736 AMBERJACK LN - ROOF CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD isil
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: RERF17-0004
Description: 2/12 PITCH
Estimated Value: 3500
Issue Date: 5/10/2017
Expiration Date: 11/6/2017
PROPERTY ADDRESS:
Address: 736 AMBERJACK LN
RE Number: 171128 0000
PROPERTY OWNER:
Name: DOMINANT ASSETS, LLC
Address: 11488 FRUIT COVE RD
SAINT JOHNS, FL 32259
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: RELIANT ROOFING INC RYAN SHOUPPE
Address: 528 Millhouse Lane Orange PARK
ORANGE PARK, FL 32065
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$7,500.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: f 36 A'lbeep c K LII Permit Number:
Legal Description39-60 17-25-21E IzoJ4I PalmS unie1 Lot481KParcel#11(12$ - nn00
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$3,5oo Proposed Work heated/cooled ly 19 non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residential LIV
If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
Florida Product Approval#r1-- 10124-PIS ShIng es AFL-1516.1-rOundert aie +
For multiple products use product approval form
Describe in detail the type of work to be performed: re —roc) - S� n g es - afl SQ--
a a Pi i-on
Property Owner Information: C,, Q
Name:I r VYt c�. et LI--C Address: Iii-185 Fruit Cove ea,
City �O%Y 1 gt7YI flV StateZip 3'2239 Phone (.(104)-704 - 3777
E-Mail or Fax#(Optional)
Contractor Information:
Company Name:Reliant Roofing,Inc Qualifying Agent: mon showy.
Address:822 N.A1A Highway Suite 310 City Ponte Vedra Beach State Ft. Zip 32082
Office Phone 904.857-0880 Job Site/Contact Number Cameron Shouppe-904.657.08.8 0 Fax# gin-ran
State Certification/Registration#CCC1330615
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address :'�1'CLO.f�
Bonding Company Name and Address
Mortgage Lender Name and Address to/V
Application is hereby made to obtain a permit to do the work and installations as indicated. I certif)•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 regulatingconstruction 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 abandoned foc a period of six(6)months at an•time
after work is commenced. I understand that separate permits must be secured for Electrical Work.Plumbing,Signs, Wells,Pools,Furnaces, oilers,
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.
1 hereby certify that I have rca 'nd examined this plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type o,work will be compile, ith 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 Feder state,or local law regulating construction or the performance of construction.
,
Signature of Owner Signature of Contractor
Print Name Ma tic IN e p.}- Print Name _ _Cameron Shouppe
Sworn to and subscribed before me Sworn to and subscribed before me
this Day of tylia .20 17 this $_Day of moty .20% 1
'rJ
Notary Publi Notary ublic
p Jennifer Kraut Revised 01.26.10
.4.1V-4..
� '� NOTARY PUBLIC t�R Jennifer Kraut
(4' STATE OF FLORIDA ` •
0 NOTARY PUBLIC
'�"`,- Comm#FF951584 STATE= OF FLORIDA
CE ill Expires 1/19/2020 ' Wit;a Comm#FF951584
OCE\ °° Expires 1/19/2020
Doc # 2017106202, OR BK 17973 Page 1179, Number Pages: 1 , Recorded
05/08/2017 at 11 : 18 AM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tex Folio No.
State of FL County of J J V�
To whom It may concern:
The undersigned hereby Informs you that Improvements will be made to certain real property,and In
accordance with Section 713 of the Florida Statutes,the following Information is stated In this NOTICE OF
COMMENCEMENT.
Li czil description of property being improved: Q—6 C) i1 atS ! c3ov a
P__01 1S Qv))t 1 1 o L is a
Address of properly being improved -136 Arr1 bcQCtG Lr
Bea
-1Q C. 6.n r FL 32 23 3
General description of improvements: re -r-v o T
Owner r)OrY n()Jr) 65sctS LLC
Address H 186 rYt)li Cove ecl SSI AiknS,r1... 327,561
Owner's interest In site of the improvement
Fee Simple Titleholder(If other than owner)
Name
Address
Contractor 12ellnfl Rc-jc,>-
Address A • ... N '.Mn rip r' ;i:I. -L 32092,
Phone No.(q w-Q-112 -3111 Fax No.
Surety(if any) _
Address Amount of bond$
Phone 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,other than himself,designated by owner upon whom notices or other
documents may be served:
Name
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),Florida Statutes.(Fill in at Owner's option).
Name
Address
Phone No. _ 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 A OWNER
: DATE 518
Before te this day of
In the
County of Duval.Stele of Prodder.hes persoeeily appeared
MLi1C Nja-e4f herein by
h'mselli herself and affirms that ell atelemetrts end declarations he oln
ere true and accurate rst� Jennifer Kraut
Olt A' NOTARY PUBLIC
/]���� (' �. o STATE OF FLORIDA
)�`" _" ` Comm#FF951g.
Notay PuLlIc el Lerpe.Stale of . COunty o1 ',•,re.t,
I'ycc1'lesionexpiro. / • w Expires 1/19/2020
Personally Known _ _ or
Produced IdenllSt —