124 CAMELIA ST RERF18-0052 Shingle , t# s,
CITY OF ATLANTIC BEACH
Ss5
0 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
,'�!a,ii9% INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF18-0052
Description: shingle re-roof- FL10674.1 & FL15216.1
Estimated Value: 10800
Issue Date: 2/22/2018
Expiration Date: 8/21/2018
PROPERTY ADDRESS:
Address: 124 CAMELIA ST
RE Number: 170847 0010
PROPERTY OWNER:
Name: BURRIS KELLY
Address: 124 CAMELIA ST
ATLANTIC BEACH, FL 32233-2518
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
,
Phone:
Name: RMX Construction
Address: 10752 Deerwood Park Blvd #100
Jacksonville, fl 32256
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.
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.
* 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 Updated 12/8/17
City of Atlantic Beach
\ :;,;,,.f 800 Seminole Road,Atlantic Beach,FL 32233
St-. �
Phone:(904)247-5826 Fax:(904)247-5845
Job Address:I1.4 ClaiftI It O.. �i/t(ilt1 I1L Be.adn F 12213 Permit Number: 14,5,E.P)c -- O°55ON
Legal DescriptionTeed O { IQ,-(�( t 1 & coMikeaval atonal+ RE#
Valuation of Work(Replacement Cost)$101766 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration 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 N/A
• Submit a Tree Removal Permit Application if any trees are to be removed� or Affidavit of No Tree Removals
Describe in detail the type of work to be performed:Teat Ott IC -coo( vi s ore S O(CY11}ccwrial
aSPhult Sh► Atte S CL I 0(01 y.1
Florida Product Approval# 1004.1 FL 15 21S. I for multiple products use product approval form
Property Owner Information
Nam II(y1 � t U« L( ►S `i Address: I '
City �L State fit_ Zip 31 PhoneQ44`3b3-item
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information y. J �• o..�e
Name of Company: 7N1 X COh4.t( l Oh Qualifying Agent: eC7a�i'Q'V I,�
Address101 S1.DCC(11uOdd%% Y. it 0106 Citys\O.(�KSON Mt State FL Zip k7 Z (LJ
Office Phone IS S"-110 9-(01. 1 Job Site/Co tact/A�umber
State Certification/Registration#C(L13 I b?S'f E-Mail 1i10 conStro G-t ibV\.COwM
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation S'Linn Inso((Wk. e0a/
Exem /insur /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
RECORDIN Y R N ICE OF COMMENCEMENT.
( ignature of Owner or Agent) (Signature of Contract
(including contractor)
Si d and sworn to(or affirmed)before e this/‘ day of Signed and sworn to(or affirmed b- •re m)klis/L da f a� _-`-
2011 ,by : __ Fek a'r_ �!P by .4
ure of Notary) u.a of N• a .
az.�«& .,:, . ...
,`; . '°N''- LORA KNOPF •
[ ersonally Known O' e,., LORA KNOPF [ ersonally Known OR = � ` 1 ` _ Notary Public -State of Florida
���` Notary Public- State of Florida [ ]Produced Identificatio iaii v
[ ]Produced Identificat �ti. • ,�
Type of Identification: ru • Co to .. Type of Identification: Commission # FF 947226
;-r , • •, •• g• 119
,;,:0 F;op�'� My Comm. Expires Dec 30,2019
Doc # 2018007726, OR BK 18247 Page 2081 , Number Pages : 1 ,
Recorded 01/11/2018 08 : 14 AM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10 . 00
AI'f Lll Mli lIM111M1 MU'AN[IL
115101 Mllnel.FI
1ISSUILI_QESIMMENCEEZEI
the undersigned hereby loves brake that Improvement will he made to certain real propa►Y.and in accadrloe with CIWpla 713.
Honda M■wtn,the futlow.ng nfotmatwn is provided is this Name ofCommaxaoera.
I Mild'RI►rN,Nda,r9UN[ary ltalatlh.applwn aft pis gvq aa(pwMoo address. lbLI
if TAX(OO Na:/1d2, iL.b)0
Mi1(11VIVmiSi17C, Are A.AC p.00X (/ / T,c-r ,or SMOG LINIT��-
_.._..._...____ _Ltv? /It+Cl,:4r /�'T�Ax�fit_ 1Ar
, v2,233
:.1,1115.01A1.
AI.11•211'1111710114 ur 11411NJV.J4 L.Jrrr p7
Taw Oil Rc•Rool
1p 1 NWNaa I..rnaMAT1o,.OR(iLrr IN,UNMATN)Pl 11 nos LLS&&MISTS&QM IOR7NISIMeROV11:141Wf: - )7
it ,n..,.w aI.Y...Xel/y B�I I,/�ili �� �.W►s•C
y t.boa•le in pagan, 100%
tett .._.. ._..._.._.
N......d.t.ae.a d he ar¢a wl•lad e6f.anw.a beta 1).w Imo!Anal ---_.
r a tTIN1TUIna•NNAMF.I RMX Construction.Jeanne Gazlay
sl
it ...a ..as... 10752 Deerwood Perk Blvd.1100 Jacksonville•FL 32256 k nan...nv.r 855-769.6262
i MlaliTn„(.Iat. U.a clay et,/,.slam•La.d..ta..Wl
a NWT! W.ae
• b Ma*wiser tett-c Amain•(Mani a
a a Li NUcUrMAMap
I...Ws aJJwe
tett..._tett tett............ ....._.... _ _.. _..-_�
7. Pawns within doe State of ride deplrlaled by Owns upon rim noli=Q of tabu doc umapu may be raved as provided by
Section 713.17(I)(07..Fl(nda Staaas•
.New Nal
i a
Ma*...Rant a&wo ded MOW..
It a In aldi6m to himeelfew herself.Omar designates or
s lu
receive a copy of the 1.1cnur's Nol.oe as provided 1n Seaton 711 13(11(b),Florida Mares
A Mw.....i.m nr imam..war,Jaw...!by flame
Y Lispaati n date anal=aleeanrnrneanerr(the eppintion date will be I yea(hon the date afrecording mlma dire!MI ane is
specilla()----.20�
meati a(()te) j ui It ANY viaiAtfameDiary IIIf:Oyl71$AFIFR ilIEI XPLRAT)QN Of TILE NOT E OF COM1NFNCEMENT
ML .•. ..' .t ' .I • a . •. I... 1 . T•tt
)(1 h LIMN Y 1. .. t I: Y. . ..0 a...., I
mama)I.N(11.R()RAN.AIT(MNFY ILLIORECUcat1-►Ctritlaknik O$BhO1)RIMM Yalp.. f)71(•1:S)F(YJMM NCFM(-NT
- -- —
(lalaatrer*IC r r to I?tAI name.rd Protide SF11ulary•a Ti1Tr/U1fea)
uAuthorised C) r4Mrettar/Pori aer/Maaaper)
Stec of
AOr• _-
('tardy of
Ltik.fe for wino insoummlraenoalcdeed before Inc this (Myer !7e e e My1_ ,fl ! 7
51t — a1
m' e r-� ------ ---
apemen) (type of ty. .e a officer,trtmee.attorney in fsci)
I.r be Li__-_--------..
• (none. sylelheriafof%hmnsuanenlwas esec West l.
IYtvrlallY Kamm (r Itodac,l IdmuOcatrn_.� 'f 1'�
. Type Produced ���.,.1,_ D, „:•.„
. f.:rr.•s4
a.Are Pet STON&HILLER
i — i.1 Commission t GG 15199)
of at(scam.
T (scam.• Notary Public) \rr '!Esker amt 16.202(
fY lye.n Swop Commissioned Name of .P lit)� T
apyFai brume 01
•' N.. In%,.l.
`...-.. .�•- -.. . •• ".'. 'ati/4';T7'r!&•S;TZ.'n.....-.v:�•• :,t r7 r..r.-•.... ....-..
Scanned by CamScanner