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1269 OCEAN BLVD - ROOF '� '� , CITY OF ATLANTIC BEACH :- J 800 SEMINOLE ROAD j ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 \0.31>f' ROOF PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 17-ROOF-3644 Job Type: ROOF PERMIT Description: re-roof modified bitumen FL-1049-RS Estimated Value: $9,000.00 Issue Date: 3/31/2017 Expiration Date: 9/27/2017 PROPERTY ADDRESS: Address: 1269 OCEAN BLVD RE Number: 171832-0000 PROPERTY OWNER: Name: HOPKINS, BRUMSEY BESSIE TRUST 0 Address: 1269 OCEAN BLVD GENERAL CONTRACTOR INFORMATION: Name: DS KILLIAN ROOFING David S. Killian, CCC1328203 Address: 3898 DUPONT CIR QA DAVID S KILLIAN Phone: - - FEES: PLAN CHECK FEES $47.50 BUILDING PERMIT FEE $95.00 I STATE DBPR SURCHARGE $2.00 I STATE DCA SURCHARGE $2.00 Total Payments: $146.50 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. 1 1 o-tv rjr, City of Atlantic Beach �sjyBuilding Department APPLICATION NUMBER 800 Seminole Road (To be assigned by the Building Department.) �`r Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 'J;119r E-mail: building-dept@coab.us City web-site: http://www.coab.us Date routed: © 3 I l ( - APPLICATION REVIEW AND TRACKING FORM Property Address: Ic..-tQr1 0C .pa.,- IjWC,1 0 - s . •• -nt review required Yes o :uilding Applicant: 0 S (--t. t�L (,L') (Z04 fl . anning &Zoning �` �J Tree Administrator Project: ( L— t p mo Ct1 RA b1LM Public Works ,(U p -P ,S-e_c b� Public Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified B Date 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: RrApproved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: VriA) TREE ADMIN. Second Review: [Approved as revised. ['Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: []Approved as revised. []Denied. Comments: Reviewed by: Date: wised 05/14/09 �"1{P Building Permit Application F, City of Atlantic Beach �� 800 Seminole Road, Atlantic Beach, FL 32233 Orr:.; : 'w PI 41414, Phone: (904) 247-5826 Fax: (904) 247-5845 1 tt '' Job Address: /G,1 CO 9 67�c-e 7 to/.l.�to 1 .W3?Permit Number: I 1 — r —3�'(--[L-( Legal Description/('// /& ? S- ae 5 �./ 4' "4,4liy II C i(i__o--,(RE# /7/ -3) --jjc�(%t') Valuation of Work(Replacement Cost)$ 1000. 000 Heated/Cooled SF f(�'�ilr Non-Heated/Cooled /,'"Z • Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool 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 • 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: ieeideLCe_ ,''.- s"'cr`r$ I RE-ROOF _ ( Florida Product Approval# . I �� 8I Tz for multiple products use product approval form Property Owner Information � ,{�� Name G S5/6 if t3���n Q"I Address: \-(0� ` O_e t. csuI City CaT�--AN \C 3 Ac 1T tate `�� Zip -3-x-7 33 Phone O`�-au. 5 3 1 E-Mail \- Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company: DS KILLIAN ROOF & GEN CONT Qualifying Agent:DAVID S KILLIAN Address 1031 MIMOSA COVE CT E City JACKSONVILLE State FL Zip 32233 Office Phone 904 246 7663 Job Site/Contact Number 904 246 7663 State Certification/Registration# CCC 1328203 E-Mail DAVE@DSKILLIAN.COM Architect Name& Phone# Engineer's Name&Phone# Workers Compensation -. 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. 1 Asz,c,,,)2_ -C-:-- (\•-Limse ( ________.______._._-------- • nature of Owner or Agent includingContract. (Signature of Contractor) (Signature g f3 Signed and sworn�tow or affirmed)before me this \ d•y of Signe and sworn to(or affirmed) before me this W) day of Mk%. . `. GL7 ,by n, =-1r ?�►1._ L L . %• !‘"VAC C V1 , -01"1- , by COLLEEN A. •�*7 l i�—_'� iki � •:;c . Commission#FF 07445(iSign• ure of Notary)Expires December 7,2017 f!TLi : o a Thu lroy Fain Insurance t100�64019 27,2020 •,, o/fw•• Bonded 1}w Notary Public Um:Mem ters E 6ersonally Known OR [ j Personally Known OR [ roduced Identificatio U [• Produced • Identificatio Type of Identification: • c•.t !,,:. % . a• ,Type of Identification: 46412-1 s L(AAP- NOTICE OF COMMENCEMENT (PREPARE IN DUPLICATE) G Permit No. ('7 goo->'3 6 "y Tax Folio No. 17/ � —G2GrX, State of 'F l crok County of +1_J g,/((Q To whom it may concern: OFFICE COPT 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. Legal description of property being improved: —/ 4/ `X' i 5 ----L2 [6 o /6 4dee�aV !V 31 fes- A --- 5 . "3 L Fr LJo'rS i o tc 1._1C_-5-e Address o propertbeing�i roved: .� 12-` A ec/e . / f); •)..". - ., .3 General description of improvements: RE ROOF Owner 3 -s5\� \ 4- LLT `n ✓'1- Address V'DCca, <<-)C _Qt'-( -3L V�J C VT L� \� RC�. .--- ..1. '32Z-3j' /G- Owner's interest in site of the improvement e",S Fee Simple Titleholder(if other than owner) kJ 7/4- Name Address „ Q/� Contractor DS KILI.IAN ROOF GENERAL&CONTRACTORS INC , /V ' Address 1031 MIMOSA COVE CTE JACKSONVILLE FL 32233 Phone No. 904 246 7663 Fax No. DAVE@DSKILLIAN.COM Surety(if any) ,v74 Address Amount of bond$ Phone No. Fax No. Name and address of a person making a loan for the construction of the improvements. Name /lam //A 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 sere Name 1-/ Address Phone 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),F rids Statutes.(Fill in at Owner's option). Name /(} A Address Phone No. Fax No. Expiration date of Notice of Commence •e•t(the ex•iration dat- is)nen )year from the date of recording unless a different date is specified): di -, G ( THIS SPACE FOR RECORDER'S USE ONLY \\ OWNER �—- VII Signe It' .. . C t `_ DATE 1 12 Before me this t!$ day of �\��, ,, e ■ In the unty of Duval.Stat Mort has•-rsonall ap•ear-• ,� t`u • P herein by l Doc#2017073623,OR BK 17928 Page 2202, ht eli/h� R�rtd atfihtis that allstatements and decl tions herein are true and accurate Number Pages:1 Recorded 03/30/2017 at 03:43 PM, ^ Ronnie Fussell CLERK CIRCUIT COURT DUVAL I COUNTY s-----'4`5 i 11: RECORDING$10.00 �� • . ~:4i1�d � Notary Public at Large.State of � •. off.'. ��,�/ # ' 074450 My commission expires: =.•M,;, '`•,or Ex rtz n• rtber 7,2017 Personally Known_ �/' _ fa t� Produced Identification I�fi p„11., •a ihru Troy rain Insurance 8003854019 _ s A OFFICE COPY cIc EXTERIOR RESEARCH&DESIGN, LLC. Certificate of Authorization#9503 1TRINITY ERD 353 Christian Street �+ Oxford,CT 06478 PHONE:(203)262-9245 FAX:(203)262-9243 EVALUATION REPORT Mule-Hide Products Co.,Inc. Evaluation Report M10000.03.08-R5 1195 Prince Hall Drive,Suite A FL10497-R5 Beloit,WI 53511 Date of Issuance:03/28/2008 Revision 5:12/14/2015 SCOPE: This Evaluation Report is issued under Rule 61G20-3 and the applicable rules and regulations governing the use of construction materials in the State of Florida. The documentation submitted has been reviewed by Robert Nieminen, P.E. for use of the product under the Florida Building Code. The product described herein has been evaluated for compliance with the 5th Edition(2014) Florida Building Code sections noted herein. DESCRIPTION: Mule-Hide SBS and APP Modified Bitumen Roof Systems LABELING: Labeling shall be in accordance with the requirements the Accredited Quality Assurance Agency noted herein. CONTINUED COMPLIANCE: This Evaluation Report is valid until such time as the named product(s) changes,the referenced Quality Assurance documentation changes,or provisions of the Code that relate to the product change. Acceptance of this Evaluation Report by the named client constitutes agreement to notify Robert Nieminen, P.E. if the product changes or the referenced Quality Assurance documentation changes. Trinity I ERD requires a complete review of this Evaluation Report relative to updated Code requirements with each Code Cycle. ADVERTISEMENT: The Evaluation Report number preceded by the words "Trinity I ERD Evaluated" may be displayed in advertising literature. If any portion of the Evaluation Report is displayed,then it shall be done in its entirety. INSPECTION: Upon request,a copy of this entire Evaluation Report shall be provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at the request of the Building Official. This Evaluation Report consists of pages 1 through 4,plus a 23-page Appendix. Prepared by: .,tttttrr, —No_sutle c- c: OF uw-_ The facsimile seal appearing was authorized Robert J.M.Nieminen,P.E. ,..;... r by Robert Nieminen,P.E.on 12/14/2015 .,r/,,�,, „0"``� Thisdoes not serve as an electronically signed document.Signed, Florida Registration No.59166,Florida DCA ANE1983 sealed hardcopies have been transmitted to the Product Approval Administrator and to the named client CERTIFICATION OF INDEPENDENCE: 1. Exterior Research&Design, LLC.d/b/a Trinity I ERD does not have,nor does it intend to acquire or will it acquire,a financial interest in any company manufacturing or distributing products it evaluates. 2. Exterior Research & Design, LLC. d/b/a Trinity I ERD is not owned, operated or controlled by any company manufacturing or distributing products it evaluates. 3. Robert Nieminen,P.E.does not have nor will acquire,a financial interest in any company manufacturing or distributing products for which the evaluation reports are being issued. 4. 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OS 1 4 4 / mt. II; ',416It' ,269 Ocean'Boulevard ? .1 ,,.. . . ., . : . . ' • • 714,d,- 6-..10 - • i...: / 6/, . . 1 • . .. ., -6--u?-(e. Li s) (it cf ,z : fa . NOTICE OF COMMENCEMENT (PREPARE IN DUPLICATEi Permit No.t7 /4,04 _ 3 6 Yr Tax Folio No.,+�/ 71 g 392 - d d4 609 State of FIoclCounty of ifk,li e 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. Legal description of property being improved. / 'tel/ `�— A S .all /6 1.1, Fr- L/cars i 0) i ( Ltir s-ct i roved: .�z I i fv�� 4/47 4 Addre s o propert being yy ! 11 O G C IG /L-5..e« � T=G) 3 :1- - 3 General description of improvements: RE ROOF Owner S5\� \-. C"--)"-- 5 -•4 sr-..- Address CD4 ()CS N. '711— D V �rt LCA NC.. fir. Th 32 Owners interest in site of the improvement of. Fee Simple Titleholder(if other than owner) r.)/A Name Address Q� Contractor T)S K1l.L1AN ROO GENI.RAL R CONTRACTORS INC /V"� Address 1031 MIMOSA COVE CT F JACKSONVTTLE FL 32233 904 246 7663 ' ..r.•cw�lv�1 • Phone No. Fax No. INIMININIMPIIIIIII Surety(if any) . allirril—'-` 161.11.1% Address • oun • •ond$ Phone No. Fax No. • 14 ► 1 1 j I: ' Name and address of a person making a loan for the constructio o�if1 ip oro rt lB SITE FOR c Name A V d �% 1 _ ; ' ; , 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 sery Name ,C/ A REVIEWED FOR CODE COMPLIANCE Address CITY OF ATLANTIC BEACH Phone No. SEE(RERMITS FOR ADDITIONAL REQUIREMENTS AND CONDITIONS 'r 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),F Arids Statutes.(Fill Do[�1dA). rn � DATE: 3/+)1//7 AlName A Address Phone No. Fax No. Expiration date of Notice of Commencerget(the exration datg i�ie )year from the date of recording unless a different date is specified): �''!�� ,�(/ THIS SPACE FOR RECORDER'S USE ONLY OWNER 4--- Sigo�� o.1 DATE in1. 2 B before me this day of_ \ • \ in the r' only of Duval.Stat Flor has•ersonall•a.•-arm. � L •i� herein by OR BK 17925 Page 2202, hi e n r athTm�that all statements and decl?•:tons herein Doc#2017073623, are true and accurate Number Pages:1 - Recorded 03/30/2017 at 03:43 PM, t Ronnie Fussell CLERK CIRCUIT COURT DUVAL , s COUNTY A.•.tii.10 RECORDING$10.00 Notari Public at Large.State of '� . Op_ ''oh.'• M�*.• ! . ' 074450 My commission expires Person `� " i ember 7,2017 produced Known_ . �. — • �� produced IdeniiEc.a on J'f p;..... ttodw ITN-Troy Fein In•ureno•8003057019