971 AMBERJACK LN RERF19-0009 ROOFING PERMIT s
REROOF SHINGLE PERMIT PERMIT NUMBER
rCITY OF ATLANTIC BEACH RERF19-0009
800 SEMINOLE ROAD
ISSUED: 1/16/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 7/15/2019
MUST CALL INSPECTION • • • 1 PM FORDAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • ' ! BUILDING
CODE, ' AND CITY OF • ! OF ORDINANCES .
ALL CONDITIONS OF • • !
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:
971 AMBERJACK LN REROOF SHINGLE SHINGLE ROOF $11683.00
ZONING:TYPE OF REALIESTATE BUILDING USE
:D •
CONSTRUCTION: NUMBER: GROUP:
171173 0000 ROYAL PALMS UNIT 01
• , ADDRESS:
PRIME ROOF 13725 BEACH BLOULEVARD, #13 JACKSONVILLE FL 32224
CONTRACTING LLC
OWNER: ADDRESS:
LUNDGREN ERIK 971 AMBERJACK LN ATLANTIC BEACH FL 32233-4226
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
BUILDING PERMIT 455-0000-322-1000 0 $110.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $114.00
Issued Date: 1/16/2019 1 of 2
Building Permit Application
City of Atlantic Beach
J 800 Seminole Road,Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904) 247-5845 G�
Job Address: 971 Amberjack Ln. Permit Number: G p 1_
Legal Description 30-60 17-2S-29E ROYAL PALMS UNIT 1 LOT 19 BLK 4 RE#
Valuation of Work(Replacement Cost)$11,683 Heated/Cooled SF 1339 Non-Heated/Cooled 218
• Class of Work(Circle one): New Addition qIteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial IEsidentia
• 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: Replace roof with asphalt shingles and modified bitumen rolls
Florida Product Approval#FL10674-R12 (shingles) FL9777-R11 (peel and sticl4r multiple products use product approval form
Property Owner Information FL19979-R1 (modified)
Name: Erik Lundgren Address: 971 Amberjack Ln.
City ATLANTIC BEACH State_FL Zip 32233 Phone (904) 537-6182
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: Prime Roof Contracting, LLC qualifying Agent: Mark Young
Address 13725 Beach Blvd Suite 13 City Jacksonville State FL Zip 32224
Office Phone (904) 530-1446 Job Site/Contact Number (904)860-0230
State Certification/Registration# CCC1329505 E-Mail office@primeroofingfl.com
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation FRSA Self Insurers Fund Inc. 12/31/19 870-040093/3EE6142 _
Exempt/Insurer/Lease Employees/Expiration Date R
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has E
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.
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
RECO DINP YO,6 NOTICE OF COMMENCEMENT.
-tul'i ,,
(Signature ner or Kgent including Contra r) (Sig6irmed)
ture of Contr or)
Si ned and sworn to(or affirmed)before me this day of Si ned and sworn to(or bef a me this 10— day of
I �LCl, by �� I; Lu Onvo , Z611 by Mark Jov,,A
Sizatur of N tar ) (Signature of Notary)
-.;And% D. Davis Andrew D Davis
C MMISSION#cc24WO ► ���' '
q/ _,� *=COMMISSION#GG2412N
[ ]Personally Known OR , ��+ EXPIRES: SePt 17,2024,1 Personally Known OR EXPIRES: Sept �7 2022
[,.}Produced Identification '�''� to I���`� Bor&Y Th['U ARM Nobgl Produced Identification 'y,� `�` '
Type of Identification: FL Th1U�M��DI Type of Identification: ���Milt`��
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of Florida - 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 Section 713 of the Florida Statutes,the following information is stated In this NOTICE OF
COMMENCEMENT.
Legal description of property being improved:30-60 17-2S-29E ROYAL PALMS UNIT 1 LOT 19 BLK 4
Address of property being improved:971 Amberjack Ln.Atlantic Beach,FL 32233
General description of improvements:Re-roof
Owner Erik Lundgren
Address 971 Amberjack Ln.Atlantic Beach,FL 32233
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Prime Roof Contracting,LLC
\v� Address 13725 Beach Blvd Suite 13,Jacksonville,FL 32224
Phone No.(904)625-1446 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,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
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 ✓/
Signed: DATE S
Before s ay of M in e J
CounryBf ;pl,Stajeuo'fnFela'�^personal) appear y.Ql �n (1< D. Davis
l' ICL e C u
are true herself and affirms th all statements and d=�o e t �0N#082412M
are true and accurate 3 gC WL
Doc#2019011947,OR BK 18660 Page 381, +F EVIREs:Sept 17.2022
Number Pages: 1 n ��TM As=NOWY
Recorded 01/16!2019 10:43 AM, D!%„`—_—'
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Notary Public at Large,State f . County of
COUNTY My commission expires:
RECORDING $10.00 Personally Known or
Produced Identification f f—