1820 LIVE OAK LN - ROOF r fn
�' �5 f CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
j —r ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
'-f
' Jlil>
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-ROOF-3671
Job Type: ROOF PERMIT
Description: REROOF SHINGLE. 30 SQUARES OWENS CORNING
SHINGLES.
Estimated Value: $1 ,200.00
Issue Date: 4/4/2017
Expiration Date: 10/1/2017
PROPERTY ADDRESS:
Address: 1820 LIVE OAK LN
RE Number: 172020-0742
PROPERTY OWNER:
Name: SCOTT, JOSEPH & MARSHA, *
Address: 1820 LIVE OAK LN
GENERAL CONTRACTOR INFORMATION:
Name: GALAXY BUILDERS INC
, CCC1329195
Address: 5544 DOVER CREST LN QA MICHAEL AARON
SUNDBERG
Phone: 904-616-8938
FEES:
BUILDING PERMIT FEE $56.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $60.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
,.,!...„ . Building Permit Application
`'= City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FL 32233
9;.,f02 Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: [& L-►\/� k(,tr)l 6veTt:,c. h Fl 3?z??��Permit Number: 1-1-Robe- 3(0-1 l
Legal Description Lest"' a1 �c�rr�
5 iaf )r t-t IDA ?13.sec, PGeD RE# 1'?ZOz -c)742-
Valuation
742Valuation of Work(Replacement Cost)$ 1-2-C=O Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercialesidentia
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed: II
La 6oin Sic�� Dwle.+nsConn. S�N le, — .�0 .ct.k:7kc-e.S
Florida Product Approval# l.:1 1 c bZ4.. I for multiple products use product approval form
Property Owner InformationrI
Name: 'L A T€ Gf
� " Address: L..ZC: _ ' c . Ln
City A-{-�� :::G State Fl Zip S.203-3C
Phone D4-24�- ( 4l(0
E-Mail 1'f � �1GS4P c& ttkoob•GQn'1
Owner or Agent(If Agent, Power oforney or Agency Letter Required)
Contractor Information DL
/' t �(J c I `
Name of Company: 0a1Ck �- I3Wt I AtirrS, t('1L• Qualifying Agent: 01 i '' Ju'l i
Address (p(DQ) CoI V�L�_Q.''f j, . S City �tkx. , State FL.- Zip 3 -$3
Office Phone ,( )L 5r)3- 0- Job Site/Contact Number (CWS) Cl TJ
State Certification/Re istration# 13 2-91 q5 E-Mail MI k-C e 1 a..1.a,X , C-O►rn
Architect Name& Phone# (I pt. Jl
Engineer's Name& Phone# MA
Workers Compensation :L ..*4 i i-a9-rt yorSi>V110
Exempt/Insurer Lease Employees/Expiration Date
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 issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
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. _
/jraibal,e_
(Signature of Ow er or Agent including Contractor) (Signature of Contractor)
Signed and sworn to(or affirmed) before me this .2 day of Signed and sworn to(or affirmed)before me this,/Olay of
Rpikt.i... , 2 1'7 , by 01 I Et-r- h A Sc Apr 1 , am] ,by ( \1 5(A,o 9
NTerry Hendr}�M4 Qp C, �� , .fi
Notary PUbIIc w (Signature of Nnr .y
(Signa/ u'e of Notary)
State of Florida
..0";k' CYNTHIA M PILLAR
My Commission Expires 11/30/2017PI • hi,', ,;;)MM1SSION#G(3011518
Commission No.FF 66026 =
•� EXPIRES July 13.2020
[ )Personally Known OR M Persona ly s 'OR
Produced Identificatio f [ )
Produc t wr No
UJete tom
l[ij'
Type of Identification: [ Q.rf 5 l ; L Type of Identification:
I
NOTICE OF COMMENCEMENT
State of r(-- County of p y/val Tax Folio No. 172,0 ),0 —024'2-
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 state�this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: 10 _ 60 0 q ---).--5 — ) C/
Address of property being improved: -Q j....„,./ i- I c �► -f 0 44___p_3..2_2-3 j
General description of improvements: P t.--1414 4 .1 f
Owner: 4I AA S co f 1' Address: /f-.2-0 4'440 oak Lam, 4-4 ,-,r'c1crcei.,
Owner's interest in site of the improvement: p-z, 11231
Fee Simple Titleholder(if other than owner):
Name:
" / Contractor: �a(�X� g,, k(t P� '1� c _Il _
Address: 66 D Co1v ,j, /"
. Gf'/`K_ P.,- So,-et, sou- 1� - 3)li4
ailAli/ . OLi — � 3 .41C 90' . 03 -wi`o
Telephone No.: � Cl/ Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone 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, othe• an himself, designated by owner upon whom notices or other documents may be
served: Name:
Address:
Telephone No: • • Fax No:
In addition to himself, owner designates the following person to receive a copy of the.Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option,) (C/
Name:
•
• Address:
Telephone No: ..77.7 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
Signed! � � � s / �f' Date: /
Heather Mooney Before me this ` - day of X417 y i 1 in the Coun of J uval,State
ti
Stated Fblk Of Florida,has personally appeared M a r SViG► lc. Scoti-
'hi Coim:Won E>piles 0210112021 Personally Known: or
Commission No.GG 68713 Produced Identification:F or i d G1 DL. S 50D-5'51-'i to-$,3-b
Notary Public:66XttW- - }teo-ho-P,V {NI Oo1�e.�
Doc#2017077118,OR BK 17933 Page 2217, My commission expires: 0 2) 01 2_02 U
Number Pages:1
Recorded 04/04/2017 at 12:34 PM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY .
RECORDING$10.00