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1925 W SELVILLA BLVD - ROOF .-? ,._,,, rt ' \'\ CITY OF ATLANTIC BEACH iso , "'\. . , ? 800 SEMINOLE ROAD .�� ATLANTIC BEACH, FL 32233 �o.219 INSPECTION PHONE LINE 247-5814 REROOF SHINGLE - MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: RERF18-0057 Description: shingle re-roof- FL10674-R12 & FL17420-R2 Estimated Value: 14083 Issue Date: 2/28/2018 Expiration Date: 8/27/2018 PROPERTY ADDRESS: Address: 1925 W SEVILLA BLVD RE Number: 169462 0165 PROPERTY OWNER: Name: GROFF HARRY J Address: 1925 SEVILLA BLVD W ATLANTIC BEACH, FL 32233-4578 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. 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 City of Atlantic Beach 800 Seminole Road, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Fax: (904) 247-5845 Q U-1 5{ ._ DOS �. Job Address: 1925 Sevilla Blvd W Permit Number: $14,083 Legal Description 45-6 08-2S-29E SEVILLA GARDENS UNIT 01 LOT 12 RE# 169462-0165 Valuation of Work(Replacement Cost) 1/j 003.O Heated/Cooled SF 2397 Non-Heated/Cooled 2994 • Class of Work(Circle one): New Addition Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s) (Circle one): Commercial gesidentia • If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No el • 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: Harry J Groff Address: 1529 Sevilla Blvd W City Atlantic Beach State FL Zip 32233 Phone (904)333-1078 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, CONSI,ILT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR,19-0 CE COMMENCEMENT. /a(Signature of Owner or Agent including Contractor) ignature ontractor) Sind and sworn to or affirmed before me this day of Sind and sworn to(or affir efo e me this ay of Zoll( , byIf _ ,d— by �� Yew 44 itw (Signature of Notary) (Signature of Notary) ,,,,,,,,' ,,,, Andrew D. Davis �Pe -f% `oQ,sP :�.'?!!e��" Andrew D. Davis COMMISSION#FF160849 / a. S ['Personally Known OR = °� : EXPIRES: •Sept. 17, 2018 [�l Personally Known OR _ �T x_ COMMISSION#FF160849 [ ]Produced Identification "%,iF * WWW.AARONNOTARY.COM I I Produced Identification -10. ;• EXPIRES: Sept. 17, 2018 �� Type of Identification: """"� Type of Identification: ''� ,��'\`` WWW.AARONNNTARY.COM NOTICE OF COMMENCEMENT (PREPARE IN DUPLICATE) Permit No. Tax Folio No. 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:45-G 08-2S-29E SEVILLA GARDENS UNIT 01 LOT 12 Address of property being improved: 1925 Sevilla Blvd W,Atlantic Beach,FL 32233 General description of improvements: Re-roof Owner Harry J Groff Address 1925 Sevilla Blvd W,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 f 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 ' - ER Signed: DATE Before me this leg day of 4� in the Cou. of Duval,St of F ,has personal! appeared 11 ^�� fit, ��Y IV Doc#20180475570 RK 1 7 ��\,�,' by H U D OR_.. 829. Page 2204 Number Pages: 1 hims f,'hers and affirms that al;statements and declare =:iRl�� g are true and accurate ;�' /M► '�= COMMISSION FF160849 Recorded 02/28/2018 01:50 PM, _ EXPIRES: Sept. 17, 2018 BONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY % Ftio?;.' WWW.AAAONNOTARY.COM "nano• RECORDING $10.00 � / T� . ry P lic at Large.Stat of County of WI%1 My commission expires: Personally Known r✓ or Produced Identification