31 5th St shingle repair permit N % CITY OF ATLANTIC BEACH
s1 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: RERF17-0121
Description: SHINGLE REPAIR
Estimated Value: 1200
Issue Date: 10/13/2017
Expiration Date: 4/11/2018
PROPERTY ADDRESS:
Address: 31 5TH ST
RE Number: 170153 0000
PROPERTY OWNER:
Name: MCCALL ROSE MOODY LIFE ESTATE
Address: 31 5TH ST
ATLANTIC BEACH, FL 32233-5307
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: SNC Square LLC
Address: 4716 Palmer AVE
JACKSONVILLE, FL 32210
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$7,500.
Building Permit Application
City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904) 247-5845
3
3�ys
Job Address: `3 / S'`� .57, i�7t��rt f Cl ` c, /=/ ' Permit Number:
Legal Description �-(�y !l�'25 ,.Z��c��F/c;, hL /J!e_ti�.� �i/' ,� /3vr'� RE# J76
Valuation of Work(Replacement Cost)$ 4 Z60M' Heated/Cooled SF 7 Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteratio Repair Move D o Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Com merci Residents
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes Q 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:
Florida Product Approval ! <�Cr q for multiple products use product approval form
Property Owner Information
Name: Address:2I S tc6- 22s s
City , �, ,tsc / State Zip J2Z33 Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: _5�4C. Qualifying Agent:
Address 41216 /"�/n.� f4-t— City_rz x State /�7 Zip 322/G
Office Phone ?0/ — 91_4�-1<;- Job Site/Contact Number 5;!2 IV 1%79/- -7=3C-
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation L,t CAA _
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 NO TI OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMEN O Y R PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR 4N ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT
Sig'M'atur'e of caner or Agent including Contract r (Signature of Contractor)
S' ne and sworn to(or affirmed)before me tof S ne and sworn to(or affirmed)b fore me th1is a of
d D/7 ,by () 0 his a ,�o!7, by Cir a) D
11
(Signature of Notary) (Signature of Notary)
=t.:
e of Ffo�4a kxpwe*1mW201l9
Notary PuWk state of Florida
ECfdi
Teresa Teresa l Dutton
[ Personal! Known CF 929296 F Commission FF 929298
y [{�]'�ersonally Known OR E
[ J Produced Identificati19 [ ]Produced Identification
Type of Identification: Type of Identification:
Doc # 2017233725 , OR BK 18149 Paqe 455 , Number Pages : 1 ,
Recorded 10/11/2017 03 : 35 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10 . 00
NOTICE OF COMMENCEMENT
State of /�-+jam Tax Folio No.
County of
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 stied in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: -( i 5 _ •�L /�,�/,,- ._ �r�r„/� ___
Address of property being improved;_. . �s, ' f > ! 3`11-1
General description of improvements: ,,- �., �_ic,.s_�.,.,,` y1!_ Si. 1-4
Owner: ,,Ojt Alo?.e 4.4 Address: s/ S 41 SiS /H/-7 i
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):- _ __ — _
Name:
Contractor: ,s!'- .,"c.,e Zz c
Address: /j/7!C r r�,.cr. ,n - %a,t 3 V --- -
1'e)e hone No.: E S%C '-
Fax No:
Surety(if any)
Address: Amount of Bond S
Telephone 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:
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 Statues. (Fill in at O%ener'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 is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signed: Date:
Before me this da- of in the Co l hf Dui 1.State
Wa of FkXids
Of Florida has personally appeared_ p �-_ C_C '_ _
tiotan Public at Large.State of Florida.County of Duval.
tton �'••
REM
r FF 926296 My commission expires2019 Personally Kno%%n: ✓_' _or
Produced Identification: