635 SELVA LAKES CIR - ROOF J t r si
CITY OF ATLANTIC BEACH
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: RERF17-0205
Description: shingle re-roof- FL16638-R1 & FL1744-4
Estimated Value: 3900
Issue Date: 12/6/2017
Expiration Date: 6/4/2018
PROPERTY ADDRESS:
Address: 635 SELVA LAKES CIR
RE Number: 172027 5560
PROPERTY OWNER:
Name: LEIGHTON JAY H
Address: 211 SEVENTEENTH ST
ST AUGUSTINE, FL 32084
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: BOBBY CAMPBELL ROOFING INC
Address: 114 N WALNUT ST 114 N. WALNUT STREET
STARKE, FL 32091
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$7,500.
Building Permit Application
Updated 5/5/17
'&& City of Atlantic Beach
k — r 800 Seminole Road,Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904) 247-5845 n F
Job Address:a5- So/LA Zes.44 C , ,¢.�s 1 3272 Permit Number: 1` e_r )1-^ O Q
Legal Description fof�'Z (F/� /_f/C �N�a-2 �r�Q' a� �//4/if- RE# / 2nZ-2- •>
Valuation of Work(Replacement Cost)$ ?r 90,0 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 esidential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No C/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:
Florida Product Approval#Q,C. J=/10-,3 / - for multiple products use product approval form
Property Owner Information I1Noris';0 1/..de- `,,Au–, -
Name: t:( Address:
City p/at 1-k State . Zip 32Z,?J Phone 9e4;41 Z.86
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: ea i /e///jai Qualifyin Agent:%f//
Address S Z sc� c k?oe pb:2o3 City SF .usH,to Stite ✓% Zip ??0P7
Office Phone 51941/46- Job Site Contact Nu WO?
Site/
Contact
Certification/Registration# ("cc'/3 Z1.:7:5-z E-Mail
Architect Name&Phone#
Engineer's Name&Phone# /
Workers Compensation ,GA'f4 /,e.iNs vei .cP, 4/, ?75 Z
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
RE ORDING YOUR N TICE OF COMMENCEMENT.
a‘ii/
o (Sig :tu ie o�Owner or Agent) (Signature of Contractor)
it
luding contractor) 7
Signed and sworn to(or affirmed) before me this 7 day of Signed and sworn to(or affirmed)before me this day of
, 2D/') , by '7 Cz ��,c�., 4cre,�5 4` , by i344r 4,,,74 /7
(Signature of Notary) / (Signature of Notary
' *+►t JASON E.PIERCE ��" !; i JASON E.PIERCE
::,R•'' '%$, MY COMMISSION N GG 009876
*; ,.. , MY COMMISSION M GG 009878 's m • EXPIRES:Jul 1 2020
��`:•• EXPIRES:July 7,2020 , o y
[_Personally Known OR 'a;9 X55,,0 i Bonded ThruNotary Public Underwdters [ Personally Known OR ,cei P Bonded ThruNotary PublicUnderwriters
[ ]Produced Identificatio . • [ ]Produced Identification `
Type of Identification: Type of Identification:
NOTICE IF COMMENCEMENT
State of 7e 4 lac/ 6 4. County of Tax Folio No. .
To Whom It May Concern:
• The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of
the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: LOJ'- g , S 1 kes i &AM- 'T o Aec'a.rd }v P/4tf
`OL 2,i, '. ..a%`..., r I .6 si . t 1' _ : 6 . . r.' - A' ' 4 i L -,.ice: & ' .
Address of property being improved: 6 3.S S vlv3- /.4-/Ce_.3 Ctr-012/ 4-1-14,0-1 C 63a_}e,k F--/ 3GV33
General description of improvements: lee/ L /, _,CI 7 L.//_ 1W..7//�
Owner: J' A Le15h4,04 Address: ‘3$ 5c/k-4-4ted £rnit//,�A1-44/her PU,A . 3 3,
Owner's interest in site of the improvement: O A14 e r /Op/
Fee Simple Titleholder(if other than owner):
Name: f ��,,-f /
Contractor: 0,6L.-ti", (,. 0 e/ �ecI-r;1 <. 7
Address: S-c' 7 S c.e . Way ' Ai 2c2 pit ?GN' S us of;nom -f—, '7 7 09--L
Telephone No.:9 Cri t(�ij 'Z-ebz Fax No:
Surety(if any)
Address: /. Amount of Bond$
Telephone No: Fax No: /�
Name and address of any person making a loan for the construction of the improvements
Name:
Address: / /
r
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: I./ .
Address: 7 J /
Telephone 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 Statues. (Fill in at Owner's option)
Name: / f
• Address: /f j
Telephone No: ( Fax No:
Expiration date of Notice of Commencement(the expiration date is one (1)yearn om the d.; of recording unless a different date is
specified): / /
THIS SPACE FOR RECORDER'S USE ONLY OWNER Or
Signed: / Date:
Doc#2017277943,OR BK 18208 Page 2126, Before me this / day of,2A�«l4`i r.` in the County of Duval,State
Number Pages:1 Of Florida,has personally appeared "Tui ft, G•ei y4 f,
Recorded 12/06/2017 10:01 AM, Personally Known: 1, or
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Produced Identification:
COUNTY Notary Public: �- A:
RECORDING$1-0.00
Oiku'• JASON E.PIERCE
tMY COMMISSION$GG 009876
:�. :.; EXPIRES:July 7.2020
';:i V Bonded Thru Notary Public Underwriters