460 SAILFISH DR - ROOF )" s, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
;JATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
�JJ�1
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ROOF-2844
Job Type: ROOF PERMIT
Description: torch-down re-roof 2/12 pitch FL16709-R2
Estimated Value: $6,000.00
Issue Date: 12/28/2016
Expiration Date: 6/26/2017
PROPERTY ADDRESS:
Address: 460 SAILFISH DR
RE Number: 171400-0000
PROPERTY OWNER:
Name: BCS ACQUISITIONS GROUP LLC
Address:
GENERAL CONTRACTOR INFORMATION:
Name: RELIANT ROOFING INC RYAN SHOUPPE
Cameron Ryan Shouppe, CCC1330615
Address: 528 Millhouse Lane Orange PARK
Phone: - -
FEES:
PLAN CHECK FEES $40.00
BUILDING PERMIT FEE $80.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $124.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
�S! �p;y,, City of Atlantic Beach APPLICATION NUMBER
is A Building Department (To be assigned by the Building Department.)
r ` 800 Seminole Road t. ) -- O F,a L4 l/
�:. _ �r Atlantic Beach, Florida 32233-5445 1
Phone(904)247-5826 Fax(904)247-5845 , l I /
a on t%' E-mail: building-dept@coab.us Date routed: l I(O
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Lkk0 0 (-" L1 Ilr\ V t ' _ wain review required Yep' No
C Building
Applicant: t iL1n- 6--0,\)n
n \'\)n t ( 0 L `Planning &Zoning
Tree Administrator
Project: \1 .----t\-wk CL(\* 9---06 11±) Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: [l pproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: / r Date: /off'?7.16
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denie .
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
BUILDING PERMIT APPLICATION
OFFICE COPY CITY OF ATLANTIC BEACH O
800 Seminole Road,Atlantic Beach,FL 32233
VIED
Office(904)247-5826` Fax(904)247-5845
Job Address: 4(eD a J(_i ' -6Sh Pr. Permit Numbe 1:l DEC 2 0 2016
31-I t.o 3a"2s-24iE RI P of'P't- of-'P-'P ' ,__,ii--,, ,,
Legal Description ttvYt9 Ot t t k" 2.A- L-O'�A f3%14 10 Parcel# _
Floor Area of Sq.Ft. p Sq.Ft �r,,
Valuation of Work$ (D000(OD Proposed Work heated/cooled �,b 1% ,_ non-heated/cooied_f
igi — fL2YtSUF-
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 cl'
Florida Product Approval# F L Ito 1(3 —R.2-
For multiple products use product approval form
Describe in detail the type of work to be performed: Rt..—‘450-c--- — (-.elGlLx.14 el
2.(Q SIGzsU.0 — 2i t2 "kA-Gy)
Property Owner in rrm(ation: �L
Name:_`CS ' '`�"�tiUIS(t Vii • Address: ( 4 f^ �Ul
City �C-S '\)'Vl;F1.Stazip 322.0 Phone tyidirl
i3—
E-Mail or Fax#(Optional)
Contractor Information:
Company Name:Reliant Roofing,Inc Qualifying Agent: CB01e=Om 88018198
Address:822 N.A1A Highway Suite 310 City Poole Veda Beach State FL Zip 32082
Office Phone 904657.0880 Job Site/Contact Number Cameron Snouppe-904.857-oeeo Fax • .., - ( 0(-6 0?
State Certification/Registration#CCC1330815 L)C,3
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address -7 ( Z 3iit
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 cer*thatation 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 abandoned for a period of six(6)months at any time
after work is 2•onrmenced. I understand that separate permits must he secured for Electrical Work.Plumbing.Signs. Wells,Pools.Furnaces,Hollers,
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 certh'that I have read and examined this ypplication and know the same to be true and correct. All provisions of laws and ordinances governin this
type of work 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 Owner C0t
Cameron Shouppe
Print Name V Signature of Contractor
Print Name
��?s- —•
Swo mo and subscri d before rrye Sworn to and subscribed before me
this Day of t i ,20 (� this q Day of Des eW,..1ir' .20 1 IP
IOW*
Nota ublic Not blic 1
Jennifer Kraut Jell te4p 6.10
Co., NOTARY PUBLIC NOTARY PUBLIC
_STATE OF FLORIDA
�' ` Ctxrttrt#FF951584 fj' , ;STATE OF FLORIDA
• iii"d•-"':-•
Comm#FF951584
' ' Expires 1/19/2020 ' '—'s
Expires 1/19/2020
Doc # 2016288526, OR BK 17815 Page 1067, Number Pages: 1, Recorded
12/19/2016 at 12:30 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
OFFICE COPY
NOTICE OF COMMENCEMENT J�
(PREPARE IN DUPLICATE) DEC2 0
Permit No./6j ''.L20°>�-a gyy 2016
Tax Folio No.
State of vCounty of 113C-03141111111111111!
To whom It may concern:
The undersigned hereby Informs you that Improvements will be made to certain real property,and In
accordance with Section 713 of the Florida Statutes,the following Information is stated In this NOTICE OF
COMMENCEMENT. C
Legal descrprion of 1."opert: a being protea 31 —I .p 36— Z5 — 2_'11
_.1L P._Q t �- -t+ 2 /1 Lc-t
1 L tc to 't _C
Address of property being improved: 4lot) E. 5�►1-�`iS1') Dr.
General description of improvements: 13'e 'Y-b( -
owner W$ F C-Q1LIS1-h6Y1 (- -ck Lt-C
Address INIct $1QtntuinuD Blt,Cl 36U. U t 1U e1 FL 31240
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Reliant Roofing,Inc.
Address 822.AIA Highway Suite 310 Petite Vedra Beach.FL 32082
Phone No.9044574)980 Fax No.904-677.7972
Surety(If any)
Address Amount of bond$
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 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 OWNER
Waned DATE 12/19/2016
Before Lbws ofPefjellbC retie
Cour rncfC�`N.Sive of Fonda has personally appeared
hewn by
hlmseW herself and affirms that ail statements and d.Naraoon a Jennifer Krait
are true and accurate NOTARY PUBLIC
cJ�,�, 1�bIAC ' '-STATE OF FLORIDA
)-" Cattm#FF951584
"/y t; Expires 1/19/2020
rrola vdt•�e al .r.. Sri 1 ! Count.;of
IA
PE:snnasi Fns.n or
Produced[donee tion