2233 SEMINOLE RD #28 - MOD. ROOFING ir,,,, ROOF NON SHINGLE PERMIT PERMIT NUMBER
.\,
t- CITY OF ATLANTIC BEACH ROOF18-0095
ISSUED: 12/6/2018
800 SEMINOLE ROAD
N=''i}'" ATLANTIC BEACH. FL 32233 EXPIRES: 6/4/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM 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
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
2233 SEMINOLE RD 28 ROOF NON SHINGLE MOD BIT ROOF
Ow/TAPERED $8029.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169519 0154 OCEAN VILLAGE ONE
CONDO
COMPANY: ADDRESS: CITY: STATE: ZIP:
Triton Roofing & 480 State Rd 13 St Johns FL 32259
Restoration LLC
OWNER: ADDRESS: CITY: STATE: ZIP:
LUCKIE DAVID M 2233 SEMINOLE RD #28 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.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000 322-1000 0 $95.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $47.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.56
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.38
Issued Date: 12/6/2018 1 of 2
/0".:51-44u) ROOF NON SHINGLE PERMIT PERMIT NUMBER
'' CITY OF ATLANTIC BEACH ROOF18-0095
J , 800 SEMINOLE ROAD ISSUED: 12/6/2018
�'; � ATLANTIC BEACH. FL 32233 EXPIRES: 6/4/2019
WORK WITHOUT PERMIT 455-0000-322-1000 0 $95.00
TOTAL:$243.44
Issued Date: 12/6/2018 2 of 2
�f u'i f, City of Atlantic Beach APPLICATION NUMBER
�s Building Department (To be assigned by the Building Department.)
r ; c��.
800 Seminole Road Cr ��
-0 Atlantic Beach, Florida 32233-5445 I: O0F I ���
Phone(904)247-5826 • Fax(904)247-5845
�o;tt9? E-mail: building-dept@coab.us Date routed: 1 0 ft P) `t 8
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
2- '98
Property Address: Z Z 3 SE4y\ II\DO LE ,`n Deent review required yNo
uilding
Applicant: C,tr TC)pJ I<Do ( N q Planning &Zoning
('-' Tree Administrator
f---Project: [ )\ oc 100 Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date •
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation I �
St. Johns River Water Management District //�
Army Corps of Engineers
. Division of Hotels and Restaurants V\
Division of Alcoholic Beverages and Tobacco
Other: i/
APPLICATION STATUS
Reviewing Department First Review: ❑Approved. Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: N./ Date: /0.99"aoi
TREE ADMIN. Second Review: A roved as revised. Denied.
,�pp ❑ ❑Not applicable --//
PUBLIC WORKS Comments:/IFor w}ki4-eJ r (2-eq S'cm t pop ttia S � e cavPV4c//
PUBLIC UTILITIES ReflaClp1 i9 4 no `J-e r m', 4—, r! eape GoL.bI* �'�—
PUBLIC SAFETY Reviewed by: M Date: /2-6-Ii"
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
OFFICE COPY J P
'f'''"'� Building Permit Application Updated 12/8/17
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1". -• - City of Atlantic Beach
• 800 Seminole Road,Atlantic Beach,FL 32233
/
R(2.8,3
Phone:(904)247-5826 Fax:(904)247-5845 ���P. �
Job Address: GT c7.i ,3 5e n n0 E road Wilt Permit Number: 18 - 009 5
CR*f"!'
Legal Description . 5- 9 &� y/1 / L l j / -2�RE# f! 07,619-615-4
Valuation of Work(Replacement Cost)$__=tesiGifk111, •'• e- •d/Cooled SF IR.(e.Q Non-Heated/Cooled_L9& 0
111"i+vj,s.
• Class of Work(Circle one): New Addi ''-. - . Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): ‹ommercjResidential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No /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:tZeo rooF Sh( L 1--(3 1-ti f, !e, On m ci Gd I r-
41arce od•bif vvl red i.si g +ordi t s t
Florida Product Approval# N _g ' k ° F-1-25. R • for multiple products use p^rod ct approval form
Property Owner information /0 Mar Val f....16j0 ; r �
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tY/ .-.)
Name: - / �` lC�f1� Address: S— Irfh tr�e
City 1,Q , an Vi 1- slack? State Zip 32`.• Phone 1" r off, . 6 "
E-M ail J'd4e e20A- r1'tCat lag.• Corn Q ry
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Owner or gent(If k'gent,Power of Attorney to Letter Required) C. c (—
ContractorInformation ���7 (�� ��,rc ` ' L•.f p Z til
Name of Compan : f A �• A _ - ; v` f c-+�'alf li iin Agent: tbgert 1��CE7 c7e-F l in
C) 0 Q
Address 4-0 ' , iSI, . 1II i City ,' �+OhelS State FL Zip -' 229 _ J1 Q
Office Phone f • 1Ir , Job Site Contact Number /.. ' • — -
State Certification/Registration# C CI, ..5EE-MailJ/ . . '�'1 / o j�l r �,• (// L"• ♦(/ ' '-1 •
Architect Name&Phone#. L:/Cj— 2 / 4. i. rn
Engineer's Name&Phone# C ,4: y
Workers Compensation F"Q.I' r s ' 00QQ Ar r O1 ,9 10, ,_ ti, -•`:-.:
Exempt/Insurer/Lease Employees/Expiration Date uJ i1J >-
Application is herebymade to obtain a a. "_•� m
pp permit to do the work and installations as indicated.I certify that no work or installation ills. t � 0
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg .t 0 W
construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, La W
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc.NOTICE:In addition to the requirements of this 5
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and W
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.
/0/70'
k - ,.4 I .
- f/ ,
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(Signature of Own:}or Agent) ignature of Contractor)
(including contractor) •
•
S a d sworn ( ffir A before • e this-I •ay of qo ed and savor to( affirm•• be •re me t i•r ✓_day s
4.
II AVATILIKI, iimEraw,
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_.,c e, ,f;; . --t r v'"• :r�:. Mr Si: ' '-', .. ;
MY C/MMIS. O #• s92596 : ES
=:': . c MY COMMISSIO 00042598
Personally K •' :• "..:1"1-.-:':; , EXPIR'S .nil 1�,2021 [ )Personally Known 0
( Produced Id.ntiil'' on [ )Produced Identiflc.ilii/{°;,•' EXPIRES April 10,2021
Type of Identificat on: Type of Identification:
Doc # 2018248482 , OR BK 18568 Page 1589, Number Pages : 1 ,
Recorded 10/18/2018 01 :24 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10 . 00
•
NOTICE OF COMMENCEMENT
r
�, ( E IN DUPLICATE)
Permit No, goo I ? M
a -0d Tax169519-0154 •
State of F1 da Folio No.
County of buval
' To whom It may concern;
The undersigned hereby Informs you that Improvements will be made to certain real propertyNO,and In
accorance with Section 713 of the Florida Statutes,the following Information Is stated In this and
OF
CSMNIdENCEMENT.
Legal description of property being Improved: g
09-2S-29E Ocean Vltt�eOne-Condominium •
dwelling Unit 28.
Address of property being Improved: 2233 Seminole Road Unit 28
Atlantic Beach,FL 32233
General description of Improvements: reraof
owner Ocean Village Association, Inc CIO Marvin&Floyd Realty Inc.
Address 1825-A North 3rd Street,Jacksonville Beach,FL 32250
•
• Owner's interest In site of the improvement President of Association,George Ridge
Fee Simple Titleholder(if other than owner)__
Name
Address •
•
Contractor Triton Roofing&Restoration,LLC
-
Address 450 SR 13N Ste 106 St Johns,FL 32259
Phone No.9a4.819.a212
Fax No.901.683.3823
Surety(If any)
Address
Amount of band S
Phone No. Fax No.
Name and address of any person making a loan for the construction of the 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
documerib may be served; .
Name G a CL G,` A -- ,,w 4
ti
Address i • a ; I .--
Phone No. 'a 4{ 6(3-ss3`•D Fax No. e'i�Ia ta•eic."* j--XI I.r� -. l
4-1
In addition to himself,owner designates the following person to receive a copy of the Uenor's Notice as provided in•
Section 713.06(2)(b),Florida Statutes.(Fill in et Owner's option).
Name . <5 t 1 •
Address
Phone No. Fax No.
Expiratfon date or Notice of Commencement(the expiration date is one(1)year from the date of recording unless a
different deli is specified):
& •
THIS SPACE FOR RECORDER'S•USE ONLY OWNER
Slamd 'w i/ri 1 1 n��Yi 1 y
'Iv i kj
Before/ha this day or -T "'��� TE in e r N)
...R' •'
Nance MT'•e,,`', _that etl .amen,and•.'SCl?:•. ' ntry
a� ,'= MY COMMISSION#GG092596
' EXPIRES April 10,2021
'?ail; , - .
Notary Pubrye al Lo A �.�'
�.; �r t i
Aly cora money
Known xxxra,=r-47:07,��-i_--///`S'// r
Produced IdentiGcetlon Ili' —'�•
.._• . . _____.
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.. __ ____
______
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Cash Register Receipt Receipt Number
'371vir
r
City of Atlantic Beach R7545
-I'll 9.
DESCRIPTION ACCOUNT QTY I PAI
PermitTRAK $243.44
ROOF18-0095 Address: 2233 SEMINOLE RD 28 APN: 169519 0154 $243.44
BUILDING $95.00
BUILDING PERMIT 455-0000-322-1000 0 $95.00
BUILDING PLAN REVIEW $47.50
BUILDING PLAN CHECK 455-0000-322-1001 0 $47.50
STATE SURCHARGES $5.94
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.56
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.38
WORK WITHOUT PERMIT $95.00
WORK WITHOUT PERMIT 455-0000-322-1000 0 $95.00
TOTAL FEES PAID BY RECEIPT: R7545 $243.4,
CITY OF ATLANTIC BEACH
800 SWINDLE RD
ATLANTIC BEAC,FL 32233
12r 06,2018 11:46:47
CREDIT CARD
VISI,SALE
Card; XXXXXXXXXXXX2670
SEQ;: 2
Batch#: 746
INVOICE 2
Approval Code: 782650
Entry Method: Manual
Mode: Online
Tax Amount: $0.00
Card Code: M
SALE AMOUNT $243,44
CUSTOMER COPY
Date Paid:Thursday, December 06, 2uia
Paid By:Triton Roofing& Restoration LLC
Cashier: BA
Pay Method: CREDIT CARD 2
Printed:Thursday, December 06,2018 11:50 AM 1 of 1
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