980 CAMELIA ST - ROOF ri '* CITY OF ATLANTIC BEACH
',_u s 800 SEMINOLE ROAD
�� "~1*
~ ATLANTIC BEACH, FL 32233
(40;1 (INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0073
Description: re-roof 7006.1-R-5 (shingles) & FL15216 (underlayment)
Estimated Value: 6500
Issue Date: 8/8/2017
Expiration Date: 2/4/2018
PROPERTY ADDRESS:
Address: 980 CAMELIA ST
RE Number: 170971 1000
PROPERTY OWNER:
Name: SYMONS MARK
Address: 980 CAMELIA ST
ATLANTIC BEACH, FL 32233-2500
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: LAND ROOFING
Address: 3526 LENOX AVE
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$7,500.
4
4
Jsr=�;'1r�,.t Building Permit Application Updated5/5/17
�, City of Atlantic Beach
"111, 800 Seminole Road,Atlantic Beach, FL 32233
un�r YFax: (904) 247-5845
Phone: (904) 247-5826
Job Address: I / O ` jvQ `ter / . "L Permit Number: C? t3
Legal Description 446"k P�c(„ S-k1A [o- gf 3 Nock- /by RE# /76T2/— /VQ)
Valuation of Work(Replacement Cost)$ l0 SOO . Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration •epair ove Demo Pool Window/Door
• 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 trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type ofwork to be performed: Porci,P —
Florida
p.tmctc avt, lcee( SA1hJ�c-Product Approval# 7 Ooh, I—2—�SIi&j(Ps FL i5,214 for multiple products use product approval form
Property Owner Information �� t d io-ptielif
Name: MA )< ' 1 pile 11S Address: IgD (( #14 e l/ r'g
Si—
City 44 ,4, /sRAck State FL Zip 1D 33 Phone 7t79- 6(')-- C(17s—
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information /� / /�
Name of Company: L.Q d Y�OD61 j C f 4/41 y Quali ing Agent: �� r'' '
Address 3c-d0t- 6ektov- 4--c City J4'(_/( ,),/,, /c._State f'" Zip 3?a(SCi •
Office Phone 1.0V- 5 c'-/ 7 4 (,,,e3 Job Site/Contact Number
State Certification/Registration#E2 /32L379 E-Mail LgKIrno4kj to ,Gge1/m Stela)l+ /-NI4
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 NOT E OF COMMENCEMENT. i
'141 kJL
(Signature of Ow r or Agent) ignature of Contractor)
(including contractor)
Si reed•and sworn to-(or affirmed)before me this 1 day of ned and sworn of affi ed. bef.re m- this day of
y � ?0[7 ,by Ar Mo 11 ,ZO ( (,by ••
�
• ,q p ..,t rofNotary) ••,. - .. ►,. .. rl
Y IVr a (_ , °r - TONI GINDLESPERGER
:I r MY COMMISSION#FF 924951
• --3-=q7,,V EXPIRES:October 6,2019
v�••'
Bonded Thru Notary Public Underwriters
[ ersona�Iy Known OR [ ] Personally Known OR. ;
[ ]Produced Identification _[.}'Produced Identificatio .
Type of Identification: Type of Identification: J� - UCS B I Co S Cv� �-
1
. .
,
: NOTICE OF COMMENCEMENT •
. ,PREPARE IN DUPLICATE'
Permit No. RERF 17 0673 Tax Folio No.
State of Fr/4,,,;,a0.- County of PL,i./4' (
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.
'
Legal description of property being) proved: /4-+[04C eqe-A .5ecsAiN II
. t_t4 ;I 1 IS toe IC_ / ((
. -
. Address of property being improved: Ct go cat we_ 6t c S'4?
(1--f-1 . ,— Agge-4, -Na 3 7
P I
General description of improvements: e Ptioki•-c eiPtc, e/4‘...,_ /Parr
•
Owner /Om,t- C y Pil 04 C
,
. Address gO rgeh.c(t .v,.4.4- pa,,Itec. A.4,6 7:-,=_ 3;,)?•"3
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
. Name
. Address
jil )qi) Contractor ‘.--0.4"\)% ikL.bv.OcorNC\ Orm-v,,c10%.0,A
Address '-' 5.at. r.ox ALE -TrxeilLoSwm i((e . --1 L 1 :22 3 4(
—
Phone No, (CIO 4/) 5sq-7& 3 t Fax No.'MO .3179-as if 3
• 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
1 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 çete is one(1)year from the.' e of recording unless a
different date Is specified):
THIS SPACE FOR RECORDER'S USE ONLY ., ,e , OWNE-4
. eoredm i Ad
day of .NIVIIIIIFII DATE
In*AO.s.k.,-, ,,
. county of st e of Florida,ihas.-. ..trniiiiirid. At., , !ttt!!!!!!r ,,,7,1,p .!!),
1 4— tm i\_. *1 .
Doc#2017185478,OR BK 18081 Page 2361, I wow/horsed and a MS at en sta ! and 7.1"7".7s,..;ei ...„.0 ti,,,!,, .,.....-•
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I
Number Pages: 1 .;!..,•31.0 ok. 40 ..1. a#'-, ;.
Recorded 08;0812017 at 03:49 PM, i
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
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.., • • - ' ..0 0 i (a: .:,:. ;,4:.,
. •,,, ,,, . ... :.-
RECORDING$10.00 Not PublIC at Laois..Stat., ' • dtlf,a,119r^
My commission exciir,•• - ,.. i`_:...c...-21-1 -,--if,.Va-Nri. ' • '..:
- Personaily Kno vn , .
•' V.f.': .P, A.--e.ii
Produced Identification -.;'- ,;.4--.4.,S1-:i-- -110•••4°...IPO'' .. ,-•.
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