85 10TH ST - ROOF k J
r ca
°1 CITY OF ATLANTIC BEACH
_re) 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
�J131>
INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0154
Description: RE ROOF SHINGLES
Estimated Value: 4500
Issue Date: 10/25/2017
Expiration Date: 4/23/2018
PROPERTY ADDRESS:
Address: 85 10TH ST
RE Number: 170263 0020
PROPERTY OWNER:
Name: HAMILTON BARBARA BELL
Address: 85 10TH ST
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name:
Address:
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$7,500.
► `
5~s `` Building Permit Application Updated 5/5/17
r,; f City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
4*,` ;u9 , Phone: (904) 247-5826 Fax: (904)247-5845 /� c
Job Address: pS 10 `S Permit Number: ]�C e 7`"v `�
Legal Description 15-3 )6gC) 2.14 'kb_ta .i, 2cif4 /'r/ot S 6 RE#
P
Valuation of Work(Replacement Cost)$ `f��t Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move 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 of work to be performed:(2642c0F 43Ciret,r A2 1/401,1:0/ki' 44,0 S‘ 4,005
C'4 ()-(f f Clvt--
Florida Product Approval 4494z,3 ft 10076 u41i&teff ny'Auk for multiple products use product approval form
Property Owner Information R
Name: L.)s( yt-yl1 j {Cr' t by-Gi1 Address: gI W Pp 6' c
City NA ler A4-17C.,- cl) , t State Zip 333 Phone_ iff —OgEft.
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company:., JYL (.(cp rc' t Qualifying Agent: 117'
Address (�T ( V`C .`f ✓ City fix'g er, State f( Zip,22fC
Office Phohe --5(514-k— Job Site/Contact Number G,296-j'
State Certification/Registration# -c o ir'f( E-Mail
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.
/ —11 , L
(Sign,ure of Owner or Agent) (Signature of Contractor)
(including contractor) �
Signe .nd swor to .r affirmed) •efore me this OJ day f Sign d an sw n to or af :d) •efor: me th••- day of
ovvBia, P; .ELAJE a S;e•E
0 °+ �° Nota. Po'. ,)
t a} t ooQ My tom dreeC� 281 ) z��=��.r.(Signature of_Noary
°; TONI c,INDLESPE
AZOV Co-mission#FF 074537 ���
����� i t _ MY COiM1P,MJSSION#FF 92491
v EXPIRES:October 6,2019
�� ;°` G.^.nded Thru NotaryPublic Undervirirers
[ ]Personally Known OR [ ]Personally Known OR� �;,,,�,,,„��
•(1 Produced Identification _ / [ ]Produced Identification
Type of Identification: JPType of Identification:
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of 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 stated in this NOTICE OF
COMMENCEMENT.
1$ 24
Legal description of property being improved: , 3q ".2$ G l�rj a 0 q Z
,/. pr I-►&i+( - bQa(iLt a ec I"'1 3'. P-' Lo{-$ ,l r i QCD 0/4,
11233 5 65 41 tre S C�
Address of property being improved: 'ii'S UV r, cP A--Inouti'G gler .di ICI
33 3
General description of improvements: t`i t.tiz_o O P
Owner i-I e 1M loa C VI r, W`�i� ((dam
i•
Address Y(7 ' .5�`' Ip-r///�.�V'iec_ ,.j` (cam 39,43
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
;rJ0XIXzI
Name m O O o c o
C)czo3 "
Address {{ z z m N
Contractor —rAeij"C--(2yd �.` Cif) _ i o -C1..1 Fri a m
��`of Address 7�9 (- h Avt S ..5"r )/4GL l r „22 a 0 (n N y N
A \ Phone No. N
�� Fax No. o m c
Surety(if any) b 0 Jo 0
. Address Amount of bond$ m K)—
co
No � .
Phone No. Fax No. O-o W
C) r
Name and address of any person making a loan for the construction of the improvements. c
Name off'
n o
Address 0 m
c
Phone No. Fax No. -I
o
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other D
documents may be served: '-'
Name
Address
Phone No. Fax No.
. . ..:ii,
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 ^ON�rNER, �
Signed: t (n�n / — DATE I.—.17...11
Before me this day of in the
Cpunly of Dwal Sta of (oric� h spa pnatty appeared
W LL�I��t \�SIC�/��» herein by
' ,�,�1Y a„, w` himself/herself end affirms that all statements and declarations herein
oa►S` �e��.,. PAMELA JEAN SHORE ere true end accurate •
I :a --� °= Notary Public-State of Florida 11 IIC(( //� y
4 ;yam l' crz My Comm.ExpiresFD Dec
4,2017 4-t J bZ"��� l9 Z J
�aPodb.0• Commission r V:2,(Vii,
,airspo ' Notary Public et Large,Sialprp V ofMy commission expires: ����//
Personally Known or
Produced Identification a