378 AQUATIC DR - ROOF , ,. 1_.1_\„3,,„.,..,r,
(.._
' ss CITY OF ATLANTIC BEACH
+ . ) 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
'-w"%o;3>>%' INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF18-0227
Description:
Estimated Value: 1915
Issue Date: 9/12/2018
Expiration Date: 3/11/2019
PROPERTY ADDRESS:
Address: 378 AQUATIC DR
RE Number: 171818 5126
PROPERTY OWNER:
Name: POZIN JESSICA
Address: 1217 11TH ST N
JACKSONVILLE BEACH, FL 32250-3643
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
,
Phone:
Name: GOLDEN HAMMER RESTORATIONS
Address: 14371 HIGHWAY 301 SOUTH JERRY RODGERS WILSON
STARKE, FL 32091
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$7,500.
A ` °r Building Permit Application Updated 12/8/17
. City of Atlantic Beach
I el3 800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845 DD
Job Address: 37F' Ap'4+1c ()v"'t A+14r)-;c BP4Lk, rl- . 32233 Permit Numberf� fe /`" v2.-Z-7
Legal Description 38-71 P-2S"2(i'E A%voF1',t, Cy-srdrns Lb+ y—A RE# 1 7)71e-6V,/'
Valuation of Work(Replacement Cost)$ I 1 K Heated/Cooled SF 12 bb Non-Heated/Cooled 12-Lig
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes Ito 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# I$3 S 5"IZ 2 for multiple products use product approval form
Property Owner Information
Name: 3tss1 c 0, If P0.1--ep .lr) Address: 17,17 llr`' SotN JacVsoov;l)c 6e4 cl,,F. 3225-0
City Jac,l'lSoroiiIle State 6- Zip 32.2-4 o Phone a69• 6O7- LI3lb
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: (Cj-olceit t4n0,w,er QtS}wtx>!7en Qualifying Agent: Jose ti), //Diver
AddressL2lo t-0-15-e,Short (31✓0) City Ja s> v)IIkt State r=te Zip 3zz)o
Office Phone go 4- 8'YO--too Job Site/Contact Number IP 9-PPO-"2O0
State Certification/Registration#CCC 132 115 6"412'124 E-Mail C fRA,Sol oienhghl mer. C o
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensatior I, 01 A—C4( . 1=X• 9
Exem.•/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 AU'RNEY BEFORE
RE711 '
O' DING YOUR N TICE OF COMMENCEMENT.
,_ Idi
(Signa ur of Owner or Agent) Signature of Contractor)
(including contractor)
:ned and sworn to(or affirmed)before m this I I day of Signed and orn to(or affirmed)before me this II day of
S e410/x— , 2°)? ,by Joseyk /t!ove (' sem„ii,rr , 2-0)? ,by ec Ic• AlfirePtd"
/� ' / / -
, ... atur- • 'otary �� ( .: at e of . . VIllirr
PersonallyKno OR .►�"'+ Notary Public State of Florida
[ 1 y,o [ ]Personally Known OR
2202/1'2190 saiidx3 � Edward Eugene Callaway Jr
[ ]Produced Identi o atiooZSBZZ 00 uoissiwwo ,c �`Tr [ I Produced Identification •
Jr.AeMepeC auabn3 p,aM W My Commission GG 229525
Type of Identificatik' p3 • Type of Identification: ] se Expires 06/24/2022
of
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of c(_ County of 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.
Legal description of property being improved: 3?-1! {1-2S -2qE
A/verbs (,tardMJ
Address of property being improved: O A9ucr,G 6 h AM rTr)E Lea FL• 32-233
General description of improvements: Q--(o s'
Owner Jell CA td,rst-D, -Pb-1-14
Address rill-) 1 S�rce-�- A) I./ASS-66v)l)-', a. 32266
Owner's interest in site of the improvement a(uY)e fl
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor I G-0Idt n' Hq rn m e r- R *e"441 vi- In c
Address 2'-ta (,a1it516:r0-41432-4 achsanvl1/r 32-210
Phone No. gDIt-gf0"'2-oFax No.
Surety(if any) IVJry'lA.I-io'►1ct fdeI.f9 /nS ate/
Address I6b4 Mc;- orld ��Lhi/4--r eom mon ate/ Amount of bond$ /(r0/QC)C
Phone No. C]D')- (a/1"401 5� Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name N
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 AV/—
Address J/
Phone No. Fax No. a r;
= ;y
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 OWNER - m ;
Signed: , DATE "I 2 0
z
Before me th' • y of In the m
County of Du .S of Flo!l4a.has personally pea d
J p�
cc, V e.C herein by r•
himself/he and affirms that all statementand eclaratbns herein
are true: .1(ccurate 1118
Z CO
c
1 7t
// ••V ' m
Nota blit t Large,St of M . County of I1,/r/A►
My commission expires: !. 1121..SA _ r,
Personally Known or
Produced Identification