1892 HICKORY LN - ROOF „,,,,,,.,„
.�� ' CITY OF ATLANTIC BEACH
° ” 800 SEMINOLE ROAD
,v ,r ATLANTIC BEACH, FL 32233
"!
Building Permit Application
, City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: 1892 Hickory Lane Permit Number: q---"G
Legal Description Lot#2, Unit#12-B, Selva Marina RE#
Valuation of Work(Replacement Cost)$ 18,800.00 Heated/Cooled SF N/A Non-Heated/Cooled N/A
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s) (Circle one): Commercial Residential
• 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:
new asphalt shingled roof(re-roof)
Florida Product Approval# shingles-10124.1 underlayment-15487.1 for multiple products use product approval form
Property Owner Information
Name: Larry Covington Address: 1892 Hickory Lane
City Atlantic Beach State FL. Zip 32233 Phone 1-904-247-1448
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: Hagerty Construction &Roofing, Inc. Qualifying Agent: Quin J. Hagerty
Address 12850 Winthrop Cove Drive City Jacksonville State FL. Zip 32224
Office Phone 1-904-992-9960 Job Site/Contact Number 1-904-591-4354
State Certification/Registration# ccc-057779 E-Mail hagertyinc@yahoo.com
Architect Name& Phone# N/A
Engineer's Name&Phone# N/A
Workers Compensation Bridgefield Employers Insurance Company
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
RECORDING YOUR NO ' E OF CO MENCEMENT.
116.4
.� • A
(Signature of Owner or Agent inding Contractor) MEW
• (Signa OT Contractor)
Signed and sworn to(or affirm•d •efore me this l P day of Signe• and sworn o(or . ed) before me this (p day of
2017 ,L k b . 1= h ►1k 4,01.i 017 • Quin J. Ha•e
ali1iO4L 1
V r1 �ta y) rrignature rNotary)
�/ •uin J.Hagerty
,►�;
••�> NOTARY PUBLIC tiraYP•a4 JAKE MILI.ENDER
a fi' STATE OF FLORIDAA * MY COMMISSION#FF 940637
� Comm#GG119052 [x]Personally Known OR *a °' EXPIRES:December 2,2019
[�Personally Known OR
_of milled led eu-gel Notiry Senior
[ ]Produced Identification Ekpirpg 612612921 [ ]Produced Identification 'E0"`
Type of Identification: Type of Identification:
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. 172020 1306
State of I FLORIDA County of DUVAL
To whoii it may concern:
The undersigned hereby informs you that improvements will be made to certain real property,and In
accord ce with Section 713 of the Florida Statutes,the following Information is stated in this NOTICE OF
COMMS CEMENT.
Legal de cription of property being improved: Lot#2, Unit#12 B, Selva Marina
Address of property being improved: 1 892 Hickory Lane,Atlantic Beach, Florida,32233
General description of improvements: new asphalt shingled roof(re-roof)
Owner _arry Covington
Address 1 892 Hickory Lane,Atlantic Beach,Florida,32233
Owner's nterest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Hagerty Construction&Roofing,Inc.
Addr ss 12850 Winthrop Cove Drive,Jacksonville,Florida,32224
Phon No. 904-992-9960 Fax No. 904-992-9961
Surety(if ny)
Address Amount of bond$
PhoneI 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
B
different date is specified): a N N
UEc 'no
THIS SPACE FOR RECORDER'S USE ONLY 1B>W ' - >•m O 8i FiNv.
SI ned L!L ,� 4 •AT'/48 D. u. CO
Before me this day of 1 ►�J[ in th Z >- 0 O rn
County of Duval,S ate of Florida,has personally ap•eared "i Q t1:1 ' `
Doc#2017264371,OR BK 18190 Page 658, LARRtf/Y her elf aNnd
herein by c ( Q
himself/herself and affirms that all statements and declarations herein 5 O 1—Number Pages:1 are true and accurate / 0 z co U W
Recorded 11/16/2017 11:51 AM,
�pT10N.
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL , i ►���,
COUNTY 11 J ��,t"'
RECORDING $10.00 �JI oy'i `y=
Notary Public at L. iiiiORIDA , County of DUVAL b01i�01a
My commission
Personally Know or
Produced Idents :ion MEW