1869 SEA OATS DR - ROOF :4s s� CITY OF ATLANTIC BEACH
, It Ai 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
x r;; )' INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0088
Description: re-roof FL10674-R10 & FL15216
Estimated Value: 10527
Issue Date: 8/31/2017
Expiration Date: 2/27/2018
PROPERTY ADDRESS:
Address: 1869 SEA OATS DR
RE Number: 172020 0538
PROPERTY OWNER:
Name: KLEIN KARL M
Address: 1869 SEA OATS DR
ATLANTIC BEACH, FL 32233
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$7,500.
0
4
Building Permit Application
pi City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: 1BtiCl £,. Aide' h Permit Number:
(1^00'38
Legal Description 3\Q•20•tpq -as•09 E. SsWcx6Actittlek.0 ruA- l LokcI
Valuation of Work(Replacement Cost)$J(?5a-J• 00 Heated/Cooled SF t D Non-Heated/Cooled Zc•
• Class of Work(Circle one): New Addition Alteration a ai Move D o Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial esidential
• 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 of work to be performed: s ��aArrN‘CLI4
��-Q-oo c ,(Lt.4..tovg0Q c plat- 3 t_4_14
ai
Florida Product Approval#_4-\ - fjOun14-`Z-1,0 for multiple products use product approval form
Property Owner Information c
Name: erMmA-A 5 Address: } °p �.
City'A,.p•{y c�� State Vt.,. Zip 37.233 Phone Q -3$to't',ZoG
E-Mail 1 .M itj,R q-1-M Cer(Y1411A.,,tank-
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Infor on t_
Name of Company: 4, LA.t G1V,1.2 Qualifying Agent:
Address ay I b Vr;Up.i Q‘-k,• City__Sple,kgpno:\\c, State t• Zip 3?z-t3'l
Office Phone °IQ'-t 5te-S4Lr , Job Site/Contact Number 0)Qt-}- 6.4142
State Certification/Registration#e . A&)zQ/') E-Mail �u-•t'1 is@4 rwc'cio1Ds • '.j)rt
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation
Exempt/Insurer/Lease Employees/Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES,BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT. 14
(Signature of Owner or Agent including Contractor) / ( nature of Contractor)
Signed and sworn to(or affirmed)� 1before me this /y day of Signed anLd sworn to(or affi ••-. before me thisp7$ day of
5/,t-t �?DJ� , by L22sJ / 1)446bn) uST , WY? , by ._ f,At -
•
4 4 SiWEtttE t'J@ Y)DEASON — Si cat'rP_nif N •=�"1
MY COA1U/ISSION N FF21807Z • ";R.<'''••. PAUL ROBERT CASSETTA
EXPIRES 'P••�•r.= Notary?ubia-State of Florida
ApN 07 2019 II ` ; {o Commission rr GG 126370
rlt7)i9e-0•S.j rk"y's°�1s'r"'c•,:er •t, •-� IAy Comm.Expires Jut ZS,2021
}ftJ(p .'
[ I Personally Known OR ---. ersonally Known OR 4 •'�Or�-,••' BCr�Nrouyhh2GOndINClary0.ftn.
pProduced Identificatio j Produced Identification
e of Identification: QS0`40b-7l-621-1-0 Type of Identification:__
Doc # 2017201774, OR BK 18104 Page 1092, Number Pages: 1, Recorded
08/28/2017 at 04:06 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
NOTICE OF COMMENCEMENT
,PRE'ARE IN DUPL'C:.TE)
Perm:Ne 71 __$p,,, ,i0.ot7 oTax Folio No I tl 2Q120-05397
State of / p County of Du V 4.-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 desuiuticn of property being improved-_
3`77 - 2 0 09 - 2S 20I e- Siva Masea ua uu,4-9 LcA--1 i t3\k ti
Address of property being impro•rec• 1� 31nP1 Sed: _.(-) GNI'i\I f--
41-1 ,,A1-t-1L f �rL 3?7'S 3
General description of improvements! a ..,--eCoic
Croner_S-Ms, `. 0..reNcis
Address I eliti S GI tDa-i•.o r. 4-( 3t .(ezey‘s .c(• 717 V,45
Owner's Interest in 6 to of the improvement Ow a.ix.P..
Fee Simple Ttteholder(lf other than owner)
Name Roger*and N.ehams e.iklse and Reding Conuaclora
Address 3415 Kori Rood,Jacksonville;brtda 32267
Contractor Jeremey S.Roger.,
Address 3416 Kort Rond.Jecksonviae FIcada 32257
Phone No 904-516.6463 _ Fax No.9C4.6'9•24D0
Surey(if any)
Address Amount of bond$
Phone No. Fax NC
Name end address of any person n•akne a soar for the construction cf the improvements
Nome
Address
Phone No. Fax No
Nome of person within tt:e State of Florida,other than herself,designated by owner Lpon whom notices or other
documents may be served.
Name Jonmey 6.Roavy
Address 3415{ori Road,Jacksonville Flor.da 32257
Phone No.504-6153463 Fax No.904-619.2400
in addition to himself.owner designates the following person is receive a copy of the Uenor's Notice as provided In
Section 713.06(2)(b).Florida Statutes.(Fitt in at Owners option,).
Name
Address
Phone No. Fax No.
t P
Expiration dale of Notice of Commencement(the exp, date is one(1)year from the date of recording unless a 4 S
different cote is specilleel:
•
THIS SPACE FOR RECORDER'S USE ONLY . OWNER
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