1140 OCEAN BLVD - ROOF 4' ' - CITY OF ATLANTIC BEACH
r 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
"!013 �' INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF18-0007
Description: SHINGLE ROOF
Estimated Value: 9399
Issue Date: 1/5/2018
Expiration Date: 7/4/2018
PROPERTY ADDRESS:
Address: 1140 OCEAN BLVD
RE Number: 170286 0000
PROPERTY OWNER:
Name: BUSH CARL F
Address: 1140 OCEAN BV
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: PREFERRED ROOFING LLC
Address: 2332 DUNN AVE QA ROLAND KEVIN GREEN
JACKSONVILLE, FL 32218
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$7,500.
t r,,-1 Building Permit Application Updated 12/8/17
V `jj City of Atlantic Beach
--- 800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845 (�
Job Address: 1140 Ocean 1310 • Permit Number: P C-R`I-(j( n 0O7
Legal Description(D'I HI-2h-2QeA-1/1 anti EO G L4) w 3 a41 RE# 11 02,Q6(7- 0000
nn
Valuation of Work(Replacement Cost)$ "I . (405 Heated/Cooled SF I (p CaCI Non-Heated/Cooled 1 CR0 2-
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial 411;- . .
• 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:
foo 21i%
1 Cow Pt-fch
Florida Product Approval# n.,...10 1914 I I k/- I b 4,24,•-R/fpr multiple products use product approval form
Proper Owner Information
r ,,
Name: • r` S\r l Address: 1 0 c• .,A tik
City Ls / • li III•i1 __Ail State Zip 32,9- ,7, phone -r - -?
E-Mail C, bJgh : .O.. 10,1"06 _cow
Owner or Agent(If Agent, Powf Attorney or Agency Letter Required) COLf I °6\e"\
Contractor Information ,� - '/
Name of Company: ( 1 'C`-v SQA &x1 � Quali ing A ent: a K. I/ ,-. A
Address[nLAO .J..Q City ' State at Zip S. v
Office Phone Z 014-'LS-1 -O, ��[j9 Job Site/Contact Number -.--/S-- -O%LI •
State Certification/Registration# C� t-1.- Au E-Mail M`jUk•2v raer1rd ou?.)JI Z_
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation
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. NOTICE:In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and
there may be additional permits required from other governmental entities such as water management districts,state agencies,or
federal agencies.
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.
2cesuzd43...,,,;(--_-____, if
Aro 441".. ...ilel
(Signature of Owner or Agent)g g ) (Signature of Contractor)
(including contractor) r
Si: ed and sworn
to``(or affirmed)befor- e this vJ day of Signed and sworn to or affir -d)before me this 5 day of
• colF1 , 'Y 4 • r , r�6 , 'Y .r, _ . • L.', to .lo
s v w
=off"YP% Notary Public State of FI.'.�J .�j ,•i Al //�,
Meagan Wolfla • iv' <- / My Commission FF 962 45 (Signature of Nota (Signature of N't.i,
y'�oc'FLo Expires 02/18/2020
"*Po NotaryPublic State of Florida
A)ersonally Known OR io`p °tee Meagan Wolfla
Produced Identificati / t [ ]Produced Identification My Commission FF 962745
Type of Identification: ,)1 I 05 Licence_ Type of dentification: '°„ / Expires 02/18/2020
— - - -
Doc # 2017295993, OR BK 18233 Page 2435 , Number Pages : 1 ,
Recorded 12/28/2017 09: 03 AM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10 . 00
NOTICE OF COMMENCEMENT
.FREP,,RC IW OUPL1CA.TCi
Pemtit No 1_ Tax Fo'io No , O r 6(4 MOO
- —
Slate 01 County cf
To whore it may concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statures,the following information Is stated in this NOTICE OF
COMMENCEMENT. tr
Legal description of property being improved
_
Address of croperty being Improved :p
General descripl on 01:marovemsnts V.eY'O-c-
Address iL G A.A Ys. • *11• 'L_L ( fta_322J
Osner•s interest in site of the improvement wor?erlt.i O(,,irvej
Fee Simple Titleholder Of other than co:nert
Name
Address
Contractors
Address 0,, _L Y
Phone No -15- r-013(4 o Fax No 745--i '--Ca )
Surety;t?any?
Address _Amount of bond$
Phage No Fax No,
Name and address of any person making a loan for the oanstn..etion of the improvements
Name
Address
=hone No Fax Na
--
Name cf person within the State of Florida.other thar himself.designated by owner upon.illom•iooces or other
documents may be served
PJame—,
Adores ....
Phone No --. . - - Fax Na.
In adotuon:o himself.owner designates the following person to recowe a Copy Of:he Lienors Notice as pro:idod in
Section 713.36 r 2,lb) Florida Statutes (I i:I in at Owner's option
Name
Ttldress
none No Fax No --_
Expiration date of Noece cf Commencement ithc explratttrt date is one(ii year horn the date of recording,,nless a
different nate is speciliedt
-
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THIS SPACE FOR RECORDER'S USE ONLY IWNE ai�dr�
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