1649 E PARK TERRACE RERF19-0003 REROOFING PERMIT REROOF SHINGLE PERMIT PERMIT NUMBER
RERF19-0003
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 1/8/2019
ATLANTIC BEACH, FIL 32233 EXPIRES: 7/7/2019
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.
ADDRESS: PERMITTYPE: DESCRIPTION: VALUE OF WORK:
1649 E PARK TER REROOF SHINGLE shingle re-roof FI-10124.1 $13000.00
TYPE OF REALESTATE BUILDING USE
ZONING: I
SUBDIVISION:
CONSTRUCTION: NUMBER:
GROUP:
1720200212 SELVA MARINA UNIT 06
COMPANY: ADDRESS: CITY: STATE: IIIlllllllllllllllI�4 I
PIMENTEL ROOFING INC 402 St. Augustine Blvd. JACKSONVILLE FL 32250
BEACH
OWNER: ADDRESS: ���K—STATE: ZIP: —
HULLENDER ALAN T 1649 E PARK TER ATLANTIC BEACH FIL 32233-5846
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 $120.00
STATE DBPR SURCHARGE 4SS-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 4SS-0000-208-0600 0 $2.00
TOTAL:$124.00
Issued Date: 1/8/2019 1 of 2
Building Permit Application
Updoted 1019118
City of Atlantic Beach Building Department
"ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: Permit Number:
&rk I kA75-i�
Legal Description 1-0ibo 9,9� 1-P 9-7 Ptr AZ 03 J ;,?� ,6eJnA"hAPE# I 7Zo,20--0212_
Valuation of Work(Replacement Cost)$ Z,,'�I� R— Heated/Cooled SF Non-Heated/Cooled
• ClassofWork: EINew DAddition 2A-Iteration EIRepair ElMove E]Demo E]Pool DWinclow/Door
• Use of existing/proposed structure(s): ElCommercial 26sidential
• If an existing structure,is a fire sprinkler system installed?: E]Yes 2<0
• Will tree(s)be removed in association with proposed project? EIYes(must submit separate Tree Removal Permit) 21�`o
Describe in detail the type of work to be performed:
k 1A) ��e, uydz, 3 o,
Florida Product Approval#_ R 6-,4 F for multiple products use product approval form
Property Owner Information
Name 7–p dd t(44 AmSk Address Pxih 7_&ff, )CA<t_
Zip 7
City LA_,A-0 State P h o n e
E-Mail
Owner or Agent(if Agent, Power of Attorney or Agency Letter Required)
Contractor Information
NameofCompany —Qualifying Agent '_K6L/nJ*#p,
Address 41e,'t, 4-r� A-,4,- C i t�M /, f3",Pk State Zip—gz.z
Office Phc�ne f6//_ Job Site Contact'Number
State Certification/Registratio�#'6CC,(3!20 iaZ-5 11 E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Ei Expiration Date & -2020
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 regulating
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 ATTORNE FIORE
RECORDING CE OF COMMENCEMENT.
(Signature of Owner or Agent) (Sigr,
Signed and sworn to(or affirmed)befo!q me thi da
is y of Signed and sworn to(or affirmed)before me this day of
:221q by 11A,.)d by v,,_w
(Signature of Notary)' (Signature of Notaryi
,qr Notary Public State of Floncla
.t'
k0ersonally Known OR Notary Public State of Flonda ersonally Known OR S
SUS 4e usanna L Pe,'rI: 5
Susanna L Pearl
GG
My C=�'"—: 22720]
x
Produced Identification Susanna L Pearl Produced Identification My Commission GG 227205
My Commission GG 227205 %0, Expires 0611112022
Type of Identification: pe of Identification:
NOTICE OF COMMENCEMENT -7 2�-O 2,0 65 U2-
State of R ., Tax Folio No.
County of-,hL4-Ijek
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:Q,3 13 2-5,-lz& Ag r�,fi 4'-ibo 12-ESJ-6
V
Address of property being improved: r 12.
General description of L-b� e- IA? 122
2 C,:
A4, e
Owner: -7 dq� tj 641 Address:i-/-4(f
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: L
Address:.. lvz�f ra�)ea-
TelephoneNo.:_ Fax No:
Surety(if any)
Address: Amount of Bond
Telephone 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 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 Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
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
Doc#2019005706,OR BK 18652 Page 675, Date:
Number Pages: I ;efore me this day of 2/9/4L—in the County of Duval,State
Recorded 01/08/2019 01:12 PM, )f Florida,has personally appeared j�( - W1,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Jotary Public at Large,State of Florida,County of Duval..
COUNTY
RECORDING $10.00 4y commission expires: 0 n zz, Nelefy Publis State 4 F1011da
lersonally Known:*=-21-0-04ri 4P Susanna L Pearlor
Iroduced Identificai'lo'n: My Commission GG 227205
tXP1fVt$Oef I U2022
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