507 SELVA LAKES CIR - ROOF �' } \sA CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
j zy 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-3729
Job Type: ROOF PERMIT
Description: Re-roof Shingle. Jacksonville Roofing LLC subcontracting
Sunbelt Homes & Roofing LLC crew.
Estimated Value: $5,800.00
Issue Date: 4/11/2017
Expiration Date: 10/8/2017
PROPERTY ADDRESS:
Address: 507 SELVA LAKES CIR
RE Number: 172027-5042
PROPERTY OWNER:
Name: CLAYTON, BOB E
Address: 507 SELVA LAKES CIR
GENERAL CONTRACTOR INFORMATION:
Name: JACKSONVILLE ROOFING LLC
, CCC1331060
Address:
Phone: - -
FEES:
BUILDING PERMIT FEE $79.00
11 STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $83.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
04,,,,°,-Yi*, Building Permit Application .
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
• 12.0 Phone:(904)247-5826 Fax:(904)247-5845 -
Job Address: 507 Selva Lakes Circle,Atlantic Beach, FL 32233 Permit Number:
Legal Description 41-55 17-2S-29E SeNa Lakes Lot 20 RE#
1 Valuation of Work(Replacement Cost)$ 5,800.00 Heated/Cooled SF 1437 Non-Heated/Cooled 487
• Class of Work(Circle one):AZ Addition Alteration Repair Move •-u• Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial •esidential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No
• 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 pe-formed: New Roof-Re-Roof
•
,Florida Product Approval# FL.18355 for multiple products use product approval form
Property Owner Information
Name: Bob Clayton _ Address: 507 Selva Lakes Circle
City Atlantic Beach _State FL zip 32233 Phone 904-241-2192
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) Own•r
Contratter Information
• Name of Company: Jacksonville Roofing,LLC Qualifying Agent: Julie Baker
• Address 11501 Columbia Park Drive West Suite 208 City Jacksonville _State FL Zip 32258-
Office Phone 904470.5293 _ lob Site/Contact Number
State Certification/Registration# CCC 1331060 E-Mail JackeonviueRoofinglLC®gmaii.com
Architect Name&Phone it N/A
Engineer's Name&Phone a N/A n 1 n _
Workers Compensation Ex•mpt CC ia. S___ 1A -l' .17�tLS_t eI) q , p}(•(
e i a tf_
Exempt/Insurer/Lease Employees/Expiration f f ' i ,sm.,Application is hereby made to obtain a permit to do the work and installations as indlcat:td.I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to mee:the standards of all the laws regulationg
con$truction in this jurisdiction.I understai.d that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WEI...5,POOLS,FURNACES,BOILERS,HEAT:,RSS;TANKS,and AIR CONDITIONERS,etc.
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that ail.cork will be done in compliance with all
applicable laws regulating construction am 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. /
�( c •
' , '
art:..
(Signature of Owner or Agan induding Contractor ('ter of Contractor) ,,fit
Signed and sworn to(or affirmed)before me this . . a•ay of Si-- ed and sworn tc(or a Irmed)before me this day of
Pazaja ,610r1,by ,ei _ sem*• ti .•. by r1`ir� !'.. rs�
Allwr
/ a,. 4 fir- ,.
turr of teary)
.0: re o otary)
, A .. MEUNDA ; :;)
•�` MELIN :.KNIGHT ,
KNIGHT
. .'' MY COMMISSION NFF01001MYCCPersonally Known OR .2017 Personally Kno • a." EX?Ir?"S :r.2+ 2017
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Doc # 2017075230, OR BK 17931 Page 360, Number Pages: 1, Recorded 04/03/2017
at 08:43 AM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00
•
NOTICE OF COMMENCEMENT
State of Florida 'I ax Folio No. ..._.___......_...
County of •Atlantic Beach
:to Whom It May Concern: •
• The undersigned hereby informs you that improvements will be made to celitun real property,and in accordance with Section 713 of
the Florida Statutes;the Iitllowing information is stated in this NOTICE OF COMMFNCEMli1:r.
Legal Description of property being improved: 41.5517-2S-29E SeNe Lakes Lot 20
Address of property being.improved: 507 Salve Lakes Circle,Mantic Bach,FL 32233-4359
General description of improvements: New Roof _._...._........_ .. • _._,....._ .._..____.r-__
, Owner..._ Clayton _._._ _.. ,. . Address: 507`Selva Lakes Circle,Atlantic Beata,FL 32233
•
Owner's interest in site ol'the improvement: Homestead .
Fee Simple-Titleholder(if other than owner): .. .. . .. . .... . ..... ......... . ..____
Name: . _ ....._ ---
• Contractor: Jacksonville Roofing,LLC
Address:j1501..Columbia Park Drive West Suite 208,Jacksonville,FL 32258 •.
'telephoto No.: 904-770-5293 l-ax No: _904-288-9839
Surety(ifany) .._ __.._._._ .._._
Address: ......Amount of 1)ondS_ .. .__.__ __..__.._
' Telephone No:
Name and address colony person staking a loan for the crnstnicticm of the improtenwttts
Name: .... . .,.._....._......... _ _. .._.__._......._. _...__._.._.....
Address: _..__..._._..___..._.._...._._......_. ........... ....... ..... . ..... . .. .._... _.. _
Phone No:_ __ Fax No: . _.. _ . .._
Name of person within the State of Florida,other than himself.designated b) owner upon whom notices or other documents may be
uncd: Name: .. ..
. . _ .._.........._.
•
• 'telephone No: — .. .... _... _......_ Fax No:. _._._-._
In addition to himself. owner designates the following'person to receive a copy of the I.tenor's Notice as provided in Section
71 3.0ft(2Xb),Florida Statues. (Fill in at Owner's option)
Name: —
•
Address: . -
Telephone No: • • Fax No: .._.___.. _. •
•
lixpindion date of Notice of Conuuencement(the expiration date is one(I)year tiom the date of recording unless a different date is . ,
specified):.. .._ _.._ . _. --_. ._. ... .__________________ .._. ... . ..
TIIIS SPACE FOR RECOICI)EK'S USE ONLY OWNER
Signed- �:qs pale. March 28, 2017
day . n1 aiae of Durst.\War
Itcttu.mcthls. .�1_,,, c.t :. __.. .. County
Of Florida.has personally'aplea'ed 1/0.\:e., e, C�Q.v,''o n.____.
Nouiry Public at largo.Stale of Florida,i.tuna:of I ii.val.
My comutisslon expires..±! ! !_._..........................................__ -
. Personally Known:.._ w
Phlikll'a.'u(di711nlCailottl.
I , x: t, MELINDA KNIGHT
4111111". A `�; A MY COMMISSION#FF010018
. - • A d EXPIRES April 21 2017
• (407)3980153 Foridano ryServ,.Com
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