389 12th St re-roof permit A J\j
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
-5814
INSPECTION PHONE LINE 247
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0168
Description: RE ROOF SHINGLES
Estimated Value: 13920
Issue Date: 11/13/2017
Expiration Date: 5/12/2018
PROPERTY ADDRESS:
Address: 389 12TH ST
RE Number: 171921 0000
PROPERTY OWNER:
Name: LIGGERO ROBERT R
Address: 389 12TH ST
ATLANTIC BEACH, FL 32233-5537
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: PEAK ROOFING & CONSTRUCTION
Address: 8653 VILLA SAN JOSE DIR E
JACKSONVILLE, FL 32017
Phone:
PERMIT INFORMATION:
Please see aftached 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
T) City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FIL 32233
Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: Sr ikkA 14�C_ &604t�31 t-3-3 P e r m i t N u m b e r:
Legal Description 1,1A eve —RE#
Valuation of Work(Replacement Cost) eated/Cooled SIF 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 (��
• 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:
XP
lepow a - /AO fwlllyle_4�
Florida Prod/ct Approval# /C:71- 4� " Z (Or multiple products use product approval form
PropertV Owner Information
Name: so/_� A d d r e s s: 12 r &Irl,e lyl
City 4 f�,f,,4 drAee State 11,:74 zip —Phone -q
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
NameofCompany: i4lflc 0.011,11V V/ V414-1/711/Xi Qualif�L!ng Agent:
Address lal 11A fA A:R s e �Ae ,I!F city JAX- State /110--74 zip _rzz/7
Office Phone —73 7 6? Job Site/Contact Number
State Certification/Registratilon#ee-c ISZrf_l'�9 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.,,/
7
(Signa-1,(/e of owner or Agent) (Siwu�r�f Contractor)
(including contractor)
Sig orn to(or affirmed) before me this_20ay of oar e m e t n Is d of
d io�ed and sworn to (or aff"- ,f h' Y
0 �,/Pl ()
_,W,–sw by i( b
611,0VU/1, SGJICIX3
179v"w:1
V018011:10 3.LV.LS n4lu're of 4o aryr (Siqa.�u77
q�p
oiiiandAbV110N
AN'
VA310H 13VHDIVI MMISSION#FF 92
51
5
5
19
9
r
My Co'
EXPIRES:October 6,,201
ILL �ilz Dc,d,d Thru NotarY Public Underwril�-
rs
Personally Known OR ]Personally Known 0
Produced Identification I Produced Identifica t n
Type of Identification: Type of Identification:
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. 01 q Tax Folio No. 1717
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.
Legal description of pr rt b9ing improved.-
cewco, Al rytIlA t&- V- __
&�Z �PjT ,43 Z12 7L
/ r7
Addres of oved:
property bein!�impr _J C1,
General description of improvements:
Owner Z,, 4z
Address ZZZ-Off
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor
A
ddress
Phone No. 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 ONL� -wo"r VWNER
Signed: IfAft �V DATE/,�'_?—&1_f17
Before me this_day of & in the
Doc#2017255772,OR BK 18178 Page 1143, CountpDo,Sjof Florid,$,h4s 6ersonall peared
Number Pages:1 .0
4- herein by
Recorded 11/07/2017 12:47 PM, himself/herself and affirms that all ments and declarations herein
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL are true and accurate /1*
COUNTY MitKAEL J.HOLEVA
RECORDING $10.00 NOTARYIPUBUC
STATE OF RID
Comm#
/2912
rge, tate of County of
My XPI S7
or
Cash Register Receipt Receipt Number
City of Atlantic Beach R5060
DESCRIPTION ACCOUNT CITY PAID
Perni $55.00
RERF17-0168 Address: 389 12TH ST APN: 1719210000 $55.00
ROOF FINAL 12/19/2017 NIJ $55.00
ROOF FINAL 12/19/2017 MJ 1 45500003221002 0 $55.00
TOTAL FEES PAID BY RECEIPT: R5060 $55.00
CITY OF ATLANTIC BEACH
800 SEKNOLE RD
ATLANTIC BEAC,R.32233
09311:49
CREDIT CARD
VISA SALE
Cad# XWOODMI90
SEQ 4: 1
Bab#: 606
INVOICE I
Approval Code: 183983
Bay w1w: MIMI
Mode: Onlre
Card Code: m
SA[E AMOUNT
CUSTOWR COPY
Date Paid:Tuesday, May 15, 2018
Paid By: LIGGERO ROBERT R
Cashier: BA
Pay Method:CREDIT CARD 1
Printed:Tuesday,May 15,2018 9:40 AM I Of 1