108 SEMINOLE ROOF 2017 -S�PJl
r CITY OF ATLANTIC BEACH
s 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0037
Description: SHINGLE ROOF
Estimated Value: 4886
Issue Date: 7/6/2017
Expiration Date: 1/2/2018
PROPERTY ADDRESS:
Address: 108 SEMINOLE RD
RE Number: 170590 0140
PROPERTY OWNER:
Name: RODNEY AND LINDA PETERS REVOCABLE TRUST
Address: 1349 GOLDENROD
HILLSBORO, KS 67063
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: PRIME ROOF CONTRACTING LLC
Address: 13792 HERONS LANDING WAY APT 9 QA MARK ANDREW
YOUNG
JACKSONVILLE, FL 32224
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU 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 RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
Building Permit Application
0 City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
Phone: (904)247-5826 Fax: (904)247-5845 �
Job Address: 108 Seminole Rd Permit Number: RC - 003- j
Legal Description 10-817-2S-29E.07 SALTAIR SEC 1 N12 LOT 608,E1,2 ST CLOSED REN
BY UIR BCH ORD#65-88-13 LYING SWLYTHEREOF
232
Valuation of Work(Replacement Cost)$ 4686.50 Heated/Cooled SIP teoo Non-Heated/Cooled
• Class of Work(Circle one): New Addition Iteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial esidentia
• If an existing structure,is afire 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: Replace asphalt shingle roof
Florida Product Approval IfFL70674-Rl2(shingles) FL17420-R2(felt) for multiple products use product approval form
Property Owner Information
Name: Rodney Peterm Address: 1349 Goldenrod
City Hillsboro State KS Zip 67063 Phone (620)38&0481
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: Prime Roof Contracting, LLC qualifying Agent: Mark Young
Address 13725 Beach Blvd Suite 13 City Jacksonville State FL zip32224
Office Phone (904) 530-1446 Job Site/Contact Number (904) 860-0230
State Certification/RegistrationIf CCC1329505 E-Mail office(Pprimeroofinofl.com
Architect Name&Phone N
Engineer's Name&Phone N
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.
(Signature of Owl or Agent including Contrac r'Tb ) no a ntracmr)
Signed and swor2.t0 fora med) rr fore tis day of Signed o o rb�me be are methis day of
(Signature of No eSignature of Nota )
'wv� Andrew D. Davis X002 IN D. Davis
At ` = COMMISSION a FF160819
COMMISSION Y FF16j1849 "` ''
Personal) Known OREXPIRES: $epi. 17, 2018
]Personally _aq 'a= LKPIRES: I. 1T(20�sonally Known OR Alit.,�,d
VrProduced ldentlficacion! ° ..... .`�� WWW,flpR0NN0TAlly)60M
doted Identification
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Type of Identification: �L IN Type of Identification:
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLIGTE)
Permit No. Tax Follo No.
Stale Of Flndda County of Duval
To whom It may concern:
The undersigned hereby Informs you that Improvements will b r 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:0 8 17-25-29E.07 SALTAIR SFA 1 NI/2 LOT 608.81/2 Sy CLOSED
By U/R BCH ORD X65 86 13 LYING SWLY THEREOF
Address of property being improved: 108 Seminole Rd.Atlantic Beach FL 32233
General description of improvements; R,.f
Owner Rodney Peters
Address 1349 GOLDENROD HILLSBORO,KS 67063
Owners Interest in site of the improvement
Fee Simple Titleholder Rf other then owner)
Name
Address
1 ' Contractor Prime Roof Contreming LLC
AddrPhone No. 004)
Blvd Suite l3.locWonville.FL 322Y1
Phone Na I�^I6�t^� Fax No.
Surety(If any)
Address Amoum of bond It
Phone No, Fax No.
Nem.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,other than himself,designated by owner upon whom notices or offer
documents may be served:
Name
Address
Phone No. Fax No.
In addition W himself owner deslynat.s the following person to receive a copy of the Lienors Notice as provided in
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option).
Name
Address
Phone Na. Fax No.
Expiration date of Notice of Commencement(the expiration date is one(1)year from the dale of recording unless e
different date is specifled): ��17
THIS SPACE FOR RECORDER'S USE ONLY QKW 1
Signed: :J DATE `.
6eMe me Mb .,of In the
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Number Pages:1 move renal alnmis that all sudearel uq dw�. el nn Andrew D. Davis
Recorded07106=17at08:41 AM, annueameccurete -a <'- COMMISSION d FF160849
CRonnie OUNTY atoll CLERK CIRCUIT COURT DUVAL « »- EXPIRES Sept 17, 2016
....
RECORDING$10.00 ` WWW.AANOBNOTARY.COM
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