587 SELVA LAKES CIR - ROOF 4110%--','-'"-t, CITY OF ATLANTIC BEACH
r,
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
vJ1319 INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0209
Description: RE ROOF SHINGLES
Estimated Value: 9165
Issue Date: 12/8/2017
Expiration Date: 6/6/2018
PROPERTY ADDRESS:
Address: 587 SELVA LAKES CIR
RE Number: 172027 5536
PROPERTY OWNER:
Name: HOGG MARY SHANNON
Address: 587 SELVA LAKES CIR
ATLANTIC BEACH, FL 32233-4376
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: SHORE ROOFING COMPANY
Address: 914 7TH AVENUE S QA THOMAS LOUIS SHORE
JACKSONVILLE BEACH, FL 32250
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$7,500.
Building Application A lication Updated5/5/17
4 iY
City of Atlantic Beach
Ptr� 800 Seminole Road,Atlantic Beach, FL 32233
''i'0 Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: 51 5 c l L R CA'(' Permit Number: iR e aF 17- O O
Legal Description I-11-1 1 "aJ `-al S (Irrr1..4Ki3 ovit-aLot 7O RE#
1G9✓
Valuation of Work(Replacement Cost)$ q I Grp 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 er€ormed: i( � (�� fJN rft�r►} /�t
R.(1/66 P Vtc,o G ►��hr•�fGrs IA-v(3 / S�►�{ ,� j
Nt& ; 167I I
Florida Product Approval#Fl JOl a'I, I / ( /,�-/L for multiple products use product approval form
Property Owner Information
Name: -.5hP- I\0(\ Ifv Address: 37 .rc,/0� f-1f .__y �Y •
City ,1�,�f ic... Atcte-L State /%( Zip 322,33 Phone 6y-3 C)Og
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: ViDtC. Rc(C Qualifying Agent: f fititiYk((540sC
Address City c /�'c c,/ State /�f Zip 322.4r
•
Office Phone 9( —5rvi Ti 42_ Job Site/Contact Number'�S,it. A)Ct— pq
State Certification/Registration# CCC O '4 '1( E-Mail i1
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation XEM p4 kc Y\Q S S kc r 2 /l( tt 9
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
RECO D G YOUR NOTICE OF COMMENCEMENT. •
X 4iwvl /-b/ Q- --
(Signature
of Owner or Agent) (Signature of Contractor)
(including contractor) i
Signed and sworn to or affirmed) before me this day f Sig ed and sworn to (or affir . before e this day of
/� y y •- , by . O o r-�
/J V ?o� AMELA �E tIal -�
1 a ,� Notary Public-State of Floridaikineks." 1/7"--1-c.„ ,—My Comm.Exp}�;s,,Qae}�,4pzl t�
•''Eo i$'S Commission`#TF-UT�53o/ ary) (Signature o Notar
o w+edoG, TONT GINDLESPERGER
[ ] rsonally Known OR [ ]Personally Know 19,I$
EXPIRES:
*= MyGOMMISSICN FF 924951
{� �p EXPIRES:October 6,2019
[ Produced Identification / [ ] Produced Identifi UnderwritersBonded ThruNotary Public
Type of Identification: ,1 ' v Type of Identification "
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. /70)7—533C:
State of County of t3 v 1/41
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 //
Legal description of property being Improved:_ z/3-// /7 5 ` '/ 1 �$ '-/''t4 /4-K Z S
LA 11' a 2-0 f- 7O
•
Address of property being Improved: 5 V7 5`t,/04- //a-t�-t s cAY'
�+ l N11'c 13 e46- P' .722-33
General description of improvements: Pe /2 or
AOwner —salkr O 1
( Address 5 1 SC-17A- Lw-1,--I (it s' 11411-A/1-,'L, (31 44 Z I 72-13.7
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address .5�f7 SG I vt4 /i1- It.( 'buY' A-+)A-ti t t. 13,-e i_L r 3/2. 3
Contractor ,ShOvt.- /Zn/71r'��!`p
Address c2 12. HI 41/". 5: f A4 /3 rt.<.,L A 32:2-fa
Phone No. ?K( Fax No.
MO7J7Jzo
moonc o Surety(if any)
o z z a m r Address Amount of bond$ •
�—Imm 7
E ° p
N Phone No. Fax No.
rn o N oo
01 o,w ! Name and address of any person making a loan for the construction of the improvements.
o
• Name
m w Address
X N X Phone No. Fax No.
o
a' ' Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other
rn documents may be served:
Name
Address
Phone No. Fax No.
D I .
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 speciified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER 1 �//�J 1�
Signed: e . v,1_`1 ` " ' ^X' t
Before me this ray of In the
Countt�rcs�Duval,State of Flo d ,has personally a peared
.- O \/ b l.�!�✓�Of ��� b herein by
�,,,,,,,,, M-�lytself/herself and affirms that all statements and declarations herein
,oS►5`Y°�o'��.,� PAMELA JEAN SHORE are true and accurate
; ; = Notary Public-State of Florida
4yt`o`o� My Comm.Expires Dec 4,2017
.,�Fo .�o,� Commission#FF 074537
Notary Public at Large,State of a , • 711Lr
My commission expires: _gory
Personally Known - or
Produced Identification DL (f/ (%�—S9 7"6a0-']t t-6