643 Selva Lakes Cir RERF18-0144 Shingle $, ;;_ 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: RERF18-0144
Description: ReRoof Shinlge
Estimated Value: 6995
Issue Date: 6/21/2018
Expiration Date: 12/18/2018
PROPERTY ADDRESS:
Address: 643 SELVA LAKES CIR
RE Number: 172027 5902
PROPERTY OWNER:
Name: SUSSMAN STEPHANIE ANN
Address: 643 SELVA LAKES CIR
ATLANTIC BEACH, FL 32233-5986
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: AMERICAN ROOFING OF JACKSONVILLE
Address: 2117 University Blvd. S
JACKSONVILLE, FL 32216
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.
0
Building Permit Application
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
' Phone:(904)247-5826 Fax:(904)247-5845 L /�
Job Address: 643 Selva Lakes Cir,Atlantic Beach,FL 32233 Permit Number:
Legal Description 44-6017-2S-29E SELVA LAKES UNIT 3 LOT 155 RE# 172027-5902
Valuation of Work(Replacement Cost)$6 445.oC Heated/Cooled SF 1.741 Non-Heated/Cooled 2,207
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
• 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: Lornpiete tear on ana root replacement
Florida Product Approval It FL16350Arch Shingles,FU1350 Synthetic Underlayment for multiple products use product approval form
Property Owner Information
Name: Stephanie A.Sussman Address: 643 Salva Lakes Circle
City Atlantic Beach State FL Zip 32233 Phone
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) NA
Contractor Information
Nameof Company: American Roofing oflacksonvllle qualifying Agent: Daniel P.Klnkel
Address 2117 University Blvd Citylacksonville State FL Zip 32216
Office Phone 904-385-4375 Job Site/Contact Number Chris Dennis,904-626-4636
State Certification/Registration# RC90227546 E-Mail dangiiamericanroofi n¢iax.com
Architect Name&Phone# NA
Engineer's Name&Phone# NA
Workers Compensation Builder's Mutal Insurance#WCV0263113,expiration 4/24/2019
Exempt/Imurer/Lease Employees/Expiration Dare
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 regular long
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
RECORDIN UR NOTICE OF COMMENCEMENT.
e 426in Contrx;dX) • (Signature of Contractor) �/'
Signed and sworn to(or affirmed before me this C" day o Signed and sworn to(or affirmed before me thisIL day of
�SrV 2W19 .by � �by
(Signature of Notary) igna are of Notary)
IOHNAICHARD50µlA.
Nmary Wblic-SlaeMrkrida „ HED BROOKE 6TREET
Personally Know " Cammissnnr6Ga1Ip5 —kersonally Known OR ? 6tete of Florida-Notary public
NY Comm&piresbn D,lail ?e' Commission#GG 201349
[ ]Produced Iden[i l ]Produced Identification My Commission Expires
Type of Identficadon: Type of Itlentification:
NOTICE OF COMMENCEMENT
Pemnit No. Tax Folio No. 172027-5902
State of Florida,County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance
with Chapter 713,Florida Statutes,the following information is provided in this Notice of Commenceme u.
1. Description of property(legal description of property and address if available):
44-60 17-2S-29E SELVA LAKES UNIT 3 LOT 155 Doc 0 2018148383,OR INK 18929 Page 702,
643 Selva Lakes Circle Atlantic Beach FL 32233 Nunber Pages:1
Reconied 06/21/201812:34 PM,
2. General Description of improvements: COUNIE FUSSELL CLERK CIRCUIT COURT DUVAL
Comolete Tear-Off and Re-Roof RECORDING $10.00
3. Owner Information:
a)Name and Address: Stephanie A Sussman 643 Selva Lakes Cir. Atlantic Beach FL 32233
b)Interest in 100%
c)Name and address of simple titleholder(if other than owner):
NA
4. Contractor Information:
a)NameandAddress: American Roofinc,)_ofJacksonville
J , 2117 University Blvd S. Jacksonville, FL 32216
b)Pbone Number. (904)385-4375
S. Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction
and final payment to the contractor,but will be one(1)year from the date of recording unless a different date is
specified:
WARNING TO OWNER ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART I,
SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR 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 COMMENCING WORK OR RECORDING
YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjut ,I decline that I have read the finegoing notice of commencement and that the facts stated
therein r-tHte to e'beat of my knowledge and belief.
�1 7rvi ntP r�tl C�mz .Y1
Sigaanur's ArldronzedOT6cer/Director/Panner Maua/ager Sigmto s Printed Name&Tr[
The foregoing instrument was acknowledged before me this 64 day of ` .20jb,
by ' A Scnsmn�
aoa:of Pers.-eking stetemenn
?ON YP , TE OF FLORIDA
RED
A ano: �ah!� n1+ d4.6rt
loHtlar6Py Known
,2021 N IdentificationType:
Revised 1/01/18