66 11th Street West REROOF REROOF SHINGLE PERMIT PERMIT NUMBER
r � CITY OF ATLANTIC BEACH RERF19-0033
V 800 SEMINOLE ROAD ISSUED: 3/5/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 9/1/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL • 'K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF i '
CODE, ' AND OF + BEACH • OF ORDINANCES .
ALL i i 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: PERMITTYPE: DESCRIPTION: VALUE OF WORK:
66 W 11TH ST REROOF SHINGLE SHINGLE ROOF $6784.00
TYPE OF
• iGROUP:
1708110200 ATLANTIC BEACH SEC H
COMPANY: ADDRESS:
SOUTHERN COAST 3622 GALLION RD JACKSONVILLE FL 32207
ROOFING & CONS
• ADDRESS:
MANN L CHARLES 165 ARLINGTON RD N JACKSONVILLE FL 32211-7863
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.
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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 $85.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $89.00
Issued Date: 3/5/2019 1 of 2
J ` Building Permit Application
lat„I.a p Updated 12/8/17
City of Atlantic Beach
”- 800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845 '�
Job Address: 66 W 11TH ST ATLANTIC BEACH FL 32233 i c�Q P I
Permit Number. r` l
Legal Description 18-34 38-2S-29E.11 ATLANTIC BEACH SEC H LOT 2 BLK 64 RE# 170811-0200
Valuation of Work(Replacement Cost)$ 6,784.73 Heated/Cooled SF 1280 Non-Heated/Cooled 1250
• Class of Work(Circle one): New Addition Alteration epair ov o Pool Window/Door
• Use of existing proposed structure(s)(Circle one): Commercial Residentia
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No C 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:
TEAR OFF RE ROOF SHINGLE TO SHINGLE TOWNHOME 2 STORY RESIDENCE (� S
Florida Product Approval# FL10124 FL [9. ( for multiple products use product approval form
Property Owner Information
Name: CHARLES MANN Address: 165 ARLINGTON RD N
City JACKSONVILLE State FL Zi 32211
E-Mail p Phone 904-721-1547
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company:SOUTHERN COAST ROOFING Qualifying Agent:MEHMET ORS
Address 3622 GALLION RD City JACKSONVILLE State FL Zip 32207
Office Phone 904-356-7663 Job Site/Contact Number TY KARAKUS 904-304-3939
State Certification/Registration# CCC1328796 E-Mail OFFICE@SOUTHERNCOASTROOFING.US
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation FRSA/EXEMPT 12/31/2019
Exempt/Insurer/Lease Employees/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 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.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) sture of Contractor)
(including contractor)
Signed and sworn to(or affirmed)before me this l�day of Signed and sworn to or affirme )before me this_day of
ao< by �. Ch��lcr N[�•,,i by
(Signature of Notary) (S nature of Not ry)
[ Personally Known OR "`'e JUDITH D.CALIFANO [qPersonally Known OR 9
:+'•'• PAMELA SOMPHONPHAKDY
[ J Produced Identification MY COMMISSION 9 GG297281 :
[ ]Produced Identification
>�-.:r EXPIRES January 31,2023 MY COMMISSION#FF-221913
Type of Identification: 'x .- Type of Identification: EXPIRES19.2019
NC/,3A8 C'b' Fbndallota SoNre.ca
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of FLORmn
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: RE# 170811-0200
LEGAL DESC.18-34 38-2S-29E.11 ATLANTIC BEACH SEC H LOT 2 BLK 64
Address of property being improved: 66 W 11TH ST Atlantic Beach FL 32233
General description of improvements. RE ROOFING
owner MANN L CHARLES
Address 165 ARLINGTON RD N JACKSONVILLE,FL 32211
Owner's interest in site of the improvement 10006
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor SOUTHERN COAST ROOFING AND CONSTRUCTION INC
Address 3622 GALLION RD JACKSONVILLE FL 32207
Phone No.904-356-7663 Fax No. 904-33(00836
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 /1 �OWyNER
Signed: 11ff l -u� //-Ua--+ ' DATE 3
Beton me a* dayof
-YY,-?aso
appeared
C _P. . . h the
Doc??2019049646,OR BK 18708 Page 267, C7*1 s s F `'�/�9 N to heraln by
Number Pages:1 titnwmharsa herein
Recorded 03/05/2019 10:44 AM, we hue andwiWi"
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL JUDITH D.CALIFANOCOUNTY MY COMMISSION#GG297281
RECORDING $10.00EXPIRES:January 31,2023
Notary Public at Large.State of I of . .• �� �
My commisslon wares: /— -
Personally Known or
Produced tdentMkatlon