410 MAIN ST - ROOF �I rl�1PJ jl Jin.
\�� ' `t. CITY OF ATLANTIC BEACH
1
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: RERF18-0012
Description: SHINGLE ROOF
Estimated Value: 6572
Issue Date: 1/10/2018
Expiration Date: 7/9/2018
PROPERTY ADDRESS:
Address: 410 MAIN ST
RE Number: 170900 0500
PROPERTY OWNER:
Name: WISNIEWSKI DION L
Address: 410 MAIN ST
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: PRIME ROOF CONTRACTING LLC
Address: 13792 HERONS LANDING WAY APT 9 QA MARK ANDREW
YOUNG
JACKSONVILLE, FL 32224
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$7,500.
Sj' l'r,),,,\ Building Permit Application
ti .r„,*,,,
City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
s s. Phone: (904) 247-5826 Fax: (904)247-5845
Job Address: 410 MAIN ST. Permit Number: - ' e,R ' r / — o o t Z
Legal Description 18-34 17-2S-29E .117 ATLANTIC BEACH SEC H LOT 5 BLK 124 RE#
Valuation of Work(Replacement Cost)$ 6,572 Heated/Cooled SF 1119
Non-Heated/Cooled 272
• Class of Work(Circle one): New Addition Iteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s) (Circle one): Commercial C(esidentia1
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No 42)
• 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: Replace asphalt shingle roof
Florida Product Approval#FL10674-R12 (shingles) FL17420-R2 (felt) for multiple products use product approval form
Property Owner Information
Name: DION WISNIEWSKI Address: 410 MAIN ST.
City ATLANTIC BEACH State FL Zip 32233 Phone 904-322-0898
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: Prime Roof Contracting, LLC Qualifying Agent: Mark Young
Address 13725 Beach Blvd Suite 13 City Jacksonville State FL Zip 32224
Office Phone (904) 530-1446 Job Site/Contact Number (904) 860-0230
State Certification/Registration# CCC1329505 E-Mail office@primeroofingfl.com
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation FRSA Self Insurers Fund Inc. 1/1/18 870-040093/3EE6142 _
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
RECORDING YOU' OTICE OF COMMENCEMENT.
/� ` A,(4) p
(Signature of Owner or Agent including Contractor) (Sig t re of Con/.ctor) r
Signed and sworn to(or(or affirmed)before me this 5 day of Signed and sworn to(or ffirmed) a•re rri this? day of
k \ aa,
3G u , 201V ,by •'co �15�{I G,,rg c' JO•At1W`� 7 D I , by 1 Ul/
1/44.....,
. A-it,i a2 ,
(Signature of Notary) (Signature of Notary)
"' '�� ndrew D. Davis
'z?t• Y..UBf. Andrew Davisau�s .,.c:zt•' �--:
'.ic �L COMMISSION#FF160849 _ �ih lam' COMMISSION#FF160849
(.1Personally Known OR ,-�����F• EXPIRES: Sept. 17, 2018 personally Known OR day-.,��, �• EXPIRES: Sept. 17, 2018
( ) �'�y;F WP ,'�`' WWW.AARONNOTARY.COM [ ) %;c" �'�
Produced Identification ,,,,����,,� Produced Identification ii,,,������ WWW.AARONNOTARY.COM
Type of Identification: Type of Identification:
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE) '1 r/
Permit No. Tax Folio No. 11 V"1 0 0- Q co 0
State of Florida 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: 18-34 17-2S-29E.117 ATLANTIC BEACH SEC H LOT 5 BLK 124
410 MAIN ST Atlantic Beach FL 32233
Address of property being improved:
General description of improvements: Re-roof
Owner DION WISNIEWSKI
Address 410 MAIN ST Atlantic Beach FL 32233
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
' Contractor Prime Roof Contracting,LLC
Address 13725 Beach Blvd Suite 13,Jacksonville,FL 32224
Phone No. (904)625-1446 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):
THIS SPACE FOR RECORDER'S USE ONLY NER
Signed: DATE
Before me th day of -r.. in the
County uv ,Sta of Floridas perso Ily appeared
(tom Sri Leh./ herein by
himself,'herself and affirms at all statements and declarations he Andrew
D.
Davis
are true and accurate N
Doc#2018007541,OR BK 18247 Page 1565, :=t• •,;1-
40V.,
Number Pages:1
�, ill �' COMMISSION#FF160849
Recorded 01/10/2018 03:08 PM, .. i7-, .....4
r:c EXPIRES: Sept. 17, 2018
� .
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL ��r,r��, WWW.AARONNOTARY.COM
COUNTY Nota Public at Large.Stat of . County of ,-oto o
RECORDING $10.00 PersonallyMy commission expires:._ _ or
Known �✓/
Produced Identification