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67 W 9TH ST - ROOF rj,,,,ply, .,'� '` , CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ,, ATLANTIC BEACH, FL 32233 rtat J;ils.)r' INSPECTION PHONE LINE 247-5814 REROOF SHINGLE - MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: RERF17-0216 Description: shingle re-roof- FL18355.R2 & FL16226-R2 Estimated Value: 6500 Issue Date: 12/13/2017 Expiration Date: 6/11/2018 PROPERTY ADDRESS: Address: 67 W 9TH ST RE Number: 170813 0000 PROPERTY OWNER: Name: GEDDES TOSHIKO Address: 16029 AVENIDA CALMA RANCHO SANTA FE, CA 92091-4174 GENERAL CONTRACTOR INFORMATION: Name: Address: , Phone: Name: EMPIRE ROOFING SALES & SERVICE Address: 2806 -1 GI GIBSON RD QA PEDRO R NUNEZ JACKSONVILLE, FL 32207 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$7,500. • BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach,FL 32233 Office(904)247-5826 Fax (904)247-5845 Job Address: 67 W.9th Street,Atlantic Beach,FL 32233 Permit Number: K-6-f-F-(1-0a(b 18-34 38-2S-29E.091 ATLANTIC BEACH SEC H W 22FT LOT 2 E Legal Description i 7FT LOT 3 BLK 67 Parcel# 1708130000 Floor Area of Sq.Ft. Sq.Ft ' i ' Valuation of Work$ t a Proposed Work heated/cooled 1,228 non-heated/cooled Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s)(circle one): Commercial 1.2asidealiALJ If an existing structure,is a fire sprinkler system in ailed?(Circle one): Yes No N/A Florida Product Approval# , t 6 6 _RR For multiple products use pro uct approve orm . Describe in detail the type of work to be performed: Property Owner Information: Name:_ Michael or Toshko Geddes Address: 16029 Avenida Calma City Rancho Santa Fe State CAZip 92091 Phone 858.759.1275 E-Mail or Fax#(Optional) _ Contractor Information: CONTRACTOR EMAIL ADDRESS: Company Name: Empire Roofing Qualifying Agent: Pedro Nunez Address: 2806-1 Gibson Road City Jacksonville State FL Zip32207 Office Phone 904.391.1007 Job Site/Contact Number Fax# 904.391.1807 State Certification/Registration# CCC 1326007 Architect Name&Phone# Engineer's Name&Phone# Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and.Address &J S Coy oN last �r1ct_ Co. Pol,t-y # to< 71114 Application is here y Cent made to oblain a perthit to do the work and installations as indicated. I certify that no work or irlstalfation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a_?eriod of six(6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools,Furnaces,Boilers,Heaters, Tanks and Air Conditioners,etc. 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. I hereb certify that I have read and examined this a plication and know the same to be true and correct. All provisions o •ws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to . - authority to violate or cancel the provisions of any other federal,state,or local law regulating construction or the performance of construction. Signature of Owner_-77—. .; ,-- Signature of Contracto / 0 X . A. 1..... Print Name Michael Geddes or Toskiko Geddes Print Name / ee- M!' g• N(/j7 e 2. • ............ Before me this Day of December 20 17 Before i e this i laylf I e irii'XIK .20/4- • A __it.4 ---y_oh. . . Notary Public N r, ary Public CAUFORNIA NOTARY ATTACHMENT r.`•'I-p`%. NURIS PEREZ TAVA `ised J 1.26.10 ' t: ��� .,; MY COMMISSION#GG 132159 rA ..,. EXPIRES:August 16,2021__.__ •••e,OF F„0•' Bonded rnry Notary Public Underwriters CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE§8202 See Attached Document (Notary to cross out lines 1-6 below) ❑ See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary) Signature of Document Signer No. 1 Signature of Document Signer No. 2(if any) A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of CaKprnia Subscribed and sworn to (or affirmed) before me County of on this day of—E. , 20 17, by Date Month Year (1) 011(, e,1 (and (2) \ \,D B -d ), Name(s)of Signer(s) KRYSTI BROWN proved to me on th basis of satisfactory evidence Commission#2052029 to be the perso (s who appeared before me. <I Notary Public-California E ivTfy, San Diego Countyt'uri My Comm.Expires Dec t5,2017 Signature Si.e re of Notaty Public Seal Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document s ' `- 103(7jpCO0 Title or Type of DocumentA\iLoJ-iOn Document Date: 01-11?O I 1 Number of Pages: Signer(s)Other Than Named Above: ©2014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5910 NOTICE OF COMMENCEMENT (PREPARE IN DUPLICATE) Permit No. Tax Folio No. 1708130000 _ State of Florida . County of Duval 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: 18-34 38-2S-29E.091 ATLANTIC BEACH SEC H W 22FT LOT 2 E 17FT LOT 3 BLK 67 Address of property beino improved: 67 W 9th St,Atlantic Beach,FL 32233 General description of improvements: ReRoof Owner Toshiko&Michael Geddes Address 16029 Avenida Calma,Rancho Santa Fe,CA 92091-4174 Owner's interest in site of the improvement Fee Simple Titleholder(if other than owner) Name Address Contractor Empire Roofing Address 2806-1 Gibson Rd,Jacksonville,FL 32207 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 Lienors 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 ONLY Signed:��p-a�y�.� _.. DATE Before rfe this day of in the County of Duval.Stele of Florida.has personally appeared Doc#2017284628,OR BK 18218 Page 737, herein by hrherself and affirms That ail statements and declarations herein Number Pages:2 are true true andd accurate Recorded 12/13/2017 10:45 AM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $18.50 • Notary Public at Large.State of . County of My commission expires: Personally Known or Produced Identification __ -CALIFORNIA NOT- __..-_ CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE §8202 .�.a,:�t,�'✓.�.t�t�t�t�t�C t t�t�t�t��t.at�t.at.at.at�t�t_at tit t C�t�t�t�t.a�t�t�t.aC.at.at.at�t�t�t�t�t. 1 .See Attached Document (Notary to cross out lines 1-6 below) ❑ See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary) Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any) A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy, or validity of that document. State of Ca' rnniia^ Subscribed and sworn to (or affirmed) before me County of ` 1 on this day of -, , 20 11 by Date Month Year (1) VICQ, I QPIJLLS (and (2) Y 1� a. l ), Name(s) of Signer(s) proved to me on the basis of satisfactory evidence :1�.:. KRYSTI BROWN to be the perso s) who appeared before me. .: Commission#2052029 �. om. •''i' z � �?� Notary Public-California z yR''' San Diego County f \ �� My Comm.Expires Dec 15,2017 F Signature � J Sig re of Notary Public Seal Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document /� , COCO -1 O�1 O Title or Type of Document:Nl 1(Ld -c 1ffrleil1C.QYYLeA. Document Date: la I-► I c30I1 Number of Pages: Signer(s) Other Than Named Above: LG�.G�.G�G�G�G�G`.G�G`.G�.G�.G�✓,G�G�:G�;G`:.G�✓G�G�G�✓,G'✓q�,G�✓,G�✓,G�✓,G�✓,i�y,<�✓,G\LGA✓,G�✓,G�✓,G�G�✓G�✓,AL.G�1'y,G�✓,G�✓,G�✓,G�✓,G�✓,G�✓,G�✓,G�✓,G ©2014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5910