459 SELVA LAKES CIR - ROOF ' ` `s 1 CITY OF ATLANTIC BEACH
- ) 800 SEMINOLE ROAD
'J v ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ROOF-741
Job Type: ROOF PERMIT
Description: REROOF
Estimated Value: $4,590.00
Issue Date: 3/28/2016
Expiration Date: 9/24/2016
PROPERTY ADDRESS:
Address: 459 SELVA LAKES CIR
RE Number: 172027-5018
PROPERTY OWNER:
Name: SMITH, LESLIE E
Address: 459 SELVA LAKES CIR
GENERAL CONTRACTOR INFORMATION:
Name: EXCEL ROOFING CONTRACTORS
Address: 5722 DUNN AVE QA HENRY SCOTT SORENSEN
Phone: - -
FEES:
BUILDING PERMIT FEE $72.95
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $76.95
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Reach, FL 32233
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Office(904)247-5826 Fax (904)247-5845
Job Address: 1./5 .. Ch _L2u s '' _A i C.44}Z.Z$Permit Number:
Legal Description '375" 1)-QS - e f,</,/,� 4 ' ; Parcel# ' 2O2 -
Valuation of Work S ej3eic -v Proposed Work heated/cooled non-heated/cooled : '
Class or Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial •; d;---
If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No (�
Florida Product Approval # /74-7414-15-Z2
For multiple products use product approval form
Describe in detail the type of work to be performed: i r'OC fcre.,✓i6z iSc=
Property Owner Information:
Name: Address: L/s"J- 1L' t�ro 0_t
City GYti <
mot_.[ - -
' I A I State/2.Zip �:3 Phone 9 /j_5!.Y-194-A0
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: _,r� ek& i ocr.�,r,�Cy ,S Qualify Agent: .. L74, /-7l i'i '
Address: 5j9 v7,7_��� City e,■, -j/e State FL_ Zip i"
Odice Phone 16;�G3/--71iG,� Job Site!Contact Number e- [ p L/
}'d. 3 �r Fax# yt�/-sty a�'�/
State Certification/Re.•gistration# ' q' ,t -,1 i 5&:._:9
Architect Name& Phone# /
Engineer's Name& Phone#
Fee Simple Title Holder Name and Address f/'�
Bonding Company Name and Address 1
Mortgage Lender Name and Address /j/
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
u.:uance 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 mull
and void if work is not commenced within six t61 months, or if construction or work is suspended or ahandoned frx a/mriod of six(6)months at any time a/ter
sbi
work is commenced I understand that separate permits must he secured for Electrical Work,Plunng,Signs, Wells,Pools,Furnaces,Boilers, Heaters,
Twtrts and Air Conditioners,do
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.
1 herebv certfy'that/have read and examined this application and know the some to be true and correct. All provisions of 1• .s and ordi Aces gown img this
lip,of work will he complied with whether specified herein or not The granting t f a permit does not presume to give auto, .ty t, iolate or cancel the
provisions of any other/eder ,state,or loc law regulating construction or die per/ormance of construction.
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iignature of Owner ' it Sisnature of Contractor �! / • i
'rint Name -A. l�a __ 'T!l.._ ..... .... _.._.. .._.. Print Name .- p1 ,n2i"e-/JS�'v!
worn to and subscribed before me Sworn to and subscribed before its
is Day of i le/11 _ 20 /e? this Day of /Y]C,, e --- _.2Q/4
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Pub is No1ary bile
o�,ar a�a�,, DENISE LYNN TAIT .•"'a�'� o
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Bonded Through National Notary Assn "� Bonded Through National Notary Assn.
Doc # 2016063415, OR BK 17499 Page 1574, Number Pages: 1, Recorded
03/22/2016 at 10:01 AM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
NOTICE OP COMMEN+CEMENF
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VI*ondersidr:ed hare$y Worms yoo thin enprovernents will be aced`to certain neat property,awl It
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xrt ss as ixgser,r bt r.3 aaorosec 459 SELVR LAKES CiRAtlantic Beach FL 32233 -�-
cto.t«44 ftscry ort 7rttarcvemeret..Re"10(3f
SMITH,LESLIE E
104ress 459 SELVA LAKES CR Atlantic Reach FL 37233 � _
lmer 3:nseest m s<te of Pie eroo,,:rne t OWNER
Fee&I v*Truett:400 lit crew than cumer3 Y-. ..„... •
Name
Address
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SELVA LAKES HOMEOWNERS ASSOCIATION
REQUEST FOR ARCHITECTURAL APPROVAL,
This r r uest form is to be coma leted b the Homeowner and submitted to the(ARC a rior to the commencement of work.
DATE RECEIVED BY ARC:
THIS SECTION TO BE COMPLETED BY HOMEOWNER
Date:iJ1U)Itt-1 q 2010 Lot# y
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Name: U6ue 12 l`T[ 1 email: lesmi-h 1x (0 a++. Ne r
Address: 1561 Se I Vtt Lakes O"•
Home Phone: (AN.5 k Q• 1100 Other Phone: QQ4"• WO.(4105
Contractor: Ji,(t`1Sill iZ Ca-- -1 ( OaS tat.C-1 •- , 1 I' -
Describe the work to be done: (i.e.screen room,addition,fence,garage door,siding,outdoor lights,exterior painting,
roof repairs/replacement,gutters,etc.)
'ROHOr1 V\3000 tirepV,,C N,,e.--1t — --v-0.,)-k- Dco,r got into e_ vJoti atX I
all aurowid Octii L,Jt tndo t-v. a-+r w OOd 4- 6ea I
?l.rne For` lrn O (Oµmo one, o( "NvO Wtneit rvS
-5C\DQ.r J ptaearYks4n--�— — \i�ve no+ `�1cx ik Dk'( bv-+ ltl(l
12. 11rer of ttVe} 'jjve -
€In\-Yav`ce Roar -C- c-�o�.v ir, Yrepluc Q. Coto,/ I s CLu►-vet off t,O►lrte .
Sec --` f i b
Location: Attach a copy of your survey indicating the location of the work to be done.
Describe Location:
Specifications: Attach a copy of the plans,drawing,picture,specifications(material,color,etc.) All exterior paint must meet SLA
specifications. Purchase at Duva Paint "/ �3rd St.South,Jacksonville Beach. Reference Selva Lakes standard.
Estimated date of completion:
NOTE: Owners are responsible for the conduct of the contractor. You are required to supervise the work being done. You are
personally responsible and 1Ia le for any d mage done to common property or adjacent property. When required by the City of
Atlantic Beach,you are q• a to provi. the ARC with a copy of the building permit.
Homeowners Signature: ' (. / ) , " Date: o/// /f
Date Approved 3 -,/33 -/ Date Denied
ARC Signature(s): �" `�
Comments or conditions: 0 V-e-
Mail form to: Selva Lakes Homeowners Association, Inc. , P.O. Box 331365,Atlantic Beach, FL 32233
Email aresla(clwnail.com for questions or comments
L
SELVA LAKES HOMEOWNERS ASSOCIATION
REQUEST FOR ARCHITECTURAL APPROVAL
This re.nest form is to be com.leted b the Homeowner and submitted to the(ARC) .rior to the commencement of work.
DATE RECEIVED BY ARC:
THIS SECTION TO BE COMPLETED BY HOMEOWNER
Date: 6111411 Lot/I
Name: (/61,1e
[e email: Ie5mrlh 1X e a++. Ne 1-
Address: (-15i)1 Se Iva iitkes CI R.
Home Phone: q04.61 * ig01) Other Phone: (loll. 2W.o
Contractor: ?X(p' \CDf 1 t'
Describe the work to be done: (i.e.screen room,addition,fence,garage door,siding,outdoor lights,exterior painting,
roof repairs/replacement,gutters,etc.)
/gee rkik aCI.,ed FSfimu{e_ G ei 1 Ue-krls-
1 R em evt+ - D5 yeo.Y 13 tab
hired 6-rill
Location: Attach a copy of your survey indicating the location of the work to be done.
Describe Location: 4 'i s e ltj i LCD 1/-e-S C c..(•e-
Specifications: Attach a copy of the plans,drawing,picture,specifications(material,color,etc.) All exterior paint must meet SLA
specifications. Purchase at Duval Paint and Hardware,3rd St.South,Jacksonville Beach. Reference Selva Lakes standard.
Estimated date of completion:
NOTE: Owners are responsible for the conduct of the contractor. You are required to supervise the work being done. You are
personally responsible and .Ie for any ',image done to common property or adjacent property. When required by the City of
Atlantic Beach,you are,c eo7to.Rrovi•I the A C with a copy of the building permit.
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Homeowners Signature: t it ►> L Daze: 3 1 J l�
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Date Approved _a — i 3-�� Date Denied
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ARC Signature(s): GTi (kt
Comments or conditions: 4
�r('v
Mail form to: Selva Lakes Homeowners Association, Inc., P.O. Box 331365,Atlantic Beach, FL 32233
Email arcsla@gmail.com for questions or comments