire sprinkler system installed?: [Yes No
Will tree(s)be removed in association with proposed project? Dies(Must submit separate ,ee Removal Permit) No
Describe in detail the type of work to be performed:
4L, c.;l.= 36 yec;r Sh.^'f1/, /1'N4 sy &k, eJti/3TV/ray, —/
71 :, / y
Florida Product Approval# /c(3 3 3 ( For multiple products use ppro',
Property Owner Information Name j bc,4- 8l y-thc Phone ('o7-.$ -tax)
Address 3(y ,c •
l
City //4.1,66_ i3 e 11 State r( Zip Jud
Email Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information Name of Company S ! O ( ROO/`N Co, Phone 91,-dye-TIN 2--
Address Address 11_5 ii.j31 AUL Sci 4" City \j-„44r3r441, State /47(
Zip 34.1S6
Qualifying Agent ,:t, mAs S/r(C State Certification/Registration# CO,C oS j i ((_
Email 'ii Show, LA-0 ), C-dirt Job Site Contact Number 961 ?...2.4.-6195-7
Worker's Compensation Insurer OR Exempt Expiration Date
Architect's Name Email Phone
Engineer's Name Email Phone
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 YOU PAYING TWICE
FOR IMPROV NTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN
ZTORN BEFORE NG YOUR NOTICE OF COMMENCEMENT.
Signature of Owner or Agent) Signature of Contractor)
Signed and sworn t jQr affirmed)before me this day of Signed and sworn to(or affirmed)before me this- 114+1
day of
U by Svly , 202- by `C[n bwvA c LL. S t. 'Q—
Signature of Notary 5 Signature of Notary
Personally Known OR [ ProLduced Identification J Personally Known"-----OR [ 9duced Identification
Type of Id: *;i. •'et):
ota• . :JEAN a
ORE Type of Identification:
1 Commission k HH 227099 VANESSA ANGERS
70e no' •Ay Comm.Expires Feb 9,2026 MY COMMISSION i«HH 244118
3cr_,2c through National Notary n.OFA' EXPIRES:March 23,2026
FOt F•
NOTICE OF COMMENCEMENT
State of
ix— ( Tax Folio No. /6 9 76/ -0 c5c)
County of 61)04
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: 5-6,9 /6").5-a9t .Q'74.1
Address of property being improved: 3/9
1
s'r 34--/'qN+-IL l.e.v 43, 1-7( az:23 3
General description of improvements: Glt-
Owner: /.1db R(- 13/y4-4 t Address: r3/f _ix r S 1. A4`Ll.3c .4
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: Silt"cc_ lZ-c' ' 'fts , m p O c 0
Address: 11,4 t +k /J vc.f J jc i c'c v X 7-7 (3 2.2.3'6 o z-<° g 't
1 d D N
2am0
Telephone No.:919—aCf( -ctj - Fax No: o
Surety(if any) CAv f N $
0 00
Address: Amount of Bond$ g m W o
o
Telephone No: Fax No: a to,
D
Name and address of any person making a loan for the construction of the improvements c 0,m
Name: o do
C m
Address:
o 9'
Phone No: Fax No:
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents
be served: Name:
Address:
Telephone 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 Statues. (Fill in at Owner's option)
Name:
Address:
Telephone 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 OWNER
Signed:. —o te:
y'o•,, PAstFIA JEAN SNORE dayof the Cou .f iuv-I StateBeforemethisjiMrejyrr1
Notary Pi.:lic•State f Ficr.?a
y• <Commission= H 227099 Of Florida,has personally appeared '. L
My Comm.Expires Fet 9,2026 Notary Public at Large,State of Florid Coun uv,}?j q
Bonded throw h National Notary Assn, My commission expires: iy L2_ V'
f p Personally Known:
Nn
or