1242 BEACH AVE - ROOF c_r'� r CITY OF ATLANTIC BEACH
iso
f 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
X0;3 >%' INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0218
Description: SHINGLE ROOF
Estimated Value: 5978
Issue Date: 12/14/2017
Expiration Date: 6/12/2018
PROPERTY ADDRESS:
Address: 1242 BEACH AVE
RE Number: 171828 0000
PROPERTY OWNER:
Name: KIRKPATRICK ROBERT BOYD TRUST
Address: 1242 BEACH AVE
ATLANTIC BEACH, FL 32233
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.
r ` Building Permit Application
City of Atlantic Beach
utt
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: 1242 Beach Ave. Permit Number: R ER 7 — 02- S
Legal Description 10-11 16-2S-29E MANDALAY LOT 6 BLK 50 RE#
Valuation of Work(Replacement Cost)$5,978 Heated/Cooled SF 1811 Non-Heated/Cooled 200
• Class of Work(Circle one): New Addition Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s) (Circle one): Commercial <ke-sidentia
• 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: JOHN AND SUSAN KING Address: 1242 BEACH AVE.
City ATLANTIC BEACH State FL Zip 32233 Phone 904-868-6957
E-Mail king9929@bellsouth.net
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
RECORDING Y R NO CE MMENCEMENT.
Ay/air /41 4440.00
(Signature of Owner or Age including Contractor) (Sig . ore of'ontractor)
Signed and sworn to(or affirmed) b ore me this 1111.day of SignedSi _ a d sworn to(or:f"rm:s before e this/day of
Tectr. , ZOIT by SVSvicas ki L01 , by R(
(Signature of Notary) (Signature of Notary)
„9f.i✓��, „ ' Andrew D. Davis
QP�. � ,• P�Y'tf7/1"', Andrew D. Davis
" ;�_
- COMMISSION?'FF160849 '2a sa` -= COMMISSION#FF160849
[1ersonally Known OR ° ��'-;• c EXPIRES: Sept. 17, 2018 ['ersonally Known OR =
�, ." • EXPIRES: Sept. 17, 2018
Produced Identification ~i it WWW.AARONNOTARY.COM : N
[ ] ,,,�������� [ ]Produced Identification WWW.AARONNOTARY.COM
Type of Identification: Type of Identification:
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: 10-11 16-2S-29E MANDALAY LOT 6 BLK 50
Address of property being improved: 1242 Beach Ave.,Atlantic Beach,FL 32233
General description of improvements: Re-roof
Owner Susan King
Address 1242 Beach Ave.,Atlantic Beach,FL 32233
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Prime Roof Contracting,LLC
�b - / Address 13725 Beach Blvd Suite 13,Jacksonville,FL 32224
�J�'f9'�" Phone No. (904)625-i4as 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 ONLY //�
Signed: dr-i / DATE/2
Before me this day of in th
Countof Duval, a of Florida,has personally appeared nv � dein by Andrew D� Davis
DCC#2017285192,OR BK 18218 Page N he
2417, himse rself an affirr s that all statements and de dri ltey
Number Pages:1 are true and accurate ' ' 11n 'O COMMISSION#FF160849
Recorded 12/13/2017 04:10 PM, ,'�*.:P= EXPIRES: Sept. 17, 2018
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL �) ,64..!6:•• ° INL4tLN.AARONN07ARY.CQA9
COUNTY t(/ n+unn
RECORDING $10.00
Nota Public Public at Large,S ate/of / County of _
My commission expires: '/1-J•
Personally Known ✓ or
Produced Identification