65 W 9TH ST - ROOF ,,,..„,./..00
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Js � CITY OF ATLANTIC BEACH
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-, > 800 SEMINOLE ROAD
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ATLANTIC BEACH, FL 32233
(Lolt �% INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0181
Description:
Estimated Value: 7493.19
Issue Date: 11/16/2017
Expiration Date: 5/15/2018
PROPERTY ADDRESS:
Address: 65 W 9TH ST
RE Number: 170812 6000
PROPERTY OWNER:
Name: STORMS MATTHEW
Address: 65 W 9TH ST
ATLANTIC BEACH, FL 32233-3464
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: PRIME ROOF CONTRACTING LLC
Address: 13792 HERONS LANDING WAY APT 9 QA MARK ANDREW
YOUNG
JACKSONVILLE, FL 32224
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$7,500.
Building Permit Application
City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: 65 W 9th Street Permit Number: g f/1"I I��' r 81
Legal Description 18-34 38-2S-29E.090 ATLANTIC BEACH SEC H W 11 FT LOT 1,E 28FT LOT 2 BLK 67 RE#
Valuation of Work(Replacement Cost)$ 7,493.19 Heated/Cooled SF 1228 Non-Heated/Cooled 248
• Class of Work(Circle one): New Addition Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s) (Circle one): Commercial (6-sidentiaJ.
• 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 performed: Replace asphalt shingle roof
Florida Product Approval#FL10674-R12 (shingles) FL17420-R2 (felt) for multiple products use product approval form
Property Owner Information
Name: MATTHEW STORMS Address: 65 W 9TH ST.
City ATLANTIC BEACH State FL Zip 32233 Phone 904-254-2454
E-Mail MCSTORMS1@YAHOO.COM
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: Prime Roof Contracting, LLC Qualifying Agent: Mark Young
Address 13725 Beach Blvd Suite 13 City Jacksonville State FL Zip 32224
Office Phone (904) 530-1446 Job Site/Contact Number (904) 860-0230
State Certification/Registration# CCC1329505 E-Mail office@primeroofingfl.com
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation FRSA Self Insurers Fund Inc. 1/1/18 870-040093/3EE6142 _
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
RECORDIN YOUR NOTICE OF COMMENCEMENT.
/
(Signature of Owner or Agent including Contractor) (S:nature of C.•tractor)
i ned a d sworn to(or affirmed.)b re me this day of Signed nd sworn to .r affirmed 0,efo e me this / day of
by riot star", , W , by
(Signature of Notary) (Signature of Notary)
,,,�'�rr,- Andrew D. Davis
; ee...�B�,- arar�r", Andrew D. Davis
,, 'fit COMMISSION#FF160849 ;tea ��� �,--
[ ] Personally Known OR F.s..fi,�;�,: EXPIRES. Sept. 17, 2018 personally Known OR # „r = COMMISSION d FF160849
;7 • e�` WWW.AARONNOTARY.COM ���•: EXPIRES: Sept. 17, 2018
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Type of Identification: f,, Type of Identification: 'mmm�
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
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.090 ATLANTIC BEACH SEC H W l TFT LOT I,E 28FT LOT 2
Address of property being improved: 65 W 9TH ST ATLANTIC BEACH,FL 32233-3464
General description of improvements: Re-roof
Owner MATTHEW STORMS
Address 65 W 9TH ST ATLANTIC BEACH,FL 32233-3464
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Prime Roof Contracting,LLC
e(cio,
v4Address 13725 Beach Blvd Suite 13,Jacksonville,FL 32224
Phone No. (904)625-1446 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 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 ONLYul /
Pr
11
Signed: DATE "t
Before me this day of f�elpri1 in the
Coun State o onda,has personally appeared
herein by p
Doc#2017264641,OR BK 18190 Page 1765, himself/herse�affir sNI allllstatementsstand deciar t rg,n Andrew D. Davis
Number Pages:1 are true and accurate Q? "'�S��o
Recorded 11/16/2017 01:46 PM, =? iii �'= COMMISSION I FF160849
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL s•,��.;* EXPIRES: Sept. 17, 2018
COUNTY .09 WWW.AARONNOTARY.COM
RECORDING $10.00 �{t�
otary Public at Large.State 9t, , County of_1)t___
My commission expires: kV 1
Personally Known or
....._.... ---.._....____...._....._.._—
Produced Identification