785 PLAZA RERF19-0008 ROOF PERMIT REROOF SHINGLE PERMIT PERMIT NUMBER
AMkCITY OF ATLANTIC BEACH RERF19-0008
_ 800 SEMINOLE ROAD ISSUED: 1/14/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 7/13/2019
MUST CALL INSPECTION • • • 14) 247-5814 BY + PM FOR • •
ALL • 'K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • '
CODE, ' OF + NTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE
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: PERMITTYPE: DESCRIPTION: VALUE OF WORK:
785 PLAZA REROOF SHINGLE SHINGLE ROOF $9500.00
TYPE OF
• • • •
171117 0000 ROYAL PALMS UNIT 01
COMPANY: ADDRESS:
FLORIDA ROOFING 4320 DEERWOOD LAKE PARKWAY
JACKSONVILLE FL 32216
EXPERTS 1001-403
• ADDRESS:
DIPIETRO JAMES M 785 PLAZA ATLANTIC BEACH FL 32233-3907
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 . •
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 4SS-0000-322-1000 0 $100.00
STATE DEER SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 4SS-0000-208-0600 0 $2.00
TOTAL: $104.00
Issued Date: 1/14/2019 1 of 2
Building Permit Application Updated 10/9/18
C
r
City of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
f S) Phone: (904) 247-5826 Fax: (904) 247-5845 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 7be p��C�L� R1� Permit Number: P\ C—_KF I ` Q 008
Legal Description V_Oyo.k `A\rr15nn �1/►i�r l.p� 21 _R:A% -- 1 RE# \-1 I WOO
Valuation of Work(Replacement Cost)$ _I � Heated/Cooled SF Non- Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): Mcommercial ❑✓ Residential
• If an existing structure, is afire sprinkler system installed?: ❑Yes ❑✓ No
• Will trees be removed in association with proposed ro ect? es must submit separate Tree Removal Permit `❑No
Describe in detail the typt~of work to be performed: ge-r-Op I 730 S � f S/) a
Florida Product Approval# )1 0 V2 `A — ?,10 C7 ifor multiple products use product approval form
Property Owner Information
Name MAV,6AV,9-f D l Address '7 7tr)�Z-A fLV
City ,411rA(4i tc. meq,«` State_ Zip 32_Z51L Phone
E-Mail aSQ 121T1,14yD b Z- iEb Ani CDM
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) n/a
Contractor Information r
Name of Company vAor' `;, � CX \� Qualifying Agent rr"�
Address cA320 %),"v.1 q* LP v-{ X_-,r `ioz) City -$^�c State Fe- Zip 322 1 LP
Office Phone C71 2 ( ` ((o Job Site Contact Number
State Certification/Registration# ( ( \3Z90 Z E-Mail V\0i1CSG�cOoR-;rw, '!>eou+10oic- tom
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer OR Exempt❑ Expiration Date 1 2dZ
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 ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
of
Si a nd4worn to (or affirm d) before me this -L Iday of Si ned and sworn to(or affirmed) before me this t 0 day of
Zo t , b ,raac - -LO lot , by __TcxWAS S\..VLJA4er
gnaWt_''r ff%N%n_rarV g re of Notary)
�votill�Pu'D1iC Jt9 a of Florida
Katharine Dotlar
�t My Commission GG 207552 . °rp- TIFFANY NEAL
t> Exp me 0411 W022 o1�ar ops
p^ �ersonall Known OR /z ` MY COMMISSION#GG229074
[ ] Personally Known OR /N4, personally {
Produced Identification � [ ] Produced Identification j EXPIRES:JUN 14,2022
Tvoe of Identification: s:-I:) C��— Type of Identification: I '' " f Bonded through 1st State Insurance
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No._
State of County of
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:
Address of property being improved: J 1 � C
General description of improvements:
Owner �k#,"d 4A 12
r i?t1l"
Address 7 S- V L A Z si - Z-- rl
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor VAO r%cS4.
Address 0 Y—W L ' 2av
Phone No �� �2���0�410 Fax No.
Surety(if any)
Address Amount of bond$
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 or herself,designated by owner upon whom
notices or other documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself or herself,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
Address
Phone 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
G mo
Sign E l��7'�Ils n?m
Before me th's 1 day of _in the a �
Coyy��,��jjr of Duval,State of Florid asp onal�y app ared $3 c
ton
(U _herein by .0' Cr
Doc#2019008840,OR BK 18656 Page 679, himself/herse nd affirms that all statem nts and declarations herein s o o N
are true and urate ro y—
Number Pages: 1 n,C) m
Recorded 01/11/2019 11:21 AM, N 4
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL 0Ch
o
COUNTY N m
RECORDING $10.00 Notary Public at Large.Slatp.of County of
My commission expires:
Personally Known or
Produced Identification �[