326 6TH ST REROOF SHING PERM REROOF SHINGLE PERMIT PERMIT NUMBER
S RERF19-0030
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ISSUED: 2/19/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 8/18/2019
CODE,MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
' OF BEACH CODEOF 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: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
326 6TH ST REROOF SHINGLE SHINGLE ROOF $7040.00
TYPE OF
• • GROUP:
169860 0000 ATLANTIC BEACH
• . . ADDRESS:
SUNBELT HOMES AND 450-106 STATE ROAD 13 NORTH, #409 ST. JOHNS FL 32259
ROOFING, LLC
• ADDRESS: STATE:
DEITCHMAN TAMI L 332 6TH ST ATLANTIC BEACH FL 32233-5348
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.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $90.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 45S-0000-208-0600 0 $2.00
TOTAL: $94.00
Issued Date: 2/19/2019 1 of 2
Building Permit Application Updated 1019/18
City of Atlantic Beach Building Department "ALL INFORMATION
V 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: Z S f A I L AN F3(_ Q W/3 Permit Number: 0 0J
�' VA � )J - 201 L A TLAwtc. GeAC41 to( I IGRE# qg�,0 ' 00 d
Legal Description � -
Valuation of Work(Replacement Cost)$ —) 0 y 9 L� Heated/Cooled SF Non-Heated/Cooled
• Class of Work: [--]New ❑Addition ❑Alteration LAepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial EAesidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes 1210
• Will trees be removed in association with proposed ro'ect? ❑Yes must submit separate Tree Removal Permit [?'No
Describe in detail the type of work to be performed: ��`
r� roc 1= 11 S `L. 1555. ► 1
Florida Product Approval# 3 S�� . I for multiple products use product approval form
Property Owner Information
Name Tarn; deJ4, tncn Address 33-?
City State ]=1 Zip :32313 Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
NameofCompany S1-J1Jf3L-t -( Wu/hel AN0 (zuori,JG Qualifying Agent TWC51A4 Q -SMIfAl
Address t1SL) 'i0,t S;", I1 N �'Ht,�1 CitySAg4< •SoNnJ_% State r- L- Zip 311j 1
Office Phone 9 OH• 635 - Job Site Contact Number
State Certification/Registration#.0 C 13 L•7 6 S I E-Mail S UNQi5L-f LAn10 NOM&S e AOI. COM
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer JI to i t.06% rnu-TL,AL_ OR Exempt o Expiration Date
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)
Signed and sworn to(or affirmed)before me this day of tSigned and sworn to(or affirmetdn),before me this 11 1day of
r6 -1oli by'1^ Mq1r �y��y T' i)(1<Cli�1 /IgY�1
J� h\
(Signature of Notary) (Si gnature of Notary)
1kw 6wlDLet sMITM :: v!^►g CAM M INB.Y
/Per,onally Kno # �+ MYCOMMISSIONf0000d103
��� [ Personally Known OR WCOIg1M$ "0 Go2� W
[ ]Produced Ident i K= EXPOS' [ ]Produced Identification Ya EKP &FeDf MS.2=
Type of Identificati Bo"ThmHO� UW Type of Identification: �•
%"'� Baidedllru PubkL%hmsbm
NOTICE OF COMMENCEMENT
!PREPARE IN JUPLICA T E) ] /
Permit No. Tax Folio No. / l7 f V 0–
State of L O n :pA ca
County of p t,,t1+4 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: �' 69 ' S- ?.5 1� A TLA,y i C- t?L--A(*jl
LoT– -1 – 3Lk D
Address of property being improved: 'L16 6 6 �' ST A f t AiJ I-y—C UAch rL Ii –11
General description of improvements: FLK 00
Owner 1 A rA I p r✓ fcH rnAAJ
Address ATL-/dn1TSC, 9LA(h rL
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor S tAd Cie[.,( Wymr A AV4 Ruo r>j(; LLC,
Address 1150- 106 22 13 d JA LIA SAAR- l" 3oNN.1 CC 112SO)
n n} Phone No.3 0 9-X35-7 l', ) Fax No.
Jam' 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 ONLYSigned DAT;:
E
r q
j Before mis day o -_ ?1i in the
County of uval.State of Florida,has It a peared
�✓�I� n�ETC>,AWN herein by
himseltl herself an affirms that all statements and declarations herein
Doc#2019036180,OR BK 18691 Page 704, are true and accurate
Number Pages: 1 ,m 'a, THOWSaWLEYSMITH
Recorded 02/13/201902:58 PM, 0 ffyOpmMlgglON#000081Q3
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL ��(//� ,Y? EXPW&Aupust2$2Mp
COUNTY '%', A ¢�' Bond�dThfuMolnYt�tbMclfndefrrrt0eft
RECORDING $10.00 Rotary Public at Large.State of
aza-
Daltion
ires:
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