334 SKATE RD REROOF }f CITY OF ATLANTIC BEACH
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: RERF18-0067
Description: shingle re-roof- FL5444.1 & FL2569-R7
Estimated Value: 10500
Issue Date: 3/16/2018
Expiration Date: 9/12/2018
PROPERTY ADDRESS:
Address: 334 SKATE RD
RE Number: 171660 0000
PROPERTY OWNER:
Name: FREEMAN HAYWOOD
Address: 334 SKATE RD
ATLANTIC BEACH, FL 32233-3820
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: ANDERSON BUILDING RESOURCES
Address: 1541 CEDAR BAY RD QA DAVID SAUL ANDERSON
JACKSONVILLE, FL 32218
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$7,500.
Building Permit Application Updated 12/8/17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
_Phone:(90"'A I I Permit Number:Pone: 247-5826 Fax:(904)247-5845 D �(
Job Address: LI � ( F
Legal Description 1 t PT 4 PPYA-t P&1s Al V L011 s Qtk' z3 RE# 1771 400
Valuation of Work(Replacement Cost)$ C7 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Reit Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): CommercialesI enti
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/
• 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:
�Q_ria
Florida Product Approval# :ff Z - 7for multiple products use product approval form
Sk%�5(� c%AY
Pro ert Owner Information
{Name: �► w0 � � LI / * � Address: ��
City `c w a. State Ft— Zip 3 2 ?� Phone !Jj) D
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Informationr,
Name of Company: 1'--�rrtff ftl Bv"U, Kesov&-ri Qualifying Agent: 3)owic� J'tnKel Sb✓�
Address I Sqt OPY& Pd City `�� •r Ue State 'PZ--Zip
Office Phone D - O g J Job Site/Contact^nNumber - 0 7 -Cf 70
State Certification/Registration# ZSZ(.ZZ E-Mail DILne c'h, 200 �EOMGAs help-
Architect Name&Phone#
Engineer's Name&Phone# /U
Workers Compensation
Exe 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 instal lation 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
RECORDING YOUR NOTICE OF COMMENCEMEN
(l/ l�--
(Signatur of Owner or Agent) (Signature of Contractor)
(including contractor)
SIU
Signed and sworn to(or affirmed)before m this 1 +qday of Signed and sworn to or affirmed)before me this H-4day of
Z J 1 by \ `r Uti�(iv- ZUl by D /t�lib L RSCS f
(l b-K,
(Signature of Notary) gnatur
MY COMMISSIrw t rF 908042
W-1-Personally Known OR 440 J"ANOERWN ] Personally Known OR * EXPIRES:Au;: '1,2019
Produced Identification * My COMMISSION1FF908042 EXPIRES:August 242019 BonCedTrru6
I ] produced Identification �Oe
I ] * , >t y
Type of Identification:
SOFn
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax FolioN
State of "f = t D� County of�U U
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. 1
Legal description of property being improved: 31-11//0 17-2S-21
E RIP W- ?7-a4 RaYAL
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Address of property being improved:
ortL�A3Z2
General description of improvements: Q�ro
Owner r
Address /'� %/[ GH ZZ '302 73
Owner's interest in site of the improvement }� //I'/1
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor
` Address CP P/ T 32?19
eJ Phone No. qd y— 7y-7-� C770 Fax No.
Surety(if any) IVDA:-:
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 Al 91R
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 N 0-Vj—r,—
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 WNER
Signed: DATE [(
Before this t ay of / In the
Coun{ty4f Duval.S to of�.✓y�ri a,has personally appeared
t ) �.i�C-i I 'C[�fi In herBi[lbY��
Doc#2018062884,OR BK 18317 Page 2409, himse hersel and affirms that 6II st�(yer+g�@d declar RSC)N
Number Pages:1 are true and accurate * MY COMMISSION#FF 908042
Recorded 03/16/2018 12:11 PM, * EXPIRES:August 24,2019
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL ��aP`Oe Btmdedlrru3udtNotary Services
COUNTY Q�Cv r
RECORDING $10.00 Notary P Ica Laarge.Stateof - county of
My comm n expires:
Personally Known V or
Produced Identification