291 Beach - Reroof }, A\l
CITY OF ATLANTIC BEACH
r '�> 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: RERF17-0113
Description: re-roof- FL10674-R10 & FL15216
Estimated Value: 4500
Issue Date: 10/10/2017
Expiration Date: 4/8/2018
PROPERTY ADDRESS:
Address: 291 BEACH AVE
RE Number: 170193 0000
PROPERTY OWNER:
Name: ANTON ROBERT C
Address: 42 3RD ST
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: J. ROGERO CONSTRUCTION INC
Address: 8620 RANCHWOOD LANE
ST AUGUSTINE, FL 32086
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$7,500.
Building Permit Application
# City of Atlantic Beach OCT 1 0 2017
800 Seminole Road, Atlantic Beach, FL 32233 e
�� .--�
Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: d� []20�i` k�Q,� .f)a>< A ULM Permit Number:
Legal Description -a, RE#
1C �
Valuation of Work Rep acement Cost)$ ��� Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move D ool Window/Door
• Use of existing/proposed structure(s) (Circle one): Commercial identi
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No /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:
T-t-T b Mn;h" I3
Florida Product Approval#(' 1()UJ k4 -Q l0; 0,15cXNU for multiple products use product approval form
Property Owner Information
Name::,Z0b Address: �3" sb '�G+-
City_k 7�.(A'JA C 11�, State (�(� Zip JQ_L5 Phone C1CU- 'scT 1 —Vt Lt2.
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: oYC040MA et an Qualifying Agent:
Address City State. 0Z Zip ;l '?
Office Phone Job Site/Contact Numbera-4 — o 1 u
State Certification/Registration# C CC 1-2a x,10%O E-Mail tW i to puX.�I bo I-- . C-0M
Architect Name& Phone# —V �a_ (0
Engineer's Name& Phone#
Workers Compensation ����OC /- - �Lt�IL` /�,?.�4TcSr? a8s:4 �
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
X ` -Z:�
(Signature of Owner or Agent including Co tor) (Signat of Contractor)
Signed and sworn to (or affirmed) before h' day of Signed and sworn to(ora armed) before rn (P day of
OC4-. 01-7 by 2417 by
°�^`'
�,, TAYLOR KA
Commission#G �Si ature of Notary) ,m��; re of Notary)
G 7a =+..► �.,�= TAYLOR KAY ACK
?� i My Commission Expires . ,� Commission# G 101742
May 04, 2021 ;? ,: My Commission Expires
"`�„°�� May 04, 2021
[ ] Personally Known OR
roduced Identification IJV ] Produced Identification
Ty e of Identification: X Type of Identification:
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE) q
Permit No, Tax Folio No.
State of r-Ats'Qa bc County of V V e—
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:5-100 l(a "a O d�- 1� •��of
PRADADtk, teG-can auk !a _ I�r��g1� . _w►,.�
I,
Address of property being improved: C /
General description of improvements: 1 L 1 C
Owner rmh Uw t
Address 't%G
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor '1"l�lr�
Address 11'Ylrtt-C ,VC to &+-CCA da &nvi ju P -X2_6?
Phone No. IDA) n0i-Can 0 Fax No.
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 ONLY
��C/WNEL� 0
Signed: DATE 2r7
Before met i day of in
Doc#2017231673,OR BK 18146 Page 805, County of Duval. to t Florid has ersonally appeared
Number Pages:1
Recorded 10/09/2017 04:11 PM, himself,'herself and affirms that all statements and d a,�F��• TAYLOR KAY BLACK
are True and accurate �o�� 4��.
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL ?. ,= Commission#GG 10174:
COUNTY M Commission Expires
RECORDING $10.00
^�� a 4, 2021
otary Pu . l Large.Slate of, County of
h1 fission expires:
ersonally Knov:n or
Produced Identification