808 AMBERJACK LN - ROOF `JS r ii:SS
CITY OF ATLANTIC BEACH
Do 0,\,,:on" �> 800 SEMINOLE ROAD
yr ATLANTIC BEACH, FL 32233
r;; L)' INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0192
Description: RE ROOF SHINGLE
Estimated Value: 5250
Issue Date: 11/29/2017
Expiration Date: 5/28/2018
PROPERTY ADDRESS:
Address: 808 AMBERJACK LN
RE Number: 171141 0000
PROPERTY OWNER:
Name: HAWORTH CHARLES F ET AL
Address: 168 ST LUCIE ST
FLORAHOME, FL 32140
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: RON RUSSELL ROOFING INC
Address: 4419 HUDNALL RD QA RONALD WAYNE RUSSELL
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$7,500.
Building Permit Application
..„„. City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
O Phone:(904)247-5826 Fax:(904)247-5845
Job Address: o0cJC Arwtbero.r-1.. t.v' Permit Number: 9-6V---P-14-0
(q 3.-
LegalDescription 30-bO Il-Zs-2,4 __ .•( 1?a\....s _U141AA Letl 3_4_3_RE1i_al 14\ - 0000
Valuation of Work(Replacement Cost)$ 5,2 51".•O 0 Heated/Cooled SF `lam 5 Non-Heated/Cooled /7,/&
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial (esidential)
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No
• 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: �S Z 1 54(
e wtovw-1 ra es.s-I;j p',,�F:�n� Pe Race .,-/ 3 +•.b 54.;,"3
i-, 44_\.. chc J 1
Florida Product Approval#/0/2'i./a I'.OW3Vea)ei- ti%SS." for multiple products use product approval form
Property Owner Information 11'' N Cv.Jev Ionto
Name: fJuKcy S.SSea- Cw.r145 Ftiworfln Address:A.?) S4 Lucte S+.
City 1`1oy•.4u wQ -..___ State 5 l Zip 32 I do Phone ,386-6.S9– 2"I
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information r�'
Name of Company:Re., Q.►%St\\ Pte:•.j,Tytc- Qualifying Agent: F�j
oaw\iik ' ',...S'S e-\
Address ulcMICt 14 l.& w-)\ Rd. City Ja..)e State Fl.- Zip 32Zo'l
Office Phone 1 I`f- I 41 e"1 Job Site/Contact Number Terry Sc*.,4 i\X
State Certification/Registration#G c c 132. )HM E-Mail Qor euS Stt(Q.ao cc Vn C.X. A r4,vA.<%.c u 1/4,--
Architect
,—Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation [3v:IJets 1.444.•eA. Zw•SIItYou"« Cof wem.N►1 %NCPIo42"t 8('O2. 'i' IZ-31-1-1
Exempt I 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 NOTICE OF COMMENCEMENT.
,,. ;re of Own r r (Signature of contractor}
Si�jned and s.-�orn to(or ffirrn If /rc day of Signed and sworn to(or affirmed)before me this /G day of
/'ill , 7.s l _,by /0.90.4 el S"$4VL ANS 2oLl__,by Riw../4 em ss I(
JJ (Signa otary) [Signe tary)
( I Personally Known OR lorersonally Known OR
[ aced Identificat o:, [ I Produced identification
Type of Identification: pts - _ Type of Identification:
�• miy„lsse Ryan Rennick Eyrick „4:4,,::,1 y Ryan Rennick Eyrick
NOTARY PUBLIC
o<* a< NOTARY PUBLIC
o �.STATE OF FLORIDA
i<"t oESTATE OF FLORIDA
,, •,...... Comm#FF945229 �la+� omm#FF945229
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PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH,FLORIDA
Project Name: 8 6 S ,4 v O.0 Y &(kc- Lv Permit #
Project Address: 809 A.,00./ a t Lr. 11 OA►,-! sac k, f-t 3 2 2-3 3
As required by Florida Statute 553.842 and Florida Administrative Code Rule 9B-72,please provide the information and product approval number(s)
for the building components listed below as applicable to the building construction project for the permit number listed above. You should contact
your product supplier if you do not know the product approval number for any of the applicable listed products. Information regarding statewide
.roduct approval may be obtained at:www.floridabuilding.or
Category/Subcategory I Manufacturer Product Description , Limitation of Use State# Local #
A. EXTERIOR DOORS
1. Swinging
2. Sliding
3. Sectional
•
4.Roll up
5.Automatic
6. Other
B.WINDOWS
1. Single hung
2.Horizontal slider
3. Casement
4.Double hung
5. Fixed
6. Awning
7.Pass-through
8.Projected
9.Mullion
10.Wind breaker
11.Dual action -------- --------------
12. Other
Category/Subcategory Manufacturer Product Description .imitation of Use State# Local#
C.PANEL WALL
1. Siding
2. Soffits
3. EIFS
4. Storefronts
5. Curtain walls
6. Wall louvers
7. Glass block
8. Membrane
9. Greenhouse
10. Synthetic stucco
11. Other
D.ROOFING PRODUCTS
1. Asphalt shingles G"f 3 4-a00 /0/24 . /0
2.Underlayments R-ex Tee k% t k Ft. 8`I 2. 1
3. Roofing fasteners
4.Nonstructural metal roof
5. Built-up roofing
6. Modified bitumen
7. Single ply roofing
8. Roofing tiles
9. Roofing insulation
10. Waterproofing
11. Wood shingles/shakes
12. Roofing slate
13.Liquid applied roofing
14. Cement-adhesive coats
15. Roof tile adhesive
16. Spray applied polyurethane
roof
2. Other
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
H.NEW EXTERIOR
ENVELOPE PRODUCTS
1.
2.
•
In addition to completing the above list of manufacturers, product description and State approval number for the products used on this project, the
Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and installation
instructions along with this Product Approval Sheet.
I certify that this product approval list is true and correct to the best of my knowledge. I further certify that use of different components other than the ones
listed in this document must be approved by the Building Official.
(Contractor Name) (Print Name) p......1 1s5 Q�� (Signature)
Company Name: P.m% (at:s e #-��
Mailing Address: 19 I R-.+t
City: J4N-pc State: FL Zip Code: ?Z to 1
Telephone Number: (5f O y ) -7/y- 1%o"1 Fax Number: ( 70 Y ) 616 -1761
Cell Phone Number: ( ) E-mail Address: 2.'v Qusse U e.--(311
NOTICE OF COMMENCEMENT
PREPARE IN DUPLICATE,
Permit No.R- Tax Folio No.
State of Florida County of Dw•l
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, 3o-6e, l7-23 -21e
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Ld+ fc�33 B1� 3
GpO
Address of property being improved: O O /�Mnb4 ss 'seat ti L✓1
J••v, Fe. 32233
General description of improvements:Reroof _
Owner C k.av 144 14 a ,a s r" e- Nevacy 5: s Q e_
Address /6 F St- Gude S--• +'1 oralAount Frr 37)9 o
Owner's interest in site of the improvement --
Fee Simple Titleholder it other than owner)
Name
Address_,—
Contractor Ron Russell Roofing,Inc.
Address 4419 Hudnall Road,Jacksonville,FL 32207
Phone No.904-714-1907 Fax No.904-636-9909
Surety if any)N/A
Address _--._Amount of bond$
Phone No. Fax No. —
Name and address of arty person making a loan for the construction of the improvements.
Name N/A —Address
Phone No. Fax No_
Name of person within the State of Florida,other than himself.designated by ownerupon whom notices or other
documents may be served:
Name Ron Russell Roofing,Inc
Address 4419 Hudnall Rd.Jacksonville,FL 32207
Phone No.
904-714.1907 Fax No.9°4-636-9909
In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06121(b),Florida Statutes.(Fill in at Owner's option).
Name N/A
Address
Phone No Fax No.
Expiration date of Notice of Commencement(the expiration date is one 11 year from the date of recording unless
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
/y/� /J°, Q A
5afore ms th s day
0,
County of DuvC.J.StatMGs of Florida.�r�ss arPaared
Ay harem
nlnlsele hornet and aa that alt statements and declarations hatain
are run and accurate
Doc#2017273314,OR BK 18202 Page 262,
Number Pages: 1
— :— -- .aunt _�_se►—
Recorded 11/29/2017 12:57 PM,
ONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING $10.00 Ryan Rennick Eyrick
��* ..' - NOTARY PUBLIC
e� STATE OF FLORIDA
rtirity!39.k Comm#FF945229
•
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