1820 Mayport RERF18-0252 >t REROOF SHINGLE PERMIT PERMIT NUMBER
n CITY OF ATLANTIC BEACH RERF18-0252
ISSUED: 10/30/2018
o 800 SEMINOLE ROAD
ATLANTIC BEACH. FL 32233 EXPIRES:4/28/2019
MUST CALL INSPECTION PHONE LINE (9D4) 247-5814 BY 4 PIM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
[NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
at may be found in the public records of this county,and there may be additional permits required from other
overnmental entities such as water management districts,state agencies,or federal agencies.
1 1 � •
1820 MAYPORT RD REROOF SHINGLE SHINGLE ROOF $4000.00
TYPE • BUILDINGZONING: SUBDIVISION:
• 1
172075 0100 SECTION LAND
COMPANY: ADDRESS:
MASTER BUILDING 310 East Jackson Street Orlando FL 32801
CONTRACTORS, LLC
OWNER: ADDRESS:
OSSI KLOTZ LLC PO BOX 330833 ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY 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 RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
Roll off container company must be on City approved list. Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILUING PERMIT
455-OO00322-1000 0 $7500
STATE DBPfl SURCHARGE
OSS OOOQ208-OJ00 0 5100
STATE OCA SURCHARGE
455-0000-2080600 0 52.00
TOTAL:$79.00
Issued Date: 10/30/2018 -"Ibe
Building Permit Application Updated 12/8/17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
op
Phone;(904)247-S826 Fax:(904)247-5845
Job Address: 1020 // 4Va L - 110.9,6 Permit Number:
Legal Description /7-oIS - 1?6'/, -�G RE# 9,1095'
Valuation of Work(Replacement Cost)$ 1- 00 ' Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Girds one): New Addition Alterationa al Move Demo Pool Window/Door
• Use of existing/proposed stmaure(s)(Circle one): Commercia 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:
-fl) Uy/E /JDo` e'5�0'414
Approval Florida' a Product A roval# FG /0 1, 70— !3 for multiple products use product approval form
ProoeM Owner Information PB BO 330 X33
Name: -S'-f/ K/07Z CCC Address:
city ,grcau7r¢ E state L zip 4?233 Phone o Si — a o
E-MailZ TZ
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Nameofcompads;rex � ye/9 Qualifying Agent: fe
q.0
Addres '
O -tstate�O zoipi✓
.23 3
Di ce Phone lob Site/Coner
90V S/6 3 - 2.F9f
State Certification/Registration# C /3a O E-Mal11'EHN,,nA/SJA/ 999 a 9ma:L lea r1,
Architect Name&Phone# 14
Engineers Name&Phone# 7 !8
Workers Compensation l`L!/ND/S UA>'/a,✓gl 2SUS4R A AOcg
Exempt/Insurer/lease Employees/Explratlon Me
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. C
Z�nx�eof Q%ner or Agent) 19gnat a Connector)
(Including contractor) QTJZ TA
ned and swom to(or affirmed)before me thiso2/ day of Signed and swom to(or affirmed)before me thisa day or
6,ti •a10i8 ,by FG d. <7aTz pet�bti . td/ bbyyZ, W d- Yg/dJANra4i
(Signature of Noyry) (Signature of Notary)
a�� LISA A.BINDER 1µr LISA A.BINDER
y}.ersonally Known OR NOTARY PUBLIC Personally Known OR , NOTARY PUBLIC
OProduced Ids tion _d [ I Produced Identification 5 STATE OF FLORIDA
=STATE OF FLORIDA
Type of Iderdificstion: _ Type of Identification: Q y�Ptggg�—
"Wr Expires 1/12/2019 1 1 Expires 1/12/2019
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of Rind. County of Duval
To whom it may concern:
The undersigned hereby Informs you that Improvements will be made to certain real property,and In
accordance with Seaton 713 of the Florida Statutes,the following Information Is stated In this NOTICE OF
COMMENCEMENT.
Legal description at property being improved: 17-2S-29E.26 /7 D 75— D /00
Address Of property being Improved: 1820 Mayport Road
General description a improvements: Roof Repair
owner LLC
Andressess POOBox 330833 Atlantic Beach,FL 32233
IOwner's interest In site ofthe improvement
Fee Single Ti9eholder in other then owner)
Name
Address
Conbaptor Master BUIBkp
Address 310 East Jackson SL Orlando,FL 32801
Phone No.(sa)ss3im`o Fax No.(904)463-7695
Surety(lfany)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction ofthe Improvements.
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 In receive a copy of the Uerwr's Nonce as provided in
Section 713.06(2)(b),Florida Statutes.(Fill In at Owner's opgon).
Name
Address
Phone No. Fez No.
Expiration data of Notice of Commencement She expum9on date is one(1)year from the date of recording unless a
different data Is specified):
THIS SPACE FOR RECORDER'S USE ONLY Gp A IE
Signed: ` DATE
a.kr.me nn d.ya nn,.
Coun .FFIX,wl.smarwm, penmalY alga— =
nlmsan neFreeulDle,w amrmemamlenameme eiw ore nedlSAX BINDER
enwaem eaurale NOTARY WBLID
STATE OF FLORIDA
Dac9201809.5801,OR8K18361 Page S32, " >CwrxrN FF1B9013
Number Pages: IKa.. K��.pC¢i r 1/722019
Recorded USSEL1811'52 AM, 9 Putlk el Lenge.sats ceudya '
RONNIE FUSSELL CLERK CIRCUIT COURT
DLIV
t
COUNTY personally xrxwnOr
— RECORDING $10.00 m