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1520 RICHARDS LN - ROOF ,. � iCITY OF ATLANTIC BEACH ~ - f 800 SEMINOLE ROAD \ �� ATLANTIC BEACH, FL 32233 �;3�s)%' INSPECTION PHONE LINE 247-5814 REROOF SHINGLE - MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: RERF18-0051 Description: re-roof shingle- FL10674-R12 & FL17420-R2 Estimated Value: 6533 Issue Date: 2/16/2018 Expiration Date: 8/15/2018 PROPERTY ADDRESS: Address: 1520 RICHARDSON LN RE Number: 172180 0100 PROPERTY OWNER: Name: SOLOMON ROSA MAE Address: 1520 RICHARDSON LN ATLANTIC BEACH, FL 32233-4331 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$7,500. t %:i1... Building Permit Application 04 s City of Atlantic Beach 800 Seminole Road,Atlantic Beach, FL 32233 `Dft'/ Phone: (904) 247-5826 Fax: (904)247-5845 Job Address: 1520 RICHARDSON LN Atlantic Beach FL 32233 Permit Number: 12— F( 0 00S- ( Legal Description 19-16 17-2S-29E.093 DONNERS R/P PT LOT 2 PT LOT D RECD O/R 9594-2488 BLK 15_E# Valuation of Work(Replacement Cost)$ 6,533 Heated/Cooled SF 1332 Non-Heated/Cooled 40 • Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial 4[esidentiaD • If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No • 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: ROSA SOLOMON Address: 1520 RICHARDSON LN City ATLANTIC BEACH State FL Zip 32233 Phone 904-887-8563 E-Mail N/A 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 ana 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 YOUR NOTICE OF COMMENCEMENT. 4 -4._ 6/ 14..L0.16.) /114_ (Signature of Owner or Agent including Contract-sr) Signature ontractor) Sign d and sworn to(or affirmed)before me this I'S day of Sieened and sworn t (or affir Worn me this IU day of rt W , 2 01 , by o c. So,ors on l&hr Jar ,ZO) , by 11 ars IC �You✓19 • Ar--riles— � 4(21-*----: 4V:14" (Sign tewt Vr (Signature of Nota ) COMMISSION#FF16OM9 ;k��v' �, Andrew D. Davis _"` ,)..z....A:= EXPIRES: Sept. 17, 2018 �2a•• ,a_� 4,'s COMMISSION i FF160849 �rsonall Known Of(%i�)F�"l� WWW•AARONNOTARV.COM [personally Known OR =_ "'_ y 'nuns"` ' .� - EXPIRES: Sept 17, 2018 [ I Produced Identification [ I Produced Identification ,if � WNW AARONNOTARY.COM Type of Identification: Type of Identification: �rnun"�� _ 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: 19-16 17-2S-29E.093DONNERS R/P PT LOT 2PT LOT D RECD O/R 9594-2488BLK 15 Address of property being improved: 1520 RICHARDSON LN Atlantic Beach FL 32233 General description of improvements: Re-roof Owner ROSA SOLOMON Address 1520 RICHARDSON LN 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 `` \)010Address 13725 Beach Blvd Suite 13,Jacksonville,FL 32224 Phone No. (904)6251446 Fax No. Surety(if any) Address Amount of bond$ Phone No. Fax No. Name and address of any person making a loan for the constructiol 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 ONLYII''I OW. R w) ? YA Signed:- ar• ,a1 A /IL AA J DATE /� -/C�-i Before me is Mi_ day of in the Coukof Duval. t e of Florida.has personall appeared ASS andar0 ,by Andrew D. Davis himsel herself and affirms that all statements and declare c fig are true and accurate _ �� '= COMMISSION I FF160849 Doc.#2018036318,OR BK 18283 Page 2144, "r.- EXPIRES: Sept. 17, 2018 ♦ ' Number Pages:1 `,;nFpF ��.�� yyyyytl,AARONNOTARV.COM Recorded 02/14/2018 01:42 PM, ��in itt` BONNIE FUSSELL CLERK CIRCUIT COURT DUVAL tary Public at Large.Stet o . County of DWR 1 COUNTY My commission expires: i or RECORDING $10.00 Personally Known Produced Identification