668 SELVA LAKES CIR - ROOF ij
��
0'r CITY OF ATLANTIC BEACH
Ss1
z „► 800 SEMINOLE ROAD
J 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-1239
Job Type: ROOF PERMIT
Description: RE- ROOF SHINGLES
Estimated Value: $6,200.00
Issue Date: 5/31/2016
Expiration Date: 11/27/2016
PROPERTY ADDRESS:
Address: 668 SELVA LAKES CIR
RE Number: 172027-5812
PROPERTY OWNER:
Name: FOX, THOMAS
Address: 668 SELVA LAKES CIR
GENERAL CONTRACTOR INFORMATION:
Name: AMERICAN ROOFING OF JACKSONVILLE
Address: 1720 Wildwood Creek LN
Phone: 904-385-4375
FEES:
PLAN CHECK FEES $40.50
BUILDING PERMIT FEE $81.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $125.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
4IkUILDIING PERMIT APPLICATION
CITY OF ATLANTIC BEACH •
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845 1 Roof-_ Z3c)
Job Address: 668 Selva Lakes Cir Permit Number:
44-60 16-2S-29E.087 SELVA LAKES UNIT 3 E 3.1 FT
Legal Description LOT 1 09,LOT 110 Parcel# 172027-5812
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$6,200.00 Proposed Work heated/cooled 1 8R5 00 non-heated/cooled 2,414.00
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
Florida Product Approval# FL16305. Summit 60 Underlayment, FL 16226
For multiple products use product approve orm
Describe in detail the type of work to be performed: Complete tear off and Re-Roof
Property Owner Information:
Name: Thomas & Roberta Fox Address: 668 Selva Lakes Cir
City Atlantic Beach State FLZip 32233 Phone (904) 246-9282
E-Mail or Fax#(Optional)_
Contractor Information:
Company Name: American Roofing of Jacksonville Qualifying Agent: Daniel P. Kinkel
Address: 1015 Atlantic Blvd, #352 City Atlantic Beach State FL Zip 32233
Office Phone 904-385-4375 Job Site/Contact Number 904.226.1205 Fax# 904.853.5318
State Certification/Registration# RC29027546
Architect Name&Phone# NA
Engineer's Name&Phone# NA
Fee Simple Title Holder Name and Address NA
Bonding Company Name and Address NA
Mortgage Lender Name and Address NA
Application is hereby made to obtain a permit to do the work and installations as indicated. I certin,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 if work is not commenced within six(6)months,or if construction or work is suspended or abandonedfor a period ofsix(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 thisplication and know the same to be true and correct. All provisions of laws and ordinances governing this
type ofwork will be complied with whether specified 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 local law regulating construction or the performance of construction.
/ /!
Signature of Own= �jt� �; Signature of Contractor �.
Print Name Rotoe,rT"4 LEt14 Print NameA( /
Sworn to and subscribed before me Sworn to . ubs • before m: I
thisiA
Oil Day of?atm) ,20 lip this fr of ikTo.T ,_ 20 l0
I . • •1L1t1ik
Not P'bl7e[� otary Pu.lic •
,,1% MARY E. SPENCER j4":7-1s-e7'i 26.10
.� MY COMMISSION N FF 976206 ., y?e: TONI GNI
•;,A,2•1
MY COMMISSION i FF 924951
•,47 EXPIRES:Mardi 28.2020 E(PIRES:October 6,2019
Bonded Thru Notary Pub*Underwriters
NOTICE OF COMMENCEMENT
Permit No. Tax Folio No. 172027-5812
State of Florida, County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement.
1. Description of property(legal description of property and address if available): 6 6 8 Selva Lakes C i r
44-60 16-25-29E 087 SFI VA I AKFS UNIT 3 F 3 1 FT LOT 109) OT 110, Atlantic Beachr_FI 52233
2. General Description of improvements:
Re-Roof
3. Owner Information: Thomas and Roberta Fox
a)Name and Address:.668 Selva Lakes Cir, Atlantic Beach, FL 32233
b)Interest in property:100%
c)Name and address of simple titleholder(if other than owner):
NA •
6,4. Contractor Information:American Roofing of Jacksonville
a)Name and Address: 1015 Atlantic Blvd, # 352, Atlantic RAac:h, Fl 32233___
Q\ `, b)Phone Number:(904) 385-4375
�v\ 5. Surety Information:
a)Name and Address: NA
b)Phone Number:
c)Amount of Bond: $
6. Lender Information:
a)Name and Address: NA
b)Phone Number:
7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13 (1)(a)7,Florida Statutes:
a)Name and Address: NA
b)Phone Numbers of Designated Person:
8. In addition to himself/herself,Owner designates NA of to receive a
copy of the Lienor's Notice as provided in Section 713.13 (1)(b),Florida Statutes.
a)Name and Address:
b)Phone Number of person or entity designated by owner:
9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction
and final payment to the contractor,but will be one(1)year from the date of recording unless a different date is
specified:
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION PART
HE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, I,
SECTION 713.13, FLORIDA STATUTES, AND CAN 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 COMMENCING WORK OR RECORDING
YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury, I declare that I have read the foregoing notice of commencement and that the facts stated
th- ein are true to the best of m knowledge and belief.
I,Iiiil 1,
12-bber12. A Fox
Signature of Owner or Owner' •uthorized Officer/Director/Partner/Manager Signatory's Printed Name&Title/Office
The foregoing instrument was acknowledged before me this (off day of KA61,V , 201 L ,
(; r
by I�OV)�'1'1'CA A 1'D", as WYI�t( for .
(Name of Person) (Type of Authority . . fficer/Attorney) (Name of Party Instrument was Executed for)
11011111111116
:3':!b'4. MARY E. SPENCER
s 4:11 My COMNNSSION•FF 976206 NOTARY P , S FLORIDA
% C EXPIRES:March 28.2020 Print Name: 'V G1 rt,i .spenGPy
0 Personally Known
RIdentification"I'ype: �L0 'f
(Affix Notary Seal Above)
Doc#201 61 21 974,OR BK 17579 Page 1195, Revised 3/15/12
Number Pages:1
Recorded 05/31/2016 at 01:30 PM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING$10.00 •