1773 E Park Terrace RERF18-0208 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: RERF18-0208
Description:
Estimated Value: 9500
Issue Date: 8/17/2018
Expiration Date: 2/13/2019
PROPERTY ADDRESS:
Address: 1773 E PARK TER
RE Number: 172020 0415
PROPERTY OWNER:
Name: HALLEAK ASSAD D
Address: 1773 PARK TER E
ATLANTIC BEACH, FL 32233-5825
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: DS KILLIAN ROOFING 8 GENERAL CONTRACTORS
Address: 3948 3RD ST S #122
JACKSONVILLE BEACH, FL 32250
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 pennit,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$7,500.
Building Permit Application Updated 12/8/17
City of Atlantic Beach
NO Seminole Road,Atlantic Beach,FL 32233
f
Phone:(904)247-5826 Fax:(904)247-5845 I��-p�`� ' ^(`
Job Address: J7/ / /A"r1Z /-oK C= Permit Number: e_QW- -0 Z4a
Legal Description 34-53 04-JS-p1"iE, 3d9 'eel .A-r, --;iy t.,fJ 6LLRE# /7.ok2 -o`l!S
Valuation of Work(Replacement Cost)$'75'00. eO Heated/Cooled SF Non-Heated/Cooled 21/6
• Class of Work(Clrcle one): New Addition Alterati epair'- ove Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commerc't" Residential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes �g7 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:
Florida Product Approval if f/ for multiple products use product approval form
Promertv Owner Information
Name: r'y'// /AAddress:
city 1liL ^«
C' Zip 31'{35 Phone 1V 65G- Or
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information L /
Name of Company: .e;llvQuafi m Agent: I�� vl� s' r 4 4,
Address��'�� Ar.(4!oGK C �-City�State L Zip
Office Phone;' Y 6 �N J lob Site/Contact Number
State Certification/Registration# E-Mail ahay+ (f p r ( a 4" c°^
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation /4 /`/
Exempt/Insurer/Lease Employees/ExplrMion 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.
/ n `
(Signature of wnor ert) a ore of Contractor)
Inc.ding Oer contractor)
Signed and sworn to(or affirmed)before me this 11P_day of ned and sworn to(or affirmed)before me this I day of
111 2019 by fSSCxL� D -F+�a(II eQL_� jDL9 by Rvi.i / p
WdierMoon" Qa� 1 1 W 11�)W X
r m �[8(Ifit (signature of Notary) aureo No
d �1�, �� R [ IPersonallY Known OR TON]GINOLFBPERGFA
W
ice Identigcati (�,,_, / to [ I Produced lden[ificati .'r_ MYGOMM1865IONtFFs1
Type of Identification: ".Ch L/1 V-PY.S LIQ .T Type of ldentifcation: E%PIREB:OcLOSar6,2019
Y•.�m- Bon
NOTICE OF COMMENCEMENT ^/
State of T C- Tax Folio No./7d 0-;0 . k 7
County of I W
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 Statures,the following information is shateQm_ this NOTIC OF COrM.r��g27N.7CEMEL41,
�i. mYl�4 ,I
Legal Description of property being improved:Zq- 35,99-�� -'Z l- '09 4 f^ r
�,a+ e7 aLOGIt 191
Address of property being improved: 4 °
7� r ,e Yt x L�aa s3
General description of improvements:
Ownm: �A�9� f�wn cel � f45 ROdress: / 773 n•- T�y1NC vIC[% i �;'3
Owner's interest in site of the improvemedt: d2e S
Fee Simple Titleholder(if other than owner): EVA
Name:
Contractor. d75
),/ I, c 6i( -
Address: 16 S I/�`V"I ' — Usg 0Ve CT L _
Telephone No.:"(VtQ � ( '7 Fax No:
Surety(if any)
Address: Amount of Bond S
Telephone No: Fax No:
Name and address of my perwn making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within t/t1_¢State of Florida,other than himself,designated by owner upon whom notices or other documents may be
served: Name:
Address:
Telephone 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*tspies. (Fill in at Owner's option)
Name: L i
Address:
Telephone No: Fa,No:
Expiration date of Notice of Correa a,?$(the expiration date is one(1)year from the date of recording unless a different date is
specified): OFC: I �O
-- THIS SPACE FOR RECORDER'S USE ONLY OWNER
DW#2018194322,OR BK18995 Page 1732,
Signed: Dater -/o -��
Number Pages:1 Before me this iln day of o I in Me Coumy of Duval,SL
Recorded 08/171201809:46 AM, Of Florida,has personally appeared 1
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Notary Public at Large,Store of Ff Duval.
COUNTY My commission expires: 02-1=1Y
RECORDING $10.00 Personally Known: or
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