1075 ATLANTIC BLVD RERF19-0011 ROOF PERMIT REROOF SHINGLE PERMIT PERMITNUMBER
CITY OF ATLANTIC BEACH RERF19-0011
800 SEMINOLE ROAD ISSUED: 1/17/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 7/16/2019
MUST CALL INSPECTION • • • 14) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT6TH EDITION1 OF • ' i BUILDING
CODE, ' OF • OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY,
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:
1075 ATLANTIC BLVD REROOF SHINGLE SHINGLE ROOF $9500.00
TYPE OFBUILDING USE
ZONING: :D •
iL • • GROUP:
177508 0000 SECTION LAND
COMPANY:� ADDRESS:
SUNBELT HOMES AND 450-106 STATE ROAD 13 NORTH, #409 ST. JOHNS FL 32259
ROOFING, LLC
• ADDRESS:
CAMPBELL VELMA KAHOE 1435 SCOTT RD JACKSONVILLE FL 32259
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 4S5-0000-322-1000 0 $100.00
STATE DBPR SURCHARGE 45S-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 45S-0000-208-0600 0 $2.00
TOTAL: $104.00
Issued Date: 1/17/2019 1 of 2
;f=L''r%, Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
``j vT
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
R Q
Job Address: 1 O 1 � A 1 LArJ1Z L (1L V I) Permit Number: ' l s' `ri 9
Legal Description 39-1.5-196 1.1% IR IX CANT(Lu Y FC(Lak(L GnAmf RE# 1-11 -11509 -0000
p P R�CQ Oim i G)`9 -1134
Valuation of Work(Replacement Cost)$ q S b 1) - Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration /Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): [/Commercial ❑Residential//
• If an existing structure,is a fire sprinkler system installed?: Dyes GdNo //
• Will trees be removed in association with proposed roiect? Dyes must submit separate Tree Removal Permit BN0
Describe in detail the type of work to be performed:
R.C (LOQ P ) S _S AfLF, IJG1,CS 1=( i 91SS, i :1
Florida Product Approval# I ) for multiple products use product approval form
Property Owner Information
Name V I'L M A CAMP 6 f:L L- Address 19 3 S C O'1"7 R p
City SA 1 AI K Su HN S State F L Zip *1115'01 Phone 01 O y - 403 -9101-
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
NameofCompany SL-nJ ✓LI' DOMES Atr) RU0(-,,JG Qualifying Agent T�IUmAs Q Siy1,�u
Address 450-106 SIL 13 AJ City SAiAK To RW State FL Zip 312-s9
Office Phone q U LI- 63 S- -7 019 Job Site Contact Number q o c,i- 61S- -)u 1c)
State Certification/Registration# CCC 111168 i E-Mail S w nJ✓3l=L f LANA 001AW a AOL.CO M
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer (IH f t UEILS /nH 1 aA(1 OR Exempt❑ Expiration Date i l -11 -1 c)
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
RECO D YOU NOTICE OF OMMENCEMENT.
/ (Signature of wner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this I -)nday of Signed and sworn to(or affirmed)before me this L-) day of
rJ aoiTby ✓EL✓1A (Am L a I 0 by T S
`�� ,., MATT
State of Florida-Notary(ra1t41ia re of Notary)
•E Commission M FF922966
E> M�?+�� p ;;�la �-' My Commission Expires
- flosd�d7lMuNot�ry��rshis 10-11-2019
Personally Kno
[ ]Produced Identi [Produced Identification
Type of Identification: Type of Identification: rt OL s 9 y' �Y VL,C_),146, 0
NOTICE OF COMMENCEMENT
State of 1" L O CL Z D A Tax Folio No. I �7 -1 S 08- 0000
County of 0 kA\./I\ L
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: -1�? 2S C 1 _1 Lf6 Q 0 C C AST2h `( r617-RL R_ _
GRANT PT- fRCctD QJ(L INolicV� - 1434
Address of property being improved: 10_) S A T L A/J rT C G LtrQ AT LAInJI.1c Ugh t✓l 31133
General description of improvements: R f%R u C
Owner: A CAmPRE1_L, Address: 143( 2u-r/ RD SAINT EC 321501
Owner's interest in site of the improvement: —
Fee Simple Titleholder(if other than owner):
Name:
Contractor: S L rJ 66lT k%niIrS iAOb fLvv fdC 1,L L —
Address: 9SO— 10(, SfR 11 d #405 _SAIIJ'f PtjS r 3225°►
Telephone No.: %9- 6 ��1�} 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
/ A
Doc#2019013859,OR BK 18662 Page 1575, Signed:
Number Pages:1
Recorded 01/17/2019 03:15 PM, Before me this 7 day of S u I,State
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Of Florida,has personally appeare _
COUNTY Notary Public at Large,State of Flo f D NO"Vikk e�wdba
RECORDING $10.00 commis xpires:
Personally Known or
Pro uce ication: