999 CAMELIA ST - ROOF .J ' i''' v , CITY OF ATLANTIC BEACH
f.:"'1 ""' :> 800 SEMINOLE ROAD
J v ATLANTIC BEACH, FL 32233
it >% INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0061
Description: REROOF SHINGLE
Estimated Value: 3000
Issue Date: 7/27/2017
Expiration Date: 1/23/2018
PROPERTY ADDRESS:
Address: 999 CAMELIA ST
RE Number: 170994 9950
PROPERTY OWNER:
Name: RIEBER WILLIAM E
Address: 13581 OSPREY POINT DR
JACKSONVILLE, FL 32224-3020
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: DS KILLIAN ROOFING
Address: 3898 DUPONT CIR QA DAVID S KILLIAN
JACKSONVILLE, FL 32254
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
T; City of Atlantic Beach
114411. t" 800 Seminole Road, Atlantic Beach, FL 32233
'� ,,A,3'. Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: / qi? ( balel�l 4-5/ Permit Number: R Eh Ft 7 - b v 6
Legal Description jf'sy 3 Y"OZ 5-02.tE gr /G goo sect RE# 70 , ' ff$27
Valuation of Work(Replacement Cost)$3,a..22-49 Heated/Cooled SF /021 Non- ated/Cooled r'
• Class of Work(Circle one): New Addition AlteratiACM. ove Demo Pool Window/Door
11 • Use of existing/proposed structure(s) (Circle one): Commercial Residential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any f��trees are to be removed or Affidavit of No Tree Removal _/
Describe in detail the type of work to be performed: _ ,d.r�s�jj`j p 5 6t1 , c-4
Florida Product Approval# F1- I 01,2q. / for multiple products use product approval form
Property Owner Infor a`tion
Name: k/%//%u1 , f. Address:6 4 41:01 S f.
City 14 a State a Zip 3 '55 Phone qDy_
E-Mail Geer ie here5/Kaf. (Oil
Owner or Agent(If Agent,Power o ttorney or Agency Letter Required)
Contractor InformaAon �vi�. ��fJ� %S ��‘ ..P.).) RO°F`� 17/ /4
Name of Company: z $ J i/,4 /`tie Qualifyi ent: L/!
Address OR/ ?MIDI* t"Ot/e GT- . City /'7 State Zip 3,2 3.5
Office Phone Job Site/Contact Number foie 72 lib 71,61
State Certification/Registration#C 133.25.23 E-Mail 2 Ove C' stv �#f• ce,"`'`
Architect Name&Phone#
Engineer's Name&Phone#
WorkersCompensationi .14tZ . —
Exempt Insurer/Lease Employees xpiration Date
Application is hereby made to obtain a permit to do the wor 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 Op AIN FIN ' ' ING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RE 01l , '' O i NOTICE OF COMMENCEMENT. // rs
,, eir
. illi,.....0 (Signature o'Owner or ,:-nt including Contractor (Signature • ontractor) s
.i,ned : d s • o(or affir -• •efore ••a this �•ay of Si "ned a d swo.[�t tol( affir • be • - i day of
1 70CAY Al � U L � byr
WA-RIO. ' WARM'
ignature o Notary) ,V (Signature o, '• ^1111 _'q
.,.. .,.. �,..n.. . --;77,--:, TONI GItJt)tFS • ,
Ai'y COMMISSION#r
if?N!GiNDLESPEFuEflOctober 6,2019
MY COMMiSSICN d FF 924951 I I EXPIPES: Public urge•wriers
:14:::: .44.!•: EXPIRES:October 6,2019 PersonallyKnown O.ry#i t'rale IT 0ary[ ]Personally Known OR ;f . Bended'lbw notary Public Underwr:ten [ ] `' "
44'Produced Identification 1 'r " [ )Produced IdentificatiQ .'
Type of Identification: Type of Identification:
NOTICE OF COMMENCEMENT
State of EL 0 c 0 4 County of !',e U Tax Folio No. /7 D zir — 5.' CO
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 NOTICP OF CMENCEMENT.
Legal Description of property being improved: Re co
/V 3L/ n— 5 -t25;e j46,4vrc t$eAc( J-.c.T ( c. oc-cc 1 g3
Address of property being improved: 9 9 (qjr 'E.( I CL Si- a- o e-Q
General description of improvements: (_00 l
,
Owner: _ '. Ara .G _ Address: / !/fie(,/ Sr Ig ' L £) 3
Owner's interest in site of the improvement: -,767--C,G,C,
Fee Simple Titleholder(if other than owner): /t
1 Name:
( Contractor: DS 1.-''',. .//i ,...7 '��{.„� C`-E"'��,� �� `�I f j�l.0 .
d,
Address:/03/ I i i �/ �� e fi _ i'7 F2.- .�a 3
Telephone N .: )14 �l�p 76 3 Fax No:
Surety(if any) WA
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any p rson making a loan for the construction of the improvements
Name: V A
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: /f-}
Address:
Telephone 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$t typs. (Fill in at Owner's option)
Name: �/
Address:
Telephone 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 •
specified):
THIS SPACE FOR RECORDER'S USE ONLY 0 •%`��'' 0,.....S►;, AIII ,r / - Date: e
/17
g e ere m: th'��`'./� .ay of c.) . 01 in the Cou y of Duv ,State
Doc#2017175115,OR BK 18066 Page 1037,
Number Pages:11
Of 'rid.,has personally..peared (,�
Recorded 07/27/2017 at 11:21 AM, Person. Kno .• /�, or
Ronnie Fussell CLERK CIRCUIT COURT DUVAL Produced Identification: R 0 - 5”' ,. - OS / v
COUNTY Notary Public:
RECORDING S10.00
My commission expires: „..,._41b____=.01.,*-_-......
'::., ---~ TOM;GIRDLE 'ERGS l'
::i1'�..yv, .
a 4"_^ MY GOM�t{S�I(N Y Fr 824951
-': -EXPIRES:October 6,2019 11: -,'`r.
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•?• •;•z g gonCeG Thru Notary PubFc underwriters