1763 PARK TER E - ROOF rj�,J`1✓ri
�' '� �y_� CITY OF ATLANTIC BEACH
4 • 800 SEMINOLE ROAD
���� ATLANTIC BEACH, FL 32233
'"�� 'r' INSPECTION PHONE LINE 247-5814
� ,3
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF18-0170
Description: SHINGLE ROOF
Estimated Value: 16550
Issue Date: 8/3/2018
Expiration Date: 1/30/2019
PROPERTY ADDRESS:
Address: 1763 E PARK TER
RE Number: 172020 0412
PROPERTY OWNER:
Name: WILLIAMS DANIEL
Address: 1763 PARK TERRACE EAST
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: JACK C. WILSON ROOFING CO.
Address: 4522 ST AUGUSTINE RD
JACKSONVILLE, FL 32207
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$7,500.
"r' Building Permit Application Updated 12/8/17
'-- Y1 City of Atlantic Beach
' ;ir / 800 Seminole Road,Atlantic Beach,FL 32233
, �• Phone:(904.)247-5826 Fax:(904)247-5845 ( /�
Job Address: nQ 3 v\ t✓l (NCL., LC- . Permit Number: Re-RE-:78-0 7 0
Legal Description CC CL. `A Ss�1,16i N'� - �}v�,k�'p RE# li. -t) " f-
C -51.h
Valuation of Work(Replacement Cost)$ �l..P J )"JHeated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move Al ool Window/Door t.--&(._?.-
• Use of existing/proposed structure(s)(Circle one): Commercial sidential
• If an existing structure,is a fire sprinkler system installed?(Circle one): es No /A 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:
ask}l x� l� U C4kL T ST2t(� S
\� +(k.c..t ( U H 7"
Florida Product Approval# \\35�-A3. , 1 .'6r\--11 r multiple products use product approval form
Property Owner Information
tvltp(. �tSSca_lp
Name: NN 1/4,),),11.Ld.a-AS R(o6e-,r Address: 1163 loA l-?-C (C-r
City State Y� Zip }--_raj Phone l)-6-<1,((r,Q1
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information LL ti� 11 1 \Q
Name of Company: `l C C. V ,A, L Qualifying Agent: (-Vt,�r( U,u 1
Address Iry\,r X' . j, -ltriv k City \( ` State A Zip ..�o l
Office Phone CAL 5Cti Job Site/Contact Number - `1t\-ti 6\.� ` 1`1
State Certification/Registration# ('(S',, 6.-6- E-Mail C1./.2)'z ' J .
Architect Name&Phone# 4 ,
Engineer's Name&Phone# (�
Workers Compensation 1--\A-4 LG ,--ICI,(,h i 414 11�
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 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 COMMENCEMENT.
1, 0
6"/7'-'
(Signature of Owner or Agent) ignature of Contractor)
(including contractor) ye
Sign d and savor too affirmed)before me this day of Signed and sworn to r affirm d)before moth's 7.3 day of f',
�1 ,by __ T by /T �uJ) 2
1.(tt r`
nature otNotary) ASigna ure of Notary) c�o w g
`2 m c
--- rn o � .0 0c
... ••..;
[ j Personally Known OR ► CHRISTOPHER VOSS j Personally Known OR Cl) .2
[,['roduced Identification a, % MY COMMISSION#GG 163488 roduced Identificatio�// E E
Type of Identification: �'.' <: .•IRES:Docerh 3.2021 ; ype of Identification: LX g..ie ( a C 4_{�c.„Qr v
odF;°,* Bonded Thru Notary PuM*.Jndenv:,:as
Doc # 2018177581, OR BK 18472 Page 1498, Number Pages: 1 ,
Recorded 07/27/2018 02 :46 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10. 00
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. Ar - SV - G�i
State of d County of ul '\C1r\
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property,and In
accordance with Section 713 of the Florida Statutes,the following information Is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: AL `Q�
(A.
Address of property being improved: 0,c; �Q�1(k(,L-• L
�� VU--- ---33
General description of improvements: C C�U
Owner ----A 'Qtc—s. u, N d•9'� '�t 1 \ ���
Address 0(03 i),1/44r, i • -. C�C� \60-Na+- �J
Owner's interest In site of the improvement 1,C1/-10
Fee Simple Titleholder(if other than owner)
Name ,r
Address
Contractor
JACK f.
Phone No. 4522 M. !-. ... ,t I.;)Fpx No.
Surety(if any) Jura:0'i':,.! . FL 7.._01
Address ( i ) 39G-1546i
Amdunt of bond$
Phone No. Fax No. i
j
Name and address of any person making a loan for the construction of thcttrrprovements.
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.
ao
of
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a > c`3 K
different date is specified): ci* 2
THIS SPACE FOR RECORDER'S USE ONLY �/ //OWNER i ..i
gg
Signed: W
"••-•...: P DATE g Ye i
Before me this d of S. iCO!
County of D 1.State of Fb. kip jt�s• -• -ly appeared S
l•l),.\ l,• herein by
hknseM/herself and affirms that all statemen-and decl herein
Sr.true and accurate •
Notary Public at Large,C4V
. County of .
My commission expires:
Personally
Known ��{ 3 1 J/ a
Produced Identlflcatlon