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254 OCEAN BLVD -ROOF r0L,i_vt. ,\ s1 CITY OF ATLANTIC BEACH �' A 800 SEMINOLE ROAD ,_, v~ ATLANTIC BEACH, FL 32233 '"!0;319%' INSPECTION PHONE LINE 247-5814 REROOF SHINGLE - MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: RERF18-0001 Description: shingle re-roof- FL10124-R19 & FL15487-R5 Estimated Value: 8300 Issue Date: 1/2/2018 Expiration Date: 7/1/2018 PROPERTY ADDRESS: Address: 254 OCEAN BLVD RE Number: 170199 0000 PROPERTY OWNER: Name: WILEY ELLEN M Address: 254 OCEAN BV ATLANTIC BEACH, FL 32233-5226 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: SCHULTZ ROOFING COMPANY INC Address: 216 N 20TH ST 216 N. 20TH STREET JACKSONVILLE BEACH, FL 32250 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$7,500. #''',,,,,, Building Permit Application } City of Atlantic Beach 800 Seminole Road,Atlantic Beach, FL 32233 vu s).'" %� Phone: (904) 247-5826-/ Fax: (904) 247-5845 I Q Job Address: 5 / Oce a. Y ) 6 1(/c • P rmit N mb r�: b ` °`oOO/ Legal Description 5 g / c - oC s - a ! E. fit-lot-711C_- RE# jO f 9 9 - VO 0 Valuation of Work(Replacement Cost)$ Ol3OO•o-a Heated/Cooled SF Non-Heated/Cooled Qa Rc1 • Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door Re- le oo-F • Use of existing/proposed structure(s)(Circle one): CommercialResidential • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No /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 wor to be performed: _5h i n51 ke -foo f t �1��.,,FJJc /�s-33 GA-F T;.r,6erI,ne CL4...,�fa UHr (.Grader'/aymen7f Ci"fa. ' llar/�G R/s, Florida Product Approval# 10/..1 9-gig Lo w rv,*f . Sys7-AS-for multiple products use product approvaforn' Property Owner Information Name: <r/ erg . LL)) I'e.y Address: QS-LI OCea-in 1 JUc City A.. . 4 tate E Zip 32 2.3 3 Phone 90 5/^ Q./Co • '778 g E-Mail em- - LAJ l `e © bP /I/so tJ i. `- 1- Owner or Agent(If Agent,Powe,�f Attorney or Agency Letter Required) Contractor Information / -7�-Ln / Name of Company: sr�ct �OO rJ 6 ../'�7 • c Qualifying Agent: boC45/4's Ja4c, ,f 2_ a./( Address o Al �O'— �)0 , City ,7,9-X /3CA State F=( Zip 122$1) Office Phone /0'1^..)_V(Q - 3/ ,_ Job Site/Contact Number 0 - ' - I i State Certification/Registration# C.0 C. 03 6 7g, E-Mail SCA rod le a.31S- )/,21,0e , Architect Name&Phnne# Engineer's Name&Phone._ Workers Compensation_S 2_ TALL/tan c•t co/vf.ohS L-LC la t0/ . - Ai 3'20,3 : , Exempt/Insurer/Lease c”.ployees/Ex irati. 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 COMMENCE OwnN� e•C -��-e_ C (Signature of Owner or Agent including Contractor) -r-�'(STgnafure of Contractor) Si n d and sworn to(or affirmed)before me\thi 'Y day of Sign9d and sworn to(or affirmed)before me thi�.9 day of . 90 /1 ,by j ) l�-v, w i1t1 PU sz/7 ,by o& c se.A - - dr _ • - •�- fir 1115 7 5-Z 02 (Signature of Notary) (Signature of Notary) glirif,~ ROBIN C MOORE • . MY COMMISSION 0 FF246774 .44:'x,°"" ROBIN C MOORE fr [ ]Personally Known c -�•, VPersonally Known O r` ;Y: MY COMMISSION a FF2457710 �, -r, i EXPIRES Juni 30,2019 ,� s; (Produced Identifi� .0 None.Naw�6•raetco, . I [ j Produced Identifica d�d�a `; : EXPIRES June 30,2019 Type of Identification •• Type of Identification:. ooh 3 8 c+53 F,n.,.,,�.,,,,r,..,�_. • Di— NOTICE OF COMMENCEMENT State of ��rj Tax Folio No. County of t q/ 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: 5- ea 9 / Co -a S - a 9 C_ 19--I-ICtr, Address of property being improved: o 5 y .n, e Q n /3 /V d • 44--/ . l3 C h - 2 3 3 General description of improvements: Owner: &// V) . (A.) I-Q�/ Address: R 5 y Oct-ea-r1 /3 k'o Owner's interest in site of the improvement: / 4� -e_ rn >e.__ Fee Simple Titleholder(if other than owner): Name: Of Contractor: s � f2, !pp Cp . �h c . �""� Address: /(' / / �c _/O� cksanv !e ace P9/4 Telephone No.: 9o'I d 1L7 3z�S� Fax No: 9 O(f - a Y 7- ,3 g O F Surety(if any) Address: Amount of Bond$ Telephone 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: Telephone 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 Statues. (Fill in at Owner's option) Name: Address: Telephone 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 OWNER Sign a 4 I - Date: i t(29/t 7 Befor • e his day of in the County of Dii, . , e Doc#2017288938,OR BK 18224 Page 39, l , Number Pages:1 Of Florida,has personally appeared r ' , : Recorded 12/18/2017 12:06 PM, Notary Public at Large,State of Flori(i(,•1C �j�ty C MOOR ••• RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL My commission expires: MT �MMISSION I FF2s5771 COUNTY Personally Known: ' ; . • ExF tttb June 30,201- or RECORDING $10.00 Produced Identification VVI —z/ 3 --53 -- 87,3 -d