825 PLAZA RERF19-0039 SHING PERM REROOF SHINGLE PERMIT PERMIT NUMBER
A
CITY OF ATLANTIC BEACH RERF19-0039
800 SEMINOLE ROAD ISSUED: 3/12/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 9/8/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL • 'K MUST CONFORM TO THE CURRENT • 1 OF • ' + BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL • • OF PERMIT APPLY, + + 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:
825 PLAZA REROOF SHINGLE shingle re-roof FL10674-R9 $6000.00
& FL15216-R2
TYPE OF
ZONING: :D •
• • GROUP:
171113 0000 ROYAL PALMS UNIT 01
COMPANY: ADDRESS:
NPS INC 1833 LIVE OAK DRIVE JACKSONVILLE FL 32246
• ADDRESS:
REAL ESTATE PROS OF 8802 RUNNYMEADE RD JACKSONVILLE FL 32257
NORTH FL
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 $85.00
STATE DBPR SURCHARGE 4SS-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$89.00
Issued Date: 3/12/2019 1 of 2
rS Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (9p04) 247-5826 EmailIS REQUIRED.
:Building-Dept@coab.us L
Job Address: 0 2� Q 14 ���rr�1G &JI b -33 Permit Number: 1� j 51-�
Legal Description 30 VO III -Z5 Zai 90,04( PlMkts 004 Y 0 3 /Y5'RE# _0003
Valuation of Work(Replacement Cost)$ (O 0 00U Heated/Cooled SF I, l OO Non-Heated/Cooled y g
r
• Class of Work: []New ❑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 ❑No
• 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:
PC - aoor-
Florida Product Approval# C-L [o k;:2Z4-9,� 1'L 1S 216 -e.Z for multiple products use product approval form
Property Owner Information
Name IZeW O—Ale PzZ (7G#JC_Z_,k* F( CLC- Address UU-2—
City o x State FL Zip Phone C_'oc�-4 -2-6
E-Mail 10-9 f7oQS 2 -, as CSVv,6Zt l. G�✓I
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company SPS Qualifying Agent -AU S 1 d2-C1x
Address 1 $ pe OQ e ` City ,(cj State �C Zip 3
Office Phone o-f n - -1 I U0 Job Site Contact Number 5 C'-0 ZC-Z -
State Certification/Registration# CAC_ 05&"a_7(- E-Mail Ll-I G cjc ►
Architect Name& Phone# N 11J
Engineer's Name& Phone# W
Workers Compensation Insurer a OR Exempt❑ 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 T&YOU PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER-OR ATTORNEY BEFORE
RECORDING Y NOTICE OF COMMENCEMENT.
i
(Signature o er or Agent) (Signature of Contractor)
Sig ed and sworn to(or affirmed)before me this 41f"day of Signe arjCe'sworn to(or affirm #��('tJ11101 rrrIf1'ri day of
001A by G�r10 0,(p or we �� Z'� f. b At'� U e",
001A
rw*&Ari QYZ 1 ci
(Sig atur _ fig ure�o`Y ry) Q
Q Go�
=:Y''"•'y4�. ANGELA BAXLEY
.< MY COMMISSION k FF 897525 I f �° p zf
: 'a, EXPIRES:Novembe 8 rmso II Known OR PVA• �'
[ ]Personally Known OR i ] Y <
Sonded Thru Notary Public n e '', ��•
Produced Identification P'PB9u d Identification '• STATE��.�`
Type of Identification: Type of Identification:
NOTICE OF COMMENCEMENT
State of 1 Tax Folio No.
County of L) CL c
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: 1-1 2-Q E
Address of property being improved: 82 S >L)aactA 3?23 J
General description of improvements:
Owner: vcm Com; was LLC._ Address: UO2- V-Q(Nr)y medQ- ZZ2
wner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name: 1
Contractor: 1"Pp-- �c, _
Address: Li uG ,
Telephone No.: rGiO`-i� �I2S -y�0- r Fax No:
Surety(if any)
Address: Amount of Bond$ _
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the im Doc#2019057414,OR EIK 18718 Page 1244,
Number Pages:1
Name: Recorded o3/14/2019 10:08 AM,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
Address: COUNTY
Phone No: Fax No: RECORDING $10.00
Name of person within the State of Florida,other than himself,designated by umml uN ,, ...._... .
be served: Name:
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 Statues. (Fill 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
Signed: Date: 3 .
Before me this ay of in the County of Duval,State
�''"• ANGELABAXLEY Of Florida,has personally appeared i-J j Q GC-o4-, 10
MY COMMISSION i FF 897525
Notary Public at Large,State of Florida,County of Duval.
'a EXPIRES:NovemL-r 8,2019
�';'•di4;''' BondedThruNoGryPublieUnderVrtiters My commission expires: (117.1 I
Personally Known: or
Produced Identification: L 1