345 1ST ST REROOF SHING PERM REROOF SHINGLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RERF19-0025
800 SEMINOLE ROAD ISSUED:
ATLANTIC BEACH. FL 32233 EXPIRES:
MUST CALL INSPECTION • i • 1 i FOR +Y INSPECTION.
ALL • ' K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • ' D+ BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL i • 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: PERMITTYPE: DESCRIPTION: VALUE OF WORK:
345 1ST ST REROOF SHINGLE SHINGLE ROOF $10058.00
TYPE OF
i • GROUP:
169766 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
PRIME ROOF 13725 BEACH BLOULEVARD, #13 JACKSONVILLE FL 32224
CONTRACTING LLC
• ADDRESS:
AVENS MARK 345 1ST ST ATLANTIC BEACH FL 32233-5227
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 455-0000-322-1000 0 $105.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $109.00
Issued Date: 1 of 2
Building Permit Application
City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
a Phone: (904) 247-5826 Fax: (904)247-5845 r�
Job Address: 345 1 st St., Atlantic Beach, FL 32233 Permit Number: C- RV, Q1 - �/ C-)
Legal Description 5-69 16-2S-29E ATLANTIC BEACH W 44FT LOT 14,E 30.8FT LOT 16 BLK 3 RE#
Valuation of Work(Replacement Cost)$10,058.00 Heated/Cooled SF 1837 Non-Heated/Cooled 266
• Class of Work(Circle one): New Addition QgREiDRepair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial 1esidentia
• 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
Florida Product Approval#FL10674-R12(shingles) FL9777-R11 (peel and stick) for multiple products use product approval form
Property Owner Information
Name: Mark and Nicole Avens Address:
City ATLANTIC BEACH State FIL _Zip 32233 Phone 904-866-1200
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-off ice@ primeroof ingf Lcom
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
RECORDING YOUR NOTICE OF COMMENCEMENT.
J�Vwu_//
(Signature of Owner or Agent including Contrac or) (Sig at re of Con ctor)
Sj&peo and sworn to(or affirmed)b fore e this Ilk day of Signe and sworn to(or bffirmed)b ore me this day of
Zoi.q by—AObY
igna Andrw)D. Davis atftmw D. Davis
•��'__COMMISSION#OG241220 __ COMMISSION#G0241220
[-personally Known OR EXPIRES: Sept 17,2022 [,personally Known OR y,,, EXPIRES: Sept 17,2022
[ ]Produced Identification ����t W Thm AM [ ]Produced Identification ��ed ThfU Am NoWy
Type of Identification: Type of Identification: __
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:5-69 16-2S-29E ATLANTIC BEACH W 44FT LOT 14,E 30.8FT LOT 16 BLK 3
Address of property being improved:345 1 st St.,Atlantic Beach,FL 32233
General description of improvements:Re-roof
Owner Mark and Nicole Avens
Address 345 1st St.,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
Address 13725 Beach Blvd Suite 13,Jacksonville,FL 32224
41� 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:me //n5 DATE
Before this day of { (�� __
Of wal ySA tate of Florida,has personally app rile my p Davi
V
.
him—�selfl1 hetf/andyiwalltrmA s that all statements an C r 1
Doc#2019027519,OR BK 18680 Page 45, are true and accurate =« ' ;�__COMMISSION I GG241220
Number Pages: 1 i EXPIRES: Sept. 17,2022
Recorded 02/04/2019 02:13 PM, � � �, ��Notary
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL �� nu► `�
COUNTY No ary Public at Large,st o County d
RECORDING $10.00 My „ es;
Personally Known _ or
Produced Identification