70 W 5TH ST - ROOF j' ' y
�� ' }\ CITY OF ATLANTIC BEACH' 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
''o;3iv% INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF18-0050
Description: shingle re-roof- FL10124 FL18686 FL16160.1
Estimated Value: 10095
Issue Date: 2/14/2018
Expiration Date: 8/13/2018
PROPERTY ADDRESS:
Address: 70 W 5TH ST
RE Number: 170822 9600
PROPERTY OWNER:
Name: CHAPPELL SALLY S ET AL
Address: 70 5TH ST W
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: BENTON INTEGRITY ROOFING & WINDOWS
Address: 5570 FLORIDA MINING BLVD S Ste S STE 310
JACKSONVILLE, FL 32257
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$7,500.
,1 J.`<=a�,,� Building Permit Application Updated 12/8/17
,.n
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845 (2 G
Job Address: 40 WLsr4• 5 Sk><`Q.t-} A}►4�}:Catzt:cC.,FI- 'SZ 33 Permit Number: ? L E.I 0 —eczSD
Legal Description 12144 38 -21E •;;-+ loun+t C.Roto r IA SEC kt Ln-a&.tc l(vRE# I'off as —et(¢0O
Valuation of Work(Replacement Cost)$ tO1095. DO Heated/Cooled SF I t 0O Non-Heated/Cooled 1 314
• Class of Work(Circle one): New Addition Alterationepalr Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial •esidenti.
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No kJ
• 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: eC-cook fdxcCs+c cry 8v i trLincis ay,&(a sets, i'l i P
w
Ra www.c .cJ r•t,et.ctc� vcis#rvtc slncne t .,s wi+l� Ptw4tir +Crx►o vrli3n� 44D arch. shir1L,e r +tr4.ata.uv tuna n.f.
Our►c>♦+ lor+� w1 c.2t+levsi-ex,irlS tl O ricaciet..vtta*S
Florida Product Approval#FL 1O 4, Ft.MO*4 FL t(e1.e o.t for multiple products use product approval form
Property Owner Information
' j '�`� vtn+(t io,,,
Name: Coi Address: 40 WLsi*• 5+' S4444.0-
City R+to.►n+c State R.- Zip 3'22,33 Phone (35a) a%10
E-Mail ---
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company:'atxrtor% in- i Rove:ncq�- Qualifying Agent: Sohn Mori-War-1
S51-0Flbrcola Mcltnin L3(v'J. S• Ss,i,Ft#31O City -Sow(CSpriviILe_ State FL Zip -32•P
Office Phone l°tb41 arma-�C43 Job Site/Contact Number Mia:. Saler Cal ou)S14i- 3Cvc.{�-
State Certification/Registration# CC.C.138,9ii48 E-Mail s's#e s.c-owe
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation J-- K Sed -T,n51nc`ec-)Fthrld �s'to—O3354-1a / EC to ILi2 bI/D1/2.817$
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 tothe requirements of this
permit,there may be add3#lonal r cho33s applicable*.fa, *as.. frropel ty that may be found the public records of this county]and
there be dditI fnaiper s seguh ed mother gnuemmerrta1• nt hies such vvateunanagem districts,state agencies,or
federal gtrtctes=
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 Y,OUR NOTICE OF COMMENCEMENT. / ,
C 1 .._ ors
lgnature of Owner or Agent) Signa ure ntractor)
(including contractor) - �_
Signed and sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed)before me this 8 day of
2O I S,by 6 - - l S FiLbn.iru , 2.bIR,by • a • •SI.
. ..... ice.. _ - .At /I��i�7fT•'
��• ature oRRYPiM ( i: a ur- • O
Notary Public-State of Florida• KWYSTAL K SALM
[ )Personally Known OR t;' F Ccmmssion4FF918403 [personally Known OR notaryPubic-Stated Ronda
••.;?;;,1 M Corm.Expires Sep 15.2019
[vy15roduced Identification y [ )Produced Identification Commission FF 918403
Type of Identification: t►2•Ilti►u'API•latltla t- •-• Type of Identification: My Comm.Expires Sep 15,2019
Doc # 2018034389, OR BK 18281 Page 1270, Number Pages : 1 ,
Recorded 02/13/2018 08 :34 AM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10. 00
I NOTICE OF COMMENCEMENT
}or
State of fl4d. Tax Folio No. 1 bet)?"A-1(PDO
County of 2) vat
To Whole It May Concern
The undersigned hereby infonus you that improvements will be made to certain real property,and in accordance with Section 713 of
The Florid2Statutes,lila following information is stated in this NOTICE OF COMMENCEMENT".
Legal Desaiption ofpropertybeingimproved:-1,1_ 3LI 353-AS-'ay E , t I -
p+loxtl;L 'Ho-aan t-j Loi a 7304 —_
Address of property being-unproved: 'gyp nuns+ 5444 ee" act, Fc 32233
General dexrfptioc of improvements: Q e -t-t,,F i5-K ncc 13v i l o(,i eek
Owner. Casom Quos 4 Address: ' to s4-5444 S'eIt..+,)q�tn nti c tat P� f'L 3 7,33
Owner's interest incite of the improvement R.s --
Fee Simple Titleholder.(if tee than owner):
Name:
Contractor geh rY 143 Ori 1 oFin3 And W.inein ws
Address: S.57 Flnvita M nt- Sled.S.,Ste 310; JacksbMvlile, FL 322_57
Telephone No.:6100 2102-77a(,S Fax (Th 4) 2(00-1355
Surety(if any)
Address: Amount of Bond S
Telephone No: Fax No:
Name and address of any person making a loan for the construction ofthe improvements
Nance:
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:
Telephone No: - Fax No: __--
In addition to Iiimsel£ owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),.Florida Statues. (Fill jn id Owner's option)
Name:
Address:
Telephone Sao Fax No: w
Expiration data of Notice-of Commencement{the expiration date is one(1)year from the date of recording unless a different date is
spam):
THIS SPACE FOR RECORDER'S USE ONLY OWNER -
Signed: _✓
)1s(//8-
D
Before me ibis," ,_121' of - in oyc Coumv of Duval,Ssscc
OFFlorida,has perarally gym* 11C81/4'
Notary Public at Large,Sure f Flo Co f Duval.
My commnisstoo ezpmu
Personally Known: or
Produccd:Idcatifeadore FL bk. p23b-11 D-€4-
KAYSU:KtAtM
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