526 SELVA LAKES CIR - ROOF JAS !•;.�`}iJ��
f CITY OF ATLANTIC BEACH
� � 800 SEMINOLE ROAD
Ny
ATLANTIC BEACH, FL 32233
S' INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0122
Description: re-roof- FL10124.1 FL15487.1 FL16160.1
Estimated Value: 9990
Issue Date: 11/3/2017
Expiration Date: 5/2/2018
PROPERTY ADDRESS:
Address: 526 SELVA LAKES CIR
RE Number: 172027 5596
PROPERTY OWNER:
Name: BRUCKMAN ANNE
Address: 4511 30TH ST APT 2
SAN DIEGO, CA 92116
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: JACK C. WILSON ROOFING CO.
Address: 4522 ST AUGUSTINE RD 4522 ST. AUGUSTINE RD.
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$7,500.
----,
III BUILDING PERMIT APPLICATION V4)4/€4\
1 OCT 1 3 2017 I1 , li CITY OF ATLANTIC BEACH \A �
I
!ph
,' ;- 800 Seminole Road,Atlantic Beach,FL 32233 \
. _ '' Office(904)247-5826 Fax(904)247-5845
Job Address: � ,� d {
r L:0`, & - �P�ermit Number. �.6(2-rl l--o ( Da_
Legal Description ``{;Th- U \1'a J"�'�E Sd v d. -k(L vkparcel#ICD n --0 ,-,1-6-.-540--0 ,-,1`65. 4
Valuation of Work$ 91 1�' Floor Area of Sq.Ft. Sq.Ft
C4
Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair . - I-molition pool/spa window/door(e.1-00C-
Use of existing/proposed structure(t)(circle one): Commercial 'eside s ':
If an existing structure ,is a fire sprinkler system installed?(Circle one): 'es No N/A
Florida Product Approval# i t_V3�,l �;(cc.,,
For multiple products use product approve orm _
Describe in detail the type of work to be performed: A Q: C Cx(
Property Owner Information: /'
Name: +! w c Lt-CX
A'h Address: �'� Q c \- Cl.Q, •
City !. State2Zip "ai. - 'Phone Tit- ?,55-LI 4
E-Mail or Fax#(Optional)
Contractor Information: t r ` `
Company Name: J L.V'.\i� �C ti CU- Qualifying Agent: , V �
Address: - Sk , ,s�(, r r City �1 l4 StateTi,�- Zip b -,:).o1
Office Phone 9t` f- Cit, L� -(p Job Site/Contac Number ct,; -c•it~- (,S Fax# Ct(Y -)f do `-i1Cb
State Certification/Registration# C� C -t't T 5'
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address r
Mortgage Lender Name and Address vJ 0 1\-•ti`S L D fvtiV 11S c.4:40n i ft f-D-.
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 pe ormed 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(61 months,or if construction or work is suspended or abandoned for aperiod of six L6)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 herebycertify that 1 have read and examined this plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type owork will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions ofany other federal,state,or local law regulating construction or the performance of construction.
Signature of Owner CA Signature of Contractor ,""°.°-....-----.
Print Name i C- (»?G.Lrl Print Name _. ..\ U..�
Sworn to and subscribed before me Swo to and subs b�Wore me
this o?� Day of S ? k1?)t-L2- .20 I this " Day of C.kJYDQ^ .2019-
No
20No blit ''* --)/.1--- ---712P-72:1 4-y&- ,..____%,o,
LTJ Annie ( verid UNCrOIILE
1 '` MY COMMISSION#GG083767 Revised 01.26.10
EXPIRES:MAR 15,2021
•' Bonded through 1st State Insurance
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE) T_0 -1 ' 1y)
y
Permit No. Tax Folio No. �� ' ' r
State of County of %x.�V8
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: &" IOC)
34, S,CAAVA. 1--041--i.i U1.,c-k-t
Y:
Address of property being improved: ¶ OVLi t� Likt... C_'-ok-,
Ku ?4a- ``.4-4-AT
General description of improvements: c ex-o'
Owner :IV . _` , NtrN.,•12.r
�h
Address S4.1j vcNi.. ftc Ct(. 'L
Owner's interest in site of the improvement li(NO610
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor JACK C.WILSON ROOFING
Address 4522 St.Augustine Rd.,
Phone No. Jacksonville, FL 32207 Fax No.
Surety(if any) (904)396-1546
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 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 specified):
THIS SPACE FOR RECORDER'S USE ONLY %' OWNER
01----.. ._
. _ n
Signed: `�-- QA'�E VP/.T
Before me thin b ,\day of N...2>31 ',,v.h;',� }U 117 In the
County of Duval.State of Wide,has pe o lly appeared
Doc#20172346 Ui..v1� AA , t\re,„++�� herein by
45, OR BK 18150 himself/herself and affirms that all statements and deciaratidns herein
Number Pages: 1 Page i 195, are true and accurate
Recorded 10/12/2017 02:29 PM,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING $10.00 Notary Public at Large,state of — , County of — ' F-- 17E-12-AL--
My
17G LMy commission expires:
Personally Keown ` ar
Produced Identification
,,,,:T.,,.'-,-1.2.i.. /.:06-7/.:06-7 Ann; a eve {riar., �,(,St