2245 N Fairway Villas Ln re-roof permit ? CITY OF ATLANTIC BEACH
f 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
�.l Oiilp%.
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-ROOF-3577
Job Type: ROOF PERMIT
Description: RE ROOF - 3/12 SHINGLES
Estimated Value: $3,500.00
Issue Date: 3/27/2017
Expiration Date: 9/23/2017
PROPERTY ADDRESS:
Address: 2245 N FAIRWAY VILLAS LN
RE Number: 169398-1082
PROPERTY OWNER:
Name: CAMPBELL, JAMES M
Address: 2245 FAIRWAY VILLAS LN
GENERAL CONTRACTOR INFORMATION:
Name: RELIANT ROOFING INC RYAN SHOUPPE
Cameron Ryan Shouppe,CCC1330615
Address: 528 Millhouse Lane Orange PARK
Phone: -
FEES:
BUILDING PERMIT FEE $67.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $71.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE F IVDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233 ZC
Office(904)247-5826 F.(904)247-5945 17 - Roo F- 5,S 77
Jab Address:
y�rAAn"V01% Lane North AWJ MC b'at"
erirn Number: /
Legal Description39-22 o@RS-29E FQIrw0V 1AWr Loi 41 Parcel#
Floor Area of Sq.FL Sq.Ft
Valuation of Work$:�SOO.D O proposed Warrrkkhealed/cooledhinA non-heated/cooled l OCOQ
Class of Work(circle one): New on AdditiAIR�. �,
�ratson Repair Move Demolition poo/spa window/door
Use of existing/proposed intersects)(circle one): Commercial Residentiala
[fan existing structure,is afire sprinkler system installed?(Circle due): Yes No N/A a,
Florida Product Approval# FL- 10124- R iAl FL-1670`1- L'Z
For multiple products use product approval form
Describe in detail the type of work to be performed:Ye- Y OuP 19 SB -�PL PiiGrl- FL-10124m RIS
Propertyowner Informaattim: fa
llone- ] , 1 QIYIDIJCLI Address: VwaO IfV1n1 A
city r-Ie5MAC,g Site ALZip $56io Phone[9�G -41y- 9966
E-Mail or Fax#(Optional)
Contractor information:
Company Name:ReIwA Racine me Qualifying Agent cdnmman^mm
Address:M N.AIA d�ehaysm.sip Cin, wn dmr.m Sii FL yip amaz
Office Phone ao^ Job Site/Contact Number namuNsnvoe.-eoresmm Fax# aN�
State Cenificatim/Rt strsurn#cccusm's
Architect Name At Phone#
Engineers Name&Phone#
Fee Simple Tide Holden Name and Address
Bonding Company Name and Add.
Mortgage Leader Name and Address
Appall...fae-nemnr made mnamin apnmircodame,wNaMtimadlal mwiMrnrM Imrh oar ne xnA ar;naalmeaa M1m mmmrnredixiarm mr
V ,=,J d aad ihm oll work xvll be peri�m meenne eiandmJ oJall laxm regulon M1isiu.vdirrion. fiu ce^mr beromct
k gac cm,d enmmemraa:ddn,Rla)m,mrm.nr Jrm,.he',,awwark:.saisl wd�aeammag, apanaafru(s)Fdoom arae e
work u eamnr Aw !d-m,,na aar,rnaran Permiu ma.�`Ae•n'm'ed j r£lHm w weak,vlambi g,sig.,, won.pawA F1rn.eo. ie.,.
°fjmem,rater aaeA;.caseinanem,em
WARNING TO OWNER:YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO OUR LENDER OR AN YOU
BEFORE RECORDING YOUR NOTICE WITH
COMMENCEMENT.
Inercey h M1ar/nave raneanee:amv�eemi p�yl4nrzon anaknawme,awzra M(rueaMearm'c Annrornwv oflaxs aMwtlinaneu govnnmKmn
nyz)xwk Hill be eomylied with wnemevpnlea nevem w nes. Sne gmnen%7a yermu dcea nw prrrvme ro 8n'r amM1orily io o;olore w a'anal the
prwmom jam orht')rderaI ar lwallax�regulauxi—srunion wrhepeemmanuegcoavounion.
Signature of Owner ��ignausreofConuacua _
Print Name JQM1!3 CGrnp til Print Name ___ Cameron Shouppe
Sworn to and subscri bed before me Swom to and subscribed before me
this Z3 Day of PY h this hof Mnrca-. .20 1-7
Notary ubhc Noir,Pablo,
0Jennifer Kraut Revised01.26.10
NOTARYPUBLIC
STATE OF FLORIDA Je nlw Kral
Co miiit FF9515M NOTARY PUBLIC
r
1 Expirm 1/19/2020 0 STATE OF FLORIDA
Coring FF951504
Expires 1/19/2020
Doc $ 2017067577, OR EK 17920 Page 2336, Number Pages: 1, Recorded
03/23/2017 at 03:48 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
NOTICE OF COMMENCEMENT
IPW➢ME M MALIGTEI
Pemgl No. To.FOIb No.
Sate of �L -- Cdarty of f111Y
To whom It may,wncern:
The undemigned hereby Informs you that Improvements will be mad.to certain mal property,and In
aceordance with Sedlon 713 of ma,Florida Statutes,the following Information Is stated In this NOTICE OF
COMMENCEMENT.
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Address of pmpery baklg lmprMw: 48 N FQ1r V1K1 1i1l1S L(l YllA
At�tf PaLhf�l gaa33
Genenldascretionofimpionams,: Y^P- k-Den-F
owneduns Campyrll
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Owner's(merest In sde of the knpmvenard _-
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Addmsa ftl2 Nort Fjj@hj,. 1d SUlit R1in, 9bvyaw Vedfn etyArA,,Pt 18P
Phone No(9OH)-71a-3111 Fes No.
Surety,(if any)
Adtlmss Amdnt id bond S
Plane Ne. Fm No.
Name and admss of any person making a ben for the mnabucuon of Me imywemenls.
Name
Address
Phone No. Fa No.
Name a person wNdn Me Slab of Ronda,other than hknseg,designed by owner upon whom notices w other
documents may be served:
Name
addmss
Phone No. Fee No.
In addition b himself,owner dissension Me folloMmg person b recaiw a Copy of No Liam's Notke as em adisa In
Section 713.06(2)(b),Florida Stabtes.(RI In a Owners option).
Name
Add..
Phone No. Fae No.
Expiration tleb of Nofice of CommenmmeM(tib expatiation dab Is am(1)year ban Me deb of wending unless e
dkbrent dote is speufied):
THIS SPACE FOR RECORDER'S ME ONLY pt1YVflER
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