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199 MAIN ST - ROOF 1411k. CITY OF ATLANTIC BEACH ' � ,� ,? 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 J f 9t> INSPECTION PHONE LINE 247-5814 REROOF SHINGLE - MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: RERF17-0167 Description: RE ROOF SHINGLE Estimated Value: 5000 Issue Date: 11/9/2017 Expiration Date: 5/8/2018 PROPERTY ADDRESS: Address: 199 MAIN ST RE Number: 170842 0000 PROPERTY OWNER: Name: ELLIS DIANE S Address: 199 MAIN ST ATLANTIC BEACH, FL 32233-2525 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: TIER 1 CONSTRUCTION Address: 33 W 6TH ST QA BRENT PARRY PARRISH 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$7,500. I AYit s"`' .4 • Building Permit Application (. 3/L7 ••• •e.• '` City of Atlantic Beach h/607 P,V ,r 800 Seminole Road,Atlantic Beach,FL 32233 • i Phone:(904)247-5826 Fax:(904)247-5845 • Job Address: J 9q AAO-In. 541-eakPermit Number: , "1'--Pi — 01(21- I IV} Legal Description i\Iiw.,4:at11 ) .� I�OT � /� �T" RE# 174zq 2-0000 Valuation of Work(Replacement Cost)$ S,0€Dl? Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New Addition Alteration Repair Move mo Pool Window/Door • Use;of existing/proposed structure(s)(Circle one): Commercial .Resident a' • If! f 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: �rG�,S� , i o c c r 1 • i 1-c.,.54:.1/401t. I . Florida Product Approval# FLOWN-14-R+Q FL.11609,--R; for multiple products use product approval form Property;Owner Information c Name: #' Address: 159 w..-Skful'- City,N>y, ,S, 1 State FL Zip 3).2 7 Phone 90K-X52--.3q41 E-Mail fif`ist`Di Ct.-ern 0i r,,,h.oU.6-'1' Owner or Agent(If Agent,Power oAttorney or Agency Letter Required) Contractor information Name of Company: l i tor 1 C. S4cul aK. C!ual in Agent:c tc ?o- s L . Address L� �iri, \u..�.{,�B\, 4-212 City`:ic �n�I;((L State FL Zip ,? a.�' Office Phone'41oLI-853-leg Job Site/Contact Number 9o(1-,So4-.SgoG State Certification/Registration#W. L3z105cf E-Mail } €i;rri£ k(v t (')—,,LatrY14, _ Architect game&Phone# Engineer's Name&Phone# Workers Compensation u:•1&X5 1,A,„J .\ WC...P IO.S'�f!$11-00 • I 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 commended Prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg constructiionlin 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'SAFFIDAVIT: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 A ATTORNEY_BEFORE REC► 'DING YOUR NOTICE OF COMMENCEMENT. (Sign. re of Owner or Agent including Contractor) (Signature of Contractor) Signed and1 �sworn to(or;affirmed)before me this .3 day of Sign and sworn to(or affirmed)before me this 3 day of kkucry.L, P....0 1/ ,by l ltc,w.r ��(`s kLuc . I1 ,by erc�.*" P 1 • t f Kto L3oi -e• KATRINA BOWEN Signature of Notary) (Signature of Notary) , .MY COM/41E131Ot s 00048914 KATRINA BOWEN ii ' , , EXAMS November 20.2020 i ' • MY COMMISSIONS 00048914 I:. . i •• "r' PIRES vember 20,2020 J Persona iy Known-cmI ' . [ ersona I Known O { [rroduced identification y '0 `• e• . • Type of Identification:f L.P t- t�U-1 1I-53-D)2-0 Type of Identification:? i i I I • NOTICE OF COMMENCEMENT State of T iob Tax Folio No. +7(Aci) ©O c)0 County of A )t,LA,E� . 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: A:i( 5G Bj •k.. SEC 1+ LOT .i UI 1961 Nlr.:.A Address of property being improved:. I C11q iV a w t g t •� �o� j �(.� �- 3'f)33 General description of improvements: Re,- 0C Owner: •i ww z. E It`,5 Address: ICICI cib r� ��`: �Ic> �G C �� 233 Owner's interest in site of the improvement: I O*4 Fee Simple Titleholder(if other than owner): Name: Contractor: ( - ,S ddress: 324S Mk ; _ :1ucX 4,-1( Telephone No.: 901-1-263-I 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: - 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: Telephone No: Fax No: In addition to himself, owner designates the following person to receiv( Doc It 2017257047,OR BK 18180 Page 480, 713.06(2)(b),Florida Statues. (Fill in at Owner's option) Number Pages:1 Name: Recorded 11/08/2017 12:45 PM,.. RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL - Address: COUNTY RECORDING $10.00 Telephone No: Fax No: Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLY OWNER Si ned � F-) �� Date: it/3) 7 ++ �`— — - Before me this . •day of hjouJ :1017 in the County of Duval,State ma mum Of Florida,has personally appeared O;, 4e_ J jlt g NOMwy1MMC.$rata ot FIOrida Notary Public at Large,State of Florida,County of Duval. •' Commission/yygccoca My commission expires: Muy, 14)102.0 , �- = My COMIC Eyifdf May 1+,2020 Personally Known: or ,,'',,°F,,,,,, cooed ti A National Notsry Assn. Produced Identification E�I,Zf�--12 7