1898 SEMINOLE RD - ROOF jr\i'l
' S� CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
jATLANTIC 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-3716
Job Type: ROOF PERMIT
Description: RE ROOF SHINGLES
Estimated Value: $9,500.00
Issue Date: 4/10/2017
Expiration Date: 10/7/2017
PROPERTY ADDRESS:
Address: 1898 SEMINOLE RD
RE Number: 172020-0528
PROPERTY OWNER:
Name: RAY, JOYCE M
Address: 1898 SEMINOLE RD
GENERAL CONTRACTOR INFORMATION:
Name: MONAHAN ROOFING
, RC0047349
Address: 2050 S KING CIR QA THOMAS L MONAHAN
Phone: - -
FEES:
BUILDING PERMIT FEE $97.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
I
ITotal Payments: $101.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 � � -Roof-371 CQ
Job Address: /d 94 e• •�c,/.' Q Permit Number:
Legal Description . -2a'G 5-2 S -21 C Jc/cam ,.,:. Parcel# � '7 2 0 Zd - CDS z B
Floor Area of Sq.Ft. y^'�'.' /",&...4$q.F't
Valuation of Work$ ? SG Proposed Work heated/cooled / non-heated/cooled
R�ro�F
Class of Work(circle one): New Addition Alteration -Repair Move Demolition pool/spa window/door
Use of existing/proposed structures)(circle one): Commercial Resi
If an existing structure,is a fire s rmlder system installed? (Circle one): Yes No ,ICT-7D
Florida Product Approval# ' G 3/. `1
For multiple products use product approval form
Describe in detail the type of work to be performed: Gr r c r G 4 F
Property Owner Information:
Name: -JG 7 - Address: /A 9 e
City A F i'.,.. / e. r s Stater'!Zip Phone a v -
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: P10,,-". C1,1, Co" < � Qualifying Agent: G"/14--
Address: 2a 3 ., C. (-. City /t/re c State Zip s' c
Office Phone 2_2 Job Site/Contact Number S( .7" 92- " Fax#
State Certification/Registration # {2 " 0 4 7 4
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
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 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 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 abandonedfor qperiod of six(6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical !Fork, Plumbing,Signs, Wells, Pools, Furnaces,Boilers,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 herebycertify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of ork 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 X'! i�� Signature of Contract. / 4Alar
Print Name ,}tee e • . .... / Print Name vC..'7u;.. { L fri on her
Before me jj Before me
•
this I l7 Day of ft r, i ,20 \ 1 this Day of tovrt 1 _ k r'e,,,� _
11 State of Florida
otary Public (5.-14-
Stated Florida otary •u.lic My Commission Expires 02/01/2021
Commission res 02!0112021 ` c No.GG 68713
1/4..,J My Revised 1
Commission No.GG 68713
coo ws
JEFF ATWATER
CHIEF FINANICAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS'COMPENSATION
** CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW**
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 4/5/2017 EXPIRATION DATE: 4/5/2019
PERSON: MONAHAN THOMAS L
FEIN: 593745856
BUSINESS NAME AND ADDRESS:
MONAHAN ROOFING CONTRACTORS INC
2050 KING CIR
NEPTUNE BEACH FL 32266
SCOPE OF BUSINESS OR TRADE:
Licensed Roofing Contractor Roofing-All Kinds and Drivers Carpentry I Detached One or Carpentry Dwellings 0 Three
Two Family Dwellings Stories or Less
IMPORTANT:Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under
this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply
only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be
exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the
person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a
certificate at any time for failure of the person named on the certificate to meet the requirements of this section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609
eft
JEFF ATWATER
CHIEF FINANICAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
**CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW**
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 7/14/2016 EXPIRATION DATE: 7/14/2018
PERSON: LUCAS PAT
FEIN: 593745856
BUSINESS NAME AND ADDRESS:
MONAHAN ROOFING CONTRACTORS INC
8423 GALVESTON AVE
JACKSONVILLE FL 32211
SCOPE OF BUSINESS OR TRADE:
Carpentry NOC Roofing-All Kinds and Drivers Cleaner-Debris Removal-
Construction
IMPORTANT:Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under
this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply
only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be
exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the
person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a
certificate at any time for failure of the person named on the certificate to meet the requirements of this section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609
.:dry : 0,
`*f'
' F
JEFF ATWATER
CHIEF FINANICAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
** CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW**
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law.
EFFECTIVE DATE: 7/14/2016 EXPIRATION DATE: 7/14/2018
PERSON: MCCALLISTER LARRY 0
FEIN: 593745856
BUSINESS NAME AND ADDRESS:
MONAHAN ROOFING CONTRACTORS INC
565 LEE RD
JACKSONVILLE FL 32225
SCOPE OF BUSINESS OR TRADE:
Carpentry.;NOC Roofing-All Kinds and Drivers Cleaner-Debris Removal-
Construction
IMPORTANT:Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under
this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply
only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be
exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the
person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a
certificate at any time for failure of the person named on the certificate to meet the requirements of this section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609
NOTICE OF COMMENCEMENT
Permit No. Tax Folio No.
State of Florida, County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713, Florida Statutes,the following information is provided in this Notice of Commencement.
1. Description of property (legal description of property and address if available):
_ 3Cv -2 O -0 `i - 7S -. 21 E LSC/Ug /'ha/,,1 , U1. , 9 La f- l`1 , ,e/ /
2. General Description of improvements: / d9 4 -J 6'1"-L°le red 4 A L.-..I-9'‘ ,et' -v
3. Owner Information: /
a)Name and Address: Joyce 2c-/ / 16,1 a 3en, snot-9.- R 4 /-ftR.r1,.- ,5--. '1/4.,,/-�
b) Interest in property: own e ✓'
c)Name and address of simple titleholder(if other than owner):
3. Contractor Information:
�/ a)Name and Address: Ma r\o ``c-^ (1-G`rt "sCo rt.,(At.(---/ C-/ ZO.S o k-`"1 - c /,--c._!-L-
) Phone Number: .2..:0-5-r '5 G - i C 2.ci
5. urety Information:
a)Name and Address: N ! ��
b) Phone Number: 6
c)Amount of Bond: $
6, Lender Information:
a)Name and Address: /v / A----
b)
Lb) Phone Number:
7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13 (1)(a) 7, Florida Statutes:
a)Name and Address: 0
b) Phone Numbers of Designated Person:
8. In addition to himself/herself,Owner designates of to receive a
copy of the Lienor's Notice as provided in Section 713.13 (l) (b), Florida Statutes.
a)Name and Address:
b) Phone Number of person or entity designated by owner:
9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction
and final payment to the contractor,but will be one (1) year from the date of recording unless a different date is
specified:
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I,
SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING
YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury, I declare that I have read the foregoing notice of commencement and that the facts stated
therein are true to the best of my knowledge and belief.
' Officer/Director/Partner/Manager er Si nato ys Printed Name& the/Office
'tg :tur- of Owner or Owner' uthorized Officer/Director/Partner/Ma g g rY
The foregoing instrument was acknowledged before me this J—day of r I , ,20 11 ,
.by J Cas �1/I W ffH '
X for I Y)'I YC 1€ 12CCcGd .
(Namelo P COKn��Person) (Type of Authority,i.e.Officer/Attorney) (Name of Party Instrument was Executed for)
l L
Meatier Mooney \, STATE
O" LORIDA
�� StateolRo� NOTARY PUBLIC, I
•My Conxnisslon Expires 0210112021 Print Name: Rf,(1\+i ec 1 A C)Dnf V
Commission No.GG 68713
Doc#2017081805.OR BK 17940 Page 421, ❑ Personally Known �� �f z°X 5 LicenS -
Revised 3/15/1'
Number Pages: 1
[�Identification/Type: I(, f
Recorded 04/10/2017 at 09:57 AM.
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING$10.00