1798 SELVA MARINA DR REROOF SHING PERM REROOF SHINGLE PERMIT PERMIT NUMBER
r CITY OF ATLANTIC BEACH RERF19-0024
V~ 800 SEMINOLE ROAD ISSUED: 2/8/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 8/7/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • '
CODE, ' OF iNTIC BEACH CODE OF • '
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.
----JOB ADDRESS: PERM-IT TYPE: DESCRIPTION: VALUE OF WORK:
1798 SELVA MARINA DR REROOF SHINGLE shingle re-roof- FL183551, $17985.00
19948, 161601
TYPE OF
ZONING: : � •
• • • •
172012 0000 SELVA MARINA UNIT 05
COMPANY: ADDRESS: CITY: STATE: ZIP:
JACK C. WILSON ROOFING 4522 STAUGUSTINE RD JACKSONVILLE FL 32207
CO.
• ADDRESS:
REITER DEE D 1798 SELVA MARINA DR ATLANTIC BEACH FL 32233-5618
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 $140.00
STATE DBPR SURCHARGE 45S-0000-208-0700 0 $2.10
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $144.10
Issued Date: 2/8/2019 1 of 2
ri' ''f% 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
Phone: (90�4)� 2(47-5826 Email: Building-Dept@coab.us n IS REQUIRED.
Job Address: 1 3(�IUV�' J�j(�ya�_ 1J�i Permit Number:
Legal Description �(?� �^ 1 J(. I_��9LV Pc' 17"1y�f lv� V �' RE#
Valuation of WorkRe lacement Cost r—
( P ) $ 1� � d - �` Heated/Cooled SF Non-Heated/Cooled ,r /
• Class of Work: ❑New ❑Addition ❑Alteration ❑RepairZivdential
ve []Demo ❑Pool ❑Window/Door r 'C-CCC,'4� V
• Use of existing/proposed structure(s): ❑Commercial C
• If an existing structure, is a fire sprinkler system installed?: Dyes PN0
• Will trees be removed in association with proposed roiect? ❑Yes must submit separate Tree Removal Permit ❑No
Describe in detail the type of work to be performed:
Florida Product Approval# �i_ 777 for multiple products use product approval form
Propertv Gwner Information _
Name ' ° ,__ & Address
City L State Phone �•
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Com any ` CO Qualifying Agent
Address 1A I City State -Zip-IA 1
Office Phone Job Site Contact Num er C
State Certification/Registration# E-Mail
�.
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer 1 1( OR Exempt❑ Expiration Date G
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or in tal I tion 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=OTICE OF COMMENCEMENT./
(Signature of Owner or Agent) (Signature of Contractor) 2
Si ned and sworn to(or affirmed)befo me this day of Signed and sworn to�r affirmed before a this J day of
LC) by�_rliQ PICik, 1�lG�Y —V I by - ,���I�` _ 0 S
ignature of Notary) Lsig a� LN'aLa
MARIA JOYA
,►Fr'!@a,
KYLE yO ?I �'- Notary Public-State of Florida
[ J ersonally Kno 0 :�� b1yCQMFdISStON#�3248t84 [v] Personally Known OR �d�' Commission A GG 248539
[�roduced Iden or n;' My Comm.Expires Aug 14,2022
e:'
EXPIRES: 13,2022 ( ] Produced Identification Bonded through National Notary Assn.
Type of Identificat n'�9,!^°`' BondeGTlvuµotar Type of Identification: own
Doc # 2019027613, OR BK 18680 Page 270, Number Pages: 1,
Recorded 02/04/2019 02 :50 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10. 00
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE) �f
Permit No. Tax Folio No.
State of County of_ 1- Ec in,
To whom It may concern:
The undersigned hereby Informs you that improvements will be made to certain real.property,and In
accordance with Section 713 of the Florida Statutes,the following information Is.stated In.thls NOTICE OF
COMMENCEMENT. ` n Q q
Legal description of property being Improved: WE h '✓` 1
5C-1 VA &Vi,V1(� Ch1
Address of propertybeing improved: I O V Marino
h Ad4M c't t; c , E& 52-2-331
General description of improvements: ke�c)
Owner
Address 1`-4 V v l . i ► . L L r 32-7-3-:2j
Owner's Interest in site of the Improvement D
Fee SimplerTjt(eol�ej�(if otCe�.��p Qtr g()•
Name
Address.
Contractor 1 JACK C.WILSOM ROOFING
Address. ;' ;;. 4522 St.Augustine Rd.,
x Jacksonville 2
Phone No. ` ° : , FL 320�Fa>t.Nr! '
Surety(if any) ' '; (904)396-1546 :':._.:
Address; Amount of bond$
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 maybe served:
Name
Address
Phone No. Fax No.
Inaddition to himself or herself,owner designates the following person to receive a copy of the Lienor's Notice as
provided in Section 7.13:06(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 �11
different date is specified): �;r
"mom�i
THIS SPACE FOR RECORDER'S.t1SE ONLY OWNER ���`z
signed: p
Before Me 1 Is day o L
U q
Count val, ay Flo i spersonal ppeared
h herein by
hlmselU or fir s th§La11-sf-a5ement a rain E 3
are trueand curate
g
9
Notary Public at Large,Sl eof -, county of. ;�'1fo :
My commission expires:
Personally Known or
Produced Identification
c