641 David St re-roof permit S lbl f
CITY OF ATLANTIC BEACH
-� 800 SEMINOLE ROAD
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: RERF17-0109
Description: re-roof- FL10674.1 & FL15216
Estimated Value: 5120
Issue Date: 10/3/2017
Expiration Date: 4/1/2018
PROPERTY ADDRESS:
Address: 641 DAVID ST
RE Number: 170539 0000
PROPERTY OWNER:
Name: LAZAR MARK A
Address: 1602 BENTIN DR N
JACKSONVILLE, FL 32250
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: ROBERT ROBERTS FIRST COAST ROOFING
Address: 4533 Sunbeam Road #803
JACKSONVILLE, FL 32257
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$7,500.
Building Permit Application Updated 5/5/17
City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: I ��} V 10 51 Permit Number: �-6rF n- O C)
Legal Description /O-$ /6-e5-29,r 5,4/64,it Sfc / Lof Sad RE# / ?05-35' -0000
Valuation of Work(Replacement Cost)$ 5 17-0 4!9- Heated/Cooled SF //S.9 Non-Heated/Cooled 15'2!/
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door fZ L- • i12 np r
• Use of existing/proposed structure(s)(Circle one): Commercial sidential
• 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: h r' �70,F w: j N( fl f't �C i 'S;p i �:4.1-S
Florida Product Approval# -L o(o 7y, Fz - (62, Z. for multiple products use product approval form
Property Owner Information
Name: 1"?fffZ k Lf4-Z A-(: Address: (o'(l 0,�-ui,� 5-r
City J4+IItAoc3�Ac,k State FC Zip 3 Phone _
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Roar=�N�
Name of Comp any: rJo,3Cfr )20,3`,2=.5 ! jg,<-, [vaSf Qualifying Agent:RD13 1;R-7
Address q fir»`/ An A-_ city;1 A�r State E Z-
Office
Office Phone yoq- 5 q i - 31- I lob Site/Contact Number 6 y `t 3Z i H
State Certification/Registration# C'(Y`(-L���7 E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
`_ s ompensatio �rr�,t_�✓ 2 �f;,ct+ IN'S �,zzl ,.l„�� Qo-uo-lfrs�a( � IZ- 3/- 2,i,7
Exempt/Insurer/pease 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.
X L ��
(Sign re of Owner or Agent) (Signature of Contractor)
(including contractor)
Signed and sworn to(or affirmed)before me this_Jf�day of Signed and sworn to(or affirmed)before me this_]±�day of
Qct2::O/-?,by IMA-2k L4Z412 e-c i-7 , by
(Signature of Notary) 4144 c,e g a✓i3
vR(°4tG Notary Public State of Florida
;� Mark James Davis
y My Commission GG 033053 9uxr&N Notary Public State of Florida
''ro,�o� Expires 09125/2020 Mark James Davis
Personally Known OR [ ]Personally Known OR ,� My Commission GG 033053
[ j Produced Identification [ ]Produced Identification orw Expires0%25/2020
Type of Identification: Type of Identification:
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. -10-539 ' 0606
State of County of D iAV4 L
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 improved:_/0 C /
Address of property being improved: _ (0 14 W, d S t f/ArJW,C
L3�
General description of improvements:
Owner_ —I-A-2& LAZ 4,/Z-
Address
Address 1 L O Z a F.S i -3Z 2-5-0
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor R--J`uif (Za vt,4 1�- P i`2 �'+si- l bo-sff
Address L/51jr � N�^•`ryvr / � i �CkS��+uZ�( 2L�7
Phone No.`ZUV Fax No. 9aj5 7/9 9,� '7
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 ONLYJ //� j
ONWWR
Signed: l trG IK( � DATE
Before me this 7,3 day of7
es in the
County of Duval,State of Florida,hpersonalty ppeared
herein by S'c
himself/KX.Ltf and affirms that all statements and declarations herein n
Doc#2017225973,OR BK 16138 Page 5, are true and accurate 3
Number Pages: 1
Recorded 10/03/2017 at 12:24 PM, o
Ronnie Fussell CLERK CIRCUIT COURT DUVAL c
COUNTY Notary Public at Large,State of Lt_ Counly of nos✓tea c C)m 0-
RECORDING$10.00 My commission expires: q,ac. ?v Z o co
Personally Known or o a
Produced Identification C.