1700 FRANCIS AVE - ROOF CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
• 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: 17-ROOF-3447
Job Type: ROOF PERMIT
Description: re-roof FL1956 & FL21350.1
Estimated Value: $12,900.00
Issue Date: 3/9/2017
Expiration Date:: 9/5/2017
PROPERTY ADDRESS:
Address: 1700 FRANCIS AVE
RE Number: 172132-0100
PROPERTY OWNER:
Name: HOLY CHURCH OF THE LIVING GOD
Address: 1700 FRANCIS AVE 1700 FRANCIS AVE
GENERAL CONTRACTOR INFORMATION:
Name: EXCEL ROOFING CONTRACTING
Henry Scott Sorensen, CCC1328406
Address: 5722 DUNN AVE HENRY SCOTT SORENSEN
Phone: - -
FEES:
BUILDING PERMIT FEE $114.50
STATE DBPR SURCHARGE $2.00
STATE DCA SURCHARGE $2.00
Total Payments: $118.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
•
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233 •
Office(904)247-5826 Fax(904)247-5845
Job Address: )' O rd.,.' flJr #I s I L4 A 1l. Permit Number: LI-V-0()f-3 44-4-
-44 iLegal Description Pt Loftye 4 Des 4ea o'/.-W2- Parcel# /9./32
'Floor o Sq-Pt. ,
afg. 5 .rt
Valuation of Work$ / )) CLQ.e' Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): tali Addition Alteration Repair Move Demolition pooVspa window/door .
Use of existing/proposed structure(s)(circle one):- mmercial Residential
If an existing structure,is a fire s !!� alder system Inst• I • . . e one): Yes No N/A
• Florida Product Approval# 0/'/ Oldie/lt�,w.,.r, t�rk x53sri
For multiple products use pro
duct approval form -
Describe in detail the type of work to be performed: R e rod- i nye-
Property
Owner Infrmation:
Name:14Olto1
iibj a Address: /9/20 s Gln�h,'S le-
City 4fe.. State FLZip ,'3g2OPhone '37C0--fo*9 •
E-Mail or Fax#(Optional)
Contractor Information:
Q fyAgent:MS/1 7*.'r e#rsei
Company Name: ;� � ��i„�: . r✓ uali �mg �
Address:..57;g A•1/�t� 'i,” City J , //f State L Zip 3a� 1K
Office Phone jo:3/- 2i, 3 Job Site/Contact Number H�.3•-; /t Fax# /41-•eee /
State Certification/Registration# C61. /, ogS1iL24,
Architect Name&Phone# J9-
Engineer's Name&Phone# %1t-
Fee Simple Title Holder Name and Address f
Bonding Company Name and Address ,4' •
Mortgage Lender Name and Address A"
. Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the
issuance ofa 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 f 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. /understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools,Furnaces,Bollen,Heaters,
Tanks and Air Condoners,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 an, .amined this cgoplication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied w' hether spec'te' herein or not The granting of a permit does not presume to gry out ori to violate or cancel the
provisions of any other federal, •at or local law re• atm: onsiruction or the performance of construction.
/
Signature of Owner .,.... /, P' _ � Signature of Contractor id �—
Print Name Cratai Print Name -500#
Sworn to and subscribed before me Sworn o and subscribed before me
this Day of r2 c;�_ •20 /7 this Day of ii .a. 20/7
Ke,...t.4,444:- /N. I'/ ' iii 0
Notary Public ` - viv --� .tarAmur.
�.0 ., /:-L• l)G. �`� .3.5'� �,.er• UICSI.EALJOM160N
• #� # My COMMISSION t FF 90D6t3 ,�c r. DENISE LYNN ised 1.26.10
Notary Public-Stab of Florida
I y, FORM Febtuaty 19,2020 •� Commission♦FFSl0169
'rosndA° 4Mlkrotfuo�rttloexySerda. My COMM.Wines Jul 27.2021
_.___ •
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' ;�A Bonded through National Notary Assn
Doc # 2017030327, OR BK 17870 Page 1694, Number Pages: 1, Recorded
02/08/2017 at 08:59 AM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
OflCE OF COMMENCEMENT •
-REPARE t?0Ua>t�47C.
Permit No. _. _ Tax Folio#`c.
State of.ems ___.__ V Count;of r 1404/
. To whom it may concern:
The undersigned hereby informs you that improverrtenis kYil#be made to certain real property.and in
accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE O'
COMMENCEMENT.
Legat,:,escription of property being in-roved: 5 p /9.�2�-. 21E. 4 :35
—._ N?jrm , AL La*4 Rethd /Loq.6 `04°r e- yi�13
Adpr
urese of property being improved: 1.if L fir ''',143,4#1‘ At./ .
General oe5cr#piton of i frprarernenis: ' ,04,4.-.. _..
O :ser 3}e3 sr� • ,Illi fid; 'lit- ;v". sf!r3%C1 ter.• g,_ f1�rf1'l /to` irt-e=^'jam.
Address i,E � 'v iii..e.A,„_&...?„ 1' 4,4.5 f�:� /7: :5J`. ti..--A
C:net's interest In s#ta of:he improvement OWNER
Fee Simple Tidely,oider(if ocher than owner)f'.3fA ,
Name 97A
Com.ractor SCOTT SORENSEN -,EXCEL ROOFING CONTRACTORS.INC _ - _....
Address 5722 Dt}NPN AVE JACKSONVILLE R32218
phone No.504.831.7683 •Fax No..904,214-0004 .�.._
Sureti of any)N
Addre_s rtrA _ �. r`mrrfrtt of bond SNIA
•
Phone No. N/A Fre.:Dia.NIA
Name and address of any person raking 3 loran for the construction of the improvements.
•
Name NIA
Address NIA .. . . .
Phone No. N/A Fax t4,. N/A
Name of oerscnf tvimhin the State of Florida.othertban himself.designated by owner won when notices or other
documents may be served:
Kafue NIA
Address{'iA
_
Plloree Pio. NIA F'ax No.NIA
•
• so areonon ie ntmseIt,owner ne.,gr•ales me fogowIng person to recesve a cov..tt of the Lie n.'�,"s Ntot .e as pr4li eLr in
Sectors?I3.06(21(b).Fronde statutes.;Fit!in et O'wner's option;
Name NIA _
Address{W'A ._._ •
Phone Na.NIA Fax No.€A w —•—•- .
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Expiration date of Wolice of Co:nmermnent lace expiration date!sone( year t om the date.of tacarding unless a
different bate is s,oett;find):
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