1090 Main St re-roof permit i LNJ�.
i`.IS CITY OF ATLANTIC BEACH
AUILFL�'�� 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
�!com 9, INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0201
Description: shingle re-roof- FL10124.1 & FL2567.R3
Estimated Value: 8140
Issue Date: 12/5/2017
Expiration Date: 6/3/2018
PROPERTY ADDRESS:
Address: 1090 MAIN ST
RE Number: 170995 0550
PROPERTY OWNER:
Name: HAYNIE JEFFREY
Address: 1090 MAIN ST
ATLANTIC BEACH, FL 32233-2624
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: ROMANO BROTHERS ROOFING, INC
Address: 155 E. Levy Road QA DANIEL JOSEPH ROMANO
Atlantic Beach, FL 32233
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$7,500.
f Building Permit Application Updated S/5/17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: l p yb in.c., Permit Number:
Legal Description 3 B_ �•,� 6t
�bJl��#� -7c,4 Vs--
Valuation
S=Valuation of Work(Replacement Cost)$ !., 1140,y U 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 /Re5ldentlal
• 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 Oetail the type of work to be performed: A.
[Q-1 . l --�a u I G C r I Ck
Florida Product Approval /t)lamfor multiple products use product approval form
Property Owner Information
Name: a G hIZ Address:_ _�O`10iti
City L State�LZip 3ZZ33 Phone `'1 (n ' �361
E-Mail N
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: kr-,c w RrX'1,5 Qualif ing Agent:
Address 45-5 E 1GtJ 1 Rd Al-, A)J,j 3 City (Sc c. StateZip Z Y-L 3'5
Office Phone 5&�( bra 6 (,t4 5 Job Site/Contact Number ioq_ 5557-*75=1
State Certification/Registration# f:11 `x45 3 E-Mail g.,es / ,cam..,..
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation WR-S; /-i97 •'l
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 NEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contra
(including contractor) '
Si ned and sworn to(or affirmed re me t i :11 day of SiOneand sworn to(o before meth' 1 day of
u J y , ✓ by t ,
t
(Signature of Notary) „ kJ16110 Ulf
MIA AMBERHICKSNotaryPublic-StateofFlorida
► ,►i Notary Public-State of Florida � My Comm,Expires Jul 27,2021
Personal) Known Commission#GG 129180 �F, „ ` BondcdltrhughNnUbnolNninryMsn.
[ ] y r vr:' My Comm.Expires Jul 27,2021 [, Personally Known O
M Produced Identific ".'<< BondedthroughNattonalNotary Assn. ]Produced Identification
Type of Identification: Type of Identification:
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit f4a. 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.
Legal desN n Af property eing impr
Address of property being improved:
r
General description of improvements:
�\� �-�-• Owner � ni
Address _- 1� Q � AV"" i ta,/� �=l, 3ZZ3 3
Owner's interest in site of the improvement
Fee i leholder(if other than owner)
Name
Address
Contr o i
Address �
r--
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 o
LL ry r
documents may be served: _
Name = " d o
wc'ii z'
Address
M r
E
E
Phone No. Fax No. T <6
T �
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). l=vim ti'4 ~,
a
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 O Y OWNER q �1
Signed: C DATE 10 t�1 Il 1
Before me this day of in e
County of Duval.$$ttji�te of Florida haspersonaily appeared
D �s� z� OR au 1 X72 P'^�1 3� ,-T•t'f rt'j G• FFut�J✓1r� herein by
CC#20,7252035,O B . 8, Page 6 himself(herself and affirm that all stat_ _n s and declarations herein f'
Number Pages: 1 ar _ ccurate
Recorded 11/03/2017 01:10 PM,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL `
COUNTY n
RECORDING $10.00
ary Public at Large,State of Coun of
My commission expires:
Personally Kno:.,n n or
Produced Identification