1915 CREEKSIDE CIR - ROOF iS ri \J
' CITY OF ATLANTIC BEACH
r- �� 800 SEMINOLE ROAD
�� �� ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0146
Description: RE ROOF SHINGLE
Estimated Value: 8395
Issue Date:
Expiration Date:
PROPERTY ADDRESS:
Address: 1915 CREEKSIDE CIR
RE Number: 172020 1216
PROPERTY OWNER:
Name: MADDY JERALD D
Address: 1915 CREEKSIDE CIR
ATLANTIC BEACH, FL 32233-4505
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: JA Edwards of America Inc
Address: 7058 Stapoint Ct
Winter Park, Fl 32792
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$7,500.
Building Permit Application
City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
Phone: (904) 247-582.6 Fax: (904)247-5845
Ack Pi 5-x-- 3
Job Address: �� 15 C - c k s 14e r 104:: Permit Number: ER1- ( 7--( J (4
Legal Description `3v w Mpy r- m A U0
`- 0- LOT 1 RE#
Valuation of Work(Replacement Cost)$ $,3 9 5 , 63 Heated/Cooled SF Non-Heated/Cooled_
• Class of Work(Circle one): New Addition Alteration Repair Move mo 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 (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: C.pt.tipl.e}4' ,.- GA r AspihAL'U 5h..79 le
305 A \71 C. set, Pr & _
Florida Product Approval# O 1 ` . 4 • Z 19 Q ( r-p thcrlinc, for multiple products use product approval form
Property Owner Information )52.. 1 Z- _�'}�►Jrt ap /cz-h to"-
Name: ..)CA" PLS VVHOOk.1 Address: l9 1 S Crec\ side Ct r
City Airces �t:C�+e9+C� J State F\ Zip 31233 Phone 9'04 . Z4R . S'G.
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: JA EO,cPaOS QP Am(c,c -Toc Qualifying Agent: ('-rt-cpcxr LP%�GhObe-r
Address 1 51 City 1/4.0i4esr QAc\L State F\ Zip 132_."14
Office Phone 401 , (,11 • "7(4Cv3 Job Site/Contact Number 117. 349• 30)3
State Certification/Registration# Cle 0 5 7 5 2k E-Mail pc 'c.e fa r�C-c1 ca. Cort
Architect Name&Phone#
Engineer's Name& Phone#
Workers Compensation tJ /c►Mt;c ,c.q %..oro•per uO lar.. 'rims / 1.1 / q /q /2 o i
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
RECORDINGyeUNOTICE OF COMMENCEMENT. /•
(Signatu e of Owner or Agent including •r ractor) (Signature of Contractor)
Signed and sworn - • . irm-• • • -_• - # say a ':ned and sworn to(or affirmed before me this 1'2,day of
v C� by - s tMA4{J1 • T , ZD , by '
-'111111111.1- II- 111111111111111,-- _
(Signature of Notary) (Signature of Notary)
1t"Pus PETER JAMES ARCOMONE =° '"PSPASu6e% PETER JAMES ARC OMONE
< MY COMMISSION q GG 035010
* �_ . MY COMMISSION a GG 035010
.'.•..9,7 EXPIRES:October 2,2020 *0_,4,,-;
N #. EXPIRES:October 2,2020
[ )Personally Known OR "� o' BondcdTNd
u& g*Notary So ' ' ersonally Known OR q,�u�u. �
OF�� Fpr HyoFBonded Thru audget Notary Services
I Produced Identification [ )Produced Identification
Type of Identification: 51..(..)RA oA17(_ Type of Identification:
Doc # 2017214344, OR BK 18122 Page 1185, Number Pages: 1, Recorded
09/20/2017 at 01:30 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. 3L -41- C9 -ZS -21C
State of Flom 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: 1 9 f S C R I°r-tt 1 Oe Cr,t_- Af1A1 e geAct1
St. -(oS o4 -2 S -294 E4 32233
SaWA MA+ZinQ• unit LOT -7
Address of property being Improved: (9 t S rracek3 t of Cr
ProorterZeito pr s g-a.�'S
General description of improvements:Re Roof
Owner it rALaO 1�IAot
Address 19'15 tit ce,k%rite dpi itATIAL.YrieBeActE, F1 322.3 3
Owner's Interest In site of the Improvement 64.1r... 4...1
Fee Simple Titleholder(dotter than owner)
Name
Address
Contractor JA Edwards of America,Inc.
Address 7058 Stapoint Ct.Winter Park Fl.32792
Phone rye.407 077.7663 Fax No.407.677.7664
Surety(if any)
Address Amount of bond
Phone No. Fax No.
Name end 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 Llerror•a Notice as provided in
Section 713.08(2)(b),Florida Statutes.(ill Inst Owners option). •
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration date S one(1)year Worn the date of recording unless a
different date Is specIfled):
THIS SPACE FOR RECORDER'S USE ONLY 4.1
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