298 Pine Street Reroof Shingle Permit CITY OF ATLANTIC BEACH
� f? 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
�F INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF18-0082
Description: shingle re-roof_ FL10124.1 & FL15216.1
Estimated Value: 3500
Issue Date: 4/16/2018
Expiration Date: 10/13/2018
PROPERTY ADDRESS:
Address: 298 PINE ST
RE Number: 170549 0000
PROPERTY OWNER:
Name: BERNSTEIN FRANK
Address: 298 PINE ST
ATLANTIC BEACH, FL 32233-4014
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: JUSTIN LARSEN CONSTRUCTION INC
Address: 4670 Hedgehog Street
MIDDLEBURG, FL 32068
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$7,500.
Building Permit Application Updated 12/8/171
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233 APR 9 2018 1:1
Phone:(904)247-5826 Fax:(904)247-5845
Job Address:r-,/ A!ue__ s+ tA 144A,i7c_ 3e,4t Permit Number:
Legal Description Wj� C2 6, 5JL,+AJd_ SSC_ RE# _J
Valuation of Work(Replacement Cost)$ f
co Heated/Cooled SIF No eated/Cooled
• Class of Work(Circle one): New Addition Alteratio Repair" Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial esidential
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes 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: PO®F 1112- 9-5/`01VI
0(LTQ1'ZJW--7)-te1q 1:5 F 111-1 1 1 r/ 1012-q, I 6-AF AetkAslyettL
Florida Product Approval# 11E I 0( 2 1( for multiple products use product approval form
Property Owner Information
Name: VA4_,eh,� heRA!24r_�iAj Address: 9n- pw-c-
City C State�(, Zip S223:3 Phone:39(o — 1ps-— CV40
E-Mail
Owner or Agent(if Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: g2&e-rA..j Qualifying Ag e
.i%j�44_LVI�7 - —
Address City M
- WiV, -d-& State _zip 39--A; '
Office Phone Job Site/Contact Number
State Certification/Registration#�M-20%Y-:7 rDk3CO
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation
I I TE.eAp_t/! urer/Lease Employees/Expiration Date
Application is hereby made to obtain a permit to ork 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 0 OR B FORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) ignature of Contractor)
(including contractor)
Si d d sworn affirmed)before me this Sign a day of
Sign to(or affir day of and sworn to (or affirmeAUefore me this
by � by J%xc0cp
f Mat (Signature of Notary)
01
Aft DAVID NATHAN&ATOFF
Personally Known OR My COMMISSION 0 FF9350i� le,sonally Known OR DAVID
f NATHAN SLATOFF
Produced Identification EXPIRES November D9.204 3roduced Identification COMMISSION FF935021
Type of Identification.
Ty l e of Identification:
14407)308.O-M EXP-1pvc NOvenober 09.2019
-CAW
NOTICE OV COMMENCEMENT
State of—�I T N
gg ax Fol.i.o o.
County of
UL
o Whom It May Concern:
The undersigned hereby informs you0at improvements4i.11 be made to certain real property,:and in accordance with Section"7:13 of
the Florida Statutes,the following information is stated in this NOTICF ORCOM IEN..CEMENT:: -
Legal Description of property.being improved:
Address of property being improved:. . ....
General description o{'improvements:
Owner:. pp,� ^� m 0;U:� <
Address: .A' M c.z o 3
Owner's interest.in site of the:improvement: -
a� 1.
- O.:
Fee Simple Titleholder(if other than owner):
c � c
G) mom c
Name: M�
c� mN_
0
ontracto ( o" r w . .;_"
t'�
N
Address: 4.70 14 ..
� 7
Tele hone:No.: �C
P Fax No:
c
Surety(if any)
Address: o
1.
Amount.o n"
rq
o
Telephone No: :... Fax No:: o .:
c
Name and address of any person making a loanfor the construction of the improvements D
m : . .
Address:
Phone.No: Fax No:...
Name of person within the State of Florida, other than himself, designated by owner upon.whom notices or otherdocuments may be
serve Name:.
.. ....
elephone:No: Fax No:
In addition to himself, owner.designates. the following person.to receive a copy of the LienWs Notice"as provided'in_Section
7.13.06(2)(b),Florida Statues. (Fill.-in at Owner's option)::::
:
Address:
Telephone No: Fax No:
Expiration date of Notice of.Commencement (the expiration date is one (_l:) year from the date of recording:unless a different date is"
specified):
: sm
HIS SPACE:FOR RECURDER'S:USE ONLY OWNER
Signed:
Lr
MY
�.Da..,.o
Before me this day of 0" Date:
t e.County of uva1,StateOf
. _ p, y..PP
�• DAVID NATHAN SLATOFF ed:: � . .
Notary
g
;�` r ,,,~ Nota orPublic at Large,
appeared:..
orida;C my of D "
AAY:COMIAISSION ak FF933021
My commission expires
EXPIRES November 09.2019- Personally.Known: ,
Dort 34&0 53 FkardaHot� s.Mc'•°°"'. or
Produced Identificatio -
'
*FF93502 i
EXPIRES November 09,2019
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