395 5TH ST - ROOF �`' t"`' . <- r;,,, CITY OF ATLANTIC BEACH
' j�l 800 SEMINOLE ROAD
JN - ATLANTIC BEACH, FL 32233
---______---2 INSPECTION PHONE LINE 247-5814
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-2787
Job Type: ROOF PERMIT
Description: ROOF
Estimated Value: $9,579.00
Issue Date: 12/2/2015
Expiration Date: 5/30/2016
PROPERTY ADDRESS:
Address: 395 5TH ST
RE Number: 169880-0000
PROPERTY OWNER:
Name: ELYANOW, MICHAEL J & KIMBERLY, *
Address: 217 PALM AVE
GENERAL CONTRACTOR INFORMATION:
Name: RELIANT ROOFING INC RYAN SHOUPPE
Address: 528 Millhouse Lane Orange PARK
Phone: - -
FEES:
BUILDING PERMIT FEE $97.90
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $101.90
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
12/01/2015 at 03:10 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10 .00
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tex Folio No. 169880-0000
State of Rork!■ County of Duval
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property,and In
accordance with Section 713 of the Florida Statutes,the following Information Is stated In this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: 5"69 16-25-29E.114 ATLANTIC BEACH
Address of property being improved: 395 5TH ST Atlantic Beach FL 32233
General description of improvements: re-roof
Owner ELYANOW MICHAEL J
Address 395 5TH ST Atlantic Beach FL 32233
Owner's interest In site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Reliant Roofing,Inc
Address 822 NA1A Highway Suite 310 Ponte Vedra Beach,FL 32082
Phone No.904-657'0880 Fax No. 904-677-7972
Surety(if any)
Address Amount of bond$
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 Lienors Notice as provided in
Section 713.06(2)(b),Florida Statutes.(Fill in at Owners option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration date is on (1 ear from the•ate of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY ' OWNER bd
Signed: 1�L// DATE 171/ `;
Before me 0-//I i°ffIl•. •_i r:s•_�- m'Ihe I County of Du r tat s eersonalry appeared ppp
, U herein by
mad se eH afirtnS that all statements and declarations herein
are true and accurate
ff
I
Nobly Public at Large.State of . County of tiQU fO
My commission expires: j1 41 iQ
Personally Known r or
Produced identification
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax(904) 247-5845 1 5— 200 F'_ Z7 c9 7
Job Address: 396 emit S. P) fl 1C., Ctfi'1,F 2a33Permit Number:
Legal Description 5m 1 ill - Z-me• i 14 Ak1CtMt PSea(h Parcel # IVI48?4i'aC' ?.
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work q 16'74.TA Proposed Work heated/cooled .a t a S i non-heated/cooled 1.32:a
Class of Work(circle one): New Addition Alter . epair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial
If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No IMMO
Florida Product Approval # GilV 3 -1-6 h k,I o ff.I 5 l is)'1
For multiple products use product approval form
Describe in detail the type of work to be performed: ce- (OOF
aSsii)- Oice i. 1 c
li Property Owner Information:
Name: tchC_l (% -no Address: 3 - S (
-l6n4+L' ^
City ty �) L 6eL Cirx StateILZip ga3 '? Phone --Clc/
E-Mail or Fax# (Optional)
Contractor Information: �y,�
Company Name: -e_han- Rld-(A4 `Y1C'.. Qualifying Agent: Co - m �." `. .0 -
Address: a. t„) At ikwiti , l:Yak- 3I6 City .0 i. •a -._.1 . tate FL.. Zip aagla
Office Phone ei( 4-2.va-ba 3 Job Site/Contact Number C4rnoton a .,. t 7-7-1T7'a -
State Certification/Registration# CC G 13'73:AlitS
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
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 laws regulating construction in this jurisdiction. This permit becomes
null and void tf work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six(6)months at any time
after work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers,
Heaters, Tanks and Air Conditioners,etc.
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.
I hereby certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether s#eci ie, herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state, or loc#1 ,' ' lacing construction or the performance of construction.
1:( 1101,--/
ntractor
Signature of Owner Signature of Contractor
Name n/G yAEL 140,4 i/ Print Name _< w'.'1
Sworn to and subsc '•ed befo•' me Sworn to and subscribed before me
thislM' Day of _c-e f . 201J this i Day of x,r14) , 20 f'7
.4_,___Ccif...,_ci2j. J Q r ratt(i. ueNct.J `
1..4e%.i... ( eildir •
, No �ry Public
N tary Public � ""� '
_ �,,.,� JOYCE CONWAY Revised 01.26.10
MARTHA DENISE QUINN
'. ._.1f, MY COMMISSION#FF921647
:`: �'- MY COMMISSION fl&@1877 2 44.., EXPIRES:SEP 24,2019
Bonded through 1st State Insurance
EXPIRES July 26.2016
(407)398.0163 nora NOgry$siYomo{MI'