1955 BRISTA DE MAR CIR - ROOF ri1yr,„
,�� 'Piii;
s, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
,vv� ATLANTIC BEACH, FL 32233
\s' os . INSPECTION PHONE LINE 247-5814
,s
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0070
Description: RE ROOF SHINGLES
Estimated Value: 12103
Issue Date:
Expiration Date:
PROPERTY ADDRESS:
Address: 1955 BRISTA DE MAR CIR
RE Number: 169506 1664
PROPERTY OWNER:
Name: VAN LIERE FREDRIK NELSON
Address: 12448 GATLEY RD S
JACKSONVILLE, FL 32225
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: ROGERO &WILLIAMS ROOFING CONTRACTORS IN
Address: 883 Lawhon Dr ST
JACKSONVILLE, FL 32259
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$7,500.
a voi Building Permit Application
AT
City of Atlantic Beach
osmi800 Seminole Road, Atlantic Beach, FL 32233
'' Phone: (904) 247-5826 Fax: (904) 247-5845
(�
RF--1 7 _ O0 7>
Job Address: 1q fl'EL I\A'cl.✓ 1�2. Permit Number:
Legal Description to-30 Sti v(A..t`i Di4 1Us 1 two Lui rO RE# 1 109 `i ls'l p q
Valuation of Work(Replacement Cost)$ /7 31)3 sq (Q Heated/Cooled SF gay( Non-Heated/Cooled L-19 /
• Class of Work(Circle one): New Addition Alteration QaLi Move Demo Pool Window/Door
• Use of existing/proposed structure(s) (Circle one): Commercialc,Residentia
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No Q
• 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: T fly_ OFt=J,-'z►`U CF — IZJj` ;h,n9 [es, v, )z')e C I col Y1.L
VUtItti inlet 1) YU.kC, 471e .Z-±-
Florida Product Approval# FL ID(Dr1 L{ for multiple products use product approval form
Property Owner Information .
.
Name: , C 00141 Vfln (�IGIC.G� Address: {`7 $ J3 Mb !_)C- Mar �lk
City h�-� /1,-.1, State Ft, Zip 322.E 3 Phone CV-1 - 2
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: i,,,`rr 0►,C51 S Qualifying Agent: -it r`'1 E
Address -31.1 1'jJ� sZL rn ' City State �L. Zip �2 2 S
Office Phone lo'- <L CD 3 Job Site/Contact Number O .7 ••c5 e.g. I
State Certification/Registration# Ls'2 / 3-563)3%7 E-Mail -1-(1i)+ c Ccs' r-Loc c- -1i-- otorS A C:.5Y-YN
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.
(Signature of Owner or Agent including Contractor) (55gnature of Contractor)
Signed and sworn to(or affirmed) before me this /1 day of Sign d,and{svyorn to(or affirmed)before me this 3 day of
TOL , , by IA i6' -stv �� 1 r, 2-t 1�, bya ✓
+' n�f�� RT REASON (Signat r of No �N,ll
1 �7 Netttas
: MY COMMISSION#cF218072 `} i;•.� " IVOlARYF'UBLIC
• ..ss: EXPIRES April 07 2019 yy. 'STATE OF
�, ' FLORIDA
+c> avec sa FIawNo�:yScrvKe.0 .� �^ Com .*FF235532
[ j Personally Known OR ersonally Known OR "41Z 1S' Expires 5/28/2019
jo Produced Identification [ ) Produced Identification
Type of Identification: V -25-1/ o2-3r3-° Type of Identification:
Doc # 2017181727, OR BK 18076 Page 658, Number Pages: 1, Recorded 08/03/2017
at 02:31 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00
NOTICE OF' COMMENCEMENT
ipRF.1ARC IN DUCLicxrr'1 n
.,.,nail Nc.-- Tax retro tJo. 0,1. c(O-((fJ(�,/�
lair.01 Tax re rN 11L 3, sa:2 _i... _--......
To whom It bay calumny _
Thu
ned
ents
neconlanCo with Section 13Informs
of the Florida ldit Statute ,thio following Informntlo+r Is stated Iiiiproperty,
tills NOTICE(It'
i COMMENCEMENT.
Legal descrlptinn of proper being hnpro•:ell:L//) ___A- 2 6-16- _
propel
t/OeT& -2,14")/7--7 1'� 6C%T �..
Address of property hoing reprove t" 9 5 `6/'/Sf� A e u /_
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General drscrripiton of Irvpmveaetnls:/26'/r.Ye
•
Owen! �f�C� /` ,I 'Jf-y1,_y (�1�,�
Adcre.:s /75 L.'tJ 6 g_ ..'� ! , 111_414.1•.L. -1 /n
Owners Interest In site.of the improvement _ "� �
Pen Simple Titleholder(If other than owner) _ -~------...-.._-.--
Nano Rogers and Whims Malkin and Renner/Cnalearmes
3415 Karl Read, eckionvikeFlodn.^,2257 ..... --.._...
Allies I•acts
1:ell:raCl0r1 errmey S.Rogeni ..-""'-."---'. ...•. ..
Address 3415 Ked Rnad,JarksenvfAe I-InrkL•e 3) c7 - —
!tone No.'W--C1 A•5•1S:i
For No.oea•r l 5.24101) .
t,ureety(If any)
---..._-_ ._._
Address Amnion of h od.c•_-y_-
-
Phone No. Fro:t•!n. --._....._. _ ..
Nome and address of any person oinking a loan for the construrllon of the enprovemems.
Nome
A<flfRSt -..—_- _____ —
Phone No. -_ . .
Name of person within the State of Florida,other Pan himself,designated by nwner upon whop'nnSces rn Mlle.
i.
nocurnen:a may be served
Name J r'rrnery S.R aRi in
Andress 3415 Kori 12oad,J acksonvlllo Florida 32257 "—"-
Phone No.'168.51n-5A53 ^. Fnx 14,914.619-240(1
la addition to himself.owner r'.ealgnates the folkxing person to receive a(slpy of the Llerar's Nmitim.n4 provided e.
Secticn 713.0G(2)lb).Florida Stahltes.(AN In et Owner's option).
Address
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Ex gnrtlun date of Nolte of Comptoncement(the o.+e,l atlon dote is one;1 from the acne of rec.�-__ -__.-- A LL
)year
rl'fferrnt date Is specified):,. g unless a 1- ■ o
ri-rs SPACE FOR RECORDER'G USC•.ONLYi ,/OWNE�R •
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