425 ATLANTIC BLVD REROOF SHINGLE REROOF SHINGLE PERMIT PERMIT NUMBER
RERF19-0032
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 2/20/2019
19r ATLANTIC BEACH. FL 32233 EXPIRES: 8/19/2019
MUST CALL INSPECTION • • 914 ' BY 4 PM FOR NEXT DAY INSPECTION.
ALL • ' K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • '
CODEJ. NEC, IPMC, AND OF ATLANTIC BEACH i OF ORDINANCES .
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: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
425 ATLANTIC BLVD REROOF SHINGLE SHINGLE ROOF - WEST $10200.00
BUILDING
TYPE OF •
ZONING: :D •
• • GROUP:
170696 0000 SALTAIR SEC 03
COMPANY: ADD.
FIRST COAST HOMES LLC 1719 10TH STREET NORTH JACKSONVILLE FL 32250
BEACH
• ADDRESS: CITY:
BEACH HOSPITALITY
SERVICES 1520 REPUBLIC DR ATLANTIC BEACH FL 32233-4021
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 45S-0000-322-1000 0 $10S.00
STATE DBPR SURCHARGE 45S-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$109.00
Issued Date: 2/20/2019 1 of 2
Building Permit Application Updated 10/9/18
r City of Atlantic Beach Building Department "ALL INFORMATION
r �rs3�r v 800 Seminole Road, Atlantic Beach, FL 32233
HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED. 7_
Job Address: A"c I%L3��233PermitNumber: R&REI
Legal Description/O"/G SFC 3 Lo'ft, Sr 34 4o- Fi,3JSS-ORE# t.�D6 Q� G'000
Valuation of Work(Replacement Cost)$ /O, .100, "c" Heated/Cooled SF Non-Heated/Cooled
• Class of Work: "ew ❑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?: ❑Yes )4No
• Will trees be removed in association with proposed roiect? Dyes must submit separate Tree Removal Permit No
ECS,
cribe ip detail the type of work to be performed: en►OJC /jQ a /c Q 5�1i a/�' 5A.v�5r,t S n i'! 7 >•
.loA+�-5 Knocun Co. -&ka V✓r T Ung}' ph t�►� P-0 to
Florida Product Approval# /O 5_ 6, r for multiple products use product approval form
:.451 e C4 e r 0.y/It —'
Pro ert Owner Information V K J p V
Name Iliv le r � C�H(5sPtTAA aTdrss c�'1r� fly
"
City �Jaci�ont11 c s State rX Zip 3.2250 Phone `JOt1-3d 3!!rS q7
E-Mail 5 Y ' 4 i lo
It, r'7
Owner or Agent(If Agent, ower of Attorney or Agency Letter Required)
Contractor Information 01 °
NameofCompany F�+-<+ t He:MG5 ' L�QualifyingAgent �Ovslks C, lat^f`
Address /?/ 9 /Q !�1*Ye et /li'c+r4-l. City,j ks,tti//r f3eacti State F_Zip
Office Phone Roy- 5-409 '.181 q Job Site Contact Number -
State Certification/Registration# 13-?l,30 E-Mail
Architect Name&Phone# 1\VA
Engineer's Name&Phone# Al/
Workers Compensation Insurer OR Exempt Expiration Date 1.2 ,2_0_/_
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
RECOR I G YRWOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this-4,4day of Signed and sworn to(or affirmed)before me this A%of
ary asy �Scl<� _, , by hOv 12S 0. �zn'
.�
Signature of Notary) (S nature of Notary)
ALLYSON DOERR
�o.�' ALLYSON DOERR ,Stafe of Florida-Notary Public
SState of Florida-Note Public [ Personally Kno r._ Commission 0 GG 178343
[/Personally Commission *GG 178343 Produced Iden M Commission Expires
[ ]Produced I B [ 1 Y P
My Commission Expires Type of Identificat a° January 24, 2022
Type of Identi at(b iu. lary 24 202
NOTICE OF COMMENCEMENT
State of rJo OXO- Tax Folio No. J r?0C 96 0000
County of ` ,LIVoL(
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: l G " /la '�/— -. S -')� Fic 3
Address of property being improved: 415- 44)a,4i � 1 Vi, /Ha,4ble- 16cr-Le-,41 , �1 3223_J�
General description of improvements: J M L/ A)G r3lace_ Q 5.0A ct_1'>< S �+ ✓��,leS Un 7 i
n 6j w wg. G,c�i/'�S'7" U
Owner: AtIVICA A15101 141/ -Z;-7C Address: �
Owner's interest in site of the improvement:Mojh.( 1 jeaci"t /2c,L4,d S
Fee Simple Titleholder(if other than owner):
Name: —
r
Contractor: � �cti4C 1Jaei1 �c Y` S� �C��S (-(0✓�e� —
Address: /o 34CkS0/UUc(/r &3r,617 FL 2;_LZ SG
Telephone No.,:, �qe — s�`t' `1�rJ Fax No:
Surety(if any)
Address: Amount of Bond$ —
Telephone No: Fax No:
Name and address ofany
/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: /(l
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 States.�(ill 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
Doc#2019039646,OR BK 18695 Page 691, Signed: Date: 2)z0 f f
Number Pages: 1 Before this lU day of in the County of Duval,State
Recorded 02/20/2019 11:03 AM, Df Florida,has personally appeared e
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Notary Public at Large,State f Florida,Co ALLYSON DOERR
COUNTY My commission expires. L�{ �� '.o�►"r ,,,
RECORDING $10.00 Personally Known: •= ion#GG 178343o
Produced Identification: ',+ My Commission Expires
nnup enuary22