353 5TH ST - ROOF d , s, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J yr ATLANTIC BEACH, FL 32233
e.3 . INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF18-0008
Description: shingle re-roof- FL10124-R15 & FL18686-R1
Estimated Value: 6500
Issue Date: 1/9/2018
Expiration Date: 7/8/2018
PROPERTY ADDRESS:
Address: 353 5TH ST
RE Number: 169868 0000
PROPERTY OWNER:
Name: HORTON JOHN W
Address: 353 5TH ST
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
,
Phone:
Name: RELIANT ROOFING INC
Address: 822 N. A1A Highway Suite 310
Ponte Vedra Beach, FL 32082
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$7,500.
' 4 . ' Building Permit Application Updated 12/8/17
r, City of Atlantic Beach
is , 800 Seminole Road,Atlantic Beach,FL 32233
[� �,, p Phone:(904)247-5826 Fax:(904)247-5845
Job Address: 3 -5.3 `J�_� l S�• Permit Number: P F—FIF-b
OOF
gDescription �—cici i G— 9 /w V''') w�/a1,otaa 8 Odb
Legal {��-a 1 E f �1 �, U ,�thrzy &KI RE# i rp q - �]°
Valuation of Work(Replacement Cost)$ 6 e c •00 Heated/Cooled SF lG(4 Non-Heated/Cooled•,a -I 7
• Class of Work(Circle one): New Addition (Alteratio)Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial (Residential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No (JV/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: r e_ ro o-e Ski inn f S -- FL- tot-2.4- r2 i5
U war laymeni-
4 FL_ - 186,86 -- gL a sols - 311a 17i-fch
Florida Product Approval# F - (] 1 5 - ;.,p - _t_for multiple products use product approval form
Property Owner Information X —t l� ��- !�a
Name: ���n C HOY�.�+LJ• Address: -3 53 S 1 1 1 �7 t ' a 3w
City P State 32233 Phone $05 — yq8 p
E-Mail CI. j b)e ORM att. Lon-)
Owner or en (If Agent,rower of Attorney or Agency Letter Required)
Contractor Information ,�(� /y Y�r �
Name of mpany: •' S •0V'C tr• Qualifying Agent: ('1 t e b11nefouc"C
Address 2, A ga�1'•10-tr,y ' '�I O City an' :• f State L Zip
Office Phone D`1- ti2Si — b4 ri t! Job Site/Contact Number ail{"1 1 Z 'Z)I(
State Certification/Registration#,:LC 133 n 421 S•-__.E-Mall) nnollesI-e1 1 on+Yb off nt3.(�)
Architect Name&Phone 4 �J
Engineer's Name&Phone 4
Workers Compensation Q QAt(.,'4 c k, Exempt/Insurer/Lease B glues/Expirationex DateCS 1"R ) 31 / 16
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.
PIA- ljetA7 —Ignature of Owner or Agent) (51 atu Contractor)
(including contractor) O
Signed and sworn to(or affirmed)before me this () day of Signed and sworn to(or affirmed)before me this b day of
-3-0.nuaf l . 201 $by SOhh 00r;f-tae' Sar114ry , 2018,by III>E�MA 711kt,*,s!,
' (Signatu • of Not. '(Signatur: ' otary/
Personally Known O' Personally Known OR
I ] ,> .roduced Identificat'• .;1n° JULIANA PANTOJA [ I Produced Identification . "1''0, JULIANA PANTOJA
Type of Identification; State of Florida-Notar Public N =State of Florida-Notary Public
�',♦ y Type of Identification: ,` :� -
%'71 , .,c " ' " =:�' ' My�Commisaion Expires
V4)311,, ,:‘' My Commission Expires !?;,,,',�` �� October 16,2021
October 16,2021
Doc # 2017289635, OR BK 18224 Page 2327 , Number Pages : 1 ,
Recorded 12/19/2017 08 :42 AM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10 . 00
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. _
State of 1--L. County of (At_
To whom It may concern:
The undersigned hereby Informs you that Improvements will be made to certain real property,and In
accordance with Section 713 of the Florida Statutes,the following Information is stated In this NOTICE OF
COMMENCEMENT.
Legaldescrrpt on of roperty eing Improved: — f
} 01411C. c C ti1 W4 /7 .o 2-1 L_ot 7 ../ -3_1(
Address of properly barn. Improved ¶r f
General description of Improvements. e 1
OwnerTDhfl ' r-3—044
Address 35341totAr)KIL.Smen
n�h c, "Beach, FL 3 2 3-3
Owner's interest in site of the Improvement,_
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Reliant Roofing
Address 822 N.MA Highway Suite 310 Ponle Vedra Beach FL 32082
Phone No.(9a4)-657'°88° Fax No.
Surety(if any)
Address Amount of bond$
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): l owsrgnee by:
THIS SPACE FOR RECORDER'S USE ONLY
'bit, kkcv{Ok. OWNER
SIgned. OATS Z 15/2017
Beton TO •^„$�ti2Sivi h the
County of r s1 Stats..r,M him psmonofly amend ,.. .�� _.
Nm . erwtland
ernmw allsralemenL �:-^-•• afef'1�ULIAN PANTOJA
era a •aoarale , co'*t.cQ`t,';Steto o'• Florida-Wary PublC
`:i•? Commission M GG 15:886
My Commission Expires
I '",;.•!:',0''* October 18,202'
• ."'ventslarye.5 .a' —• • 01'r"rA1
My commission s pk
Personalty Known or
Produced IdenIrrr _ _