562 VIKINGS LN RERF19-0045 SHING ROOF PERM REROOF SHINGLE PERMIT PERMIT NUMBER
RERF19-0045
CITY OF ATLANTIC BEACH
V� 800 SEMINOLE ROAD ISSUED: 3/25/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 9/21/2019
MUST CALL • • • • • + 247-5814 BY + PM FOR • •
ALL • 'K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • ' D+ BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE 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 ADD' • OF • '
562 VIKINGS LN REROOF SHINGLE SHINGLE ROOF $9800.00
TYPE OF
• • GROUP:
1707030286 SEASPRAY
COMPANY: ADDRESS:
STONEBRIDGE 12550 AGATITE RD JACKSONVILLE FL 32258
CONSTRUCTION
• ADDRESS: '
HENDERSON ROBERT 159 11TH ST ATLANTIC BEACH FL 32233
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 4S5-0000-322-1000 0 $100.00
STATE DBPR SURCHARGE 4S5-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $104.00,
Issued Date: 3/25/2019 1 of 2
Building Permit Application Updated 12/8/17
7 City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845
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Job Address: 562 Vikings Ln Atlantic Beach, FL 32233 Permit Number: J ��`�
Legal Description 35-64 17-2S-29E Seaspray Lot? Blk 2 RE# 170703-0286
Valuation of Work(Replacement Cost)$. 9,800.00 Heated/Cooled SF 1210 Non-Heated/Cooled 1734
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residential
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No 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:
Roof Replacement 29sq 4/12 pitch GAF Shingles
Florida Product Approval# FL10124 for multiple products use product approval form
Property Owner Information
Name: Robert or Lynn Henderson Address: 159 11th St
City Atlantic Beach State FL Zip 32233 Phone 904-710-7665
E-Mail henderson11(a1comcast.net
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: Stonebridge Construction Services LLC Qualifying Agent: Brian Vick
Address 6956 Philips Parkway Dr N City Jacksonville State FL Zip 32256
Office Phone 904-262-6636 Job Site/Contact Number Rick Newman /904-524-5818
State Certification/Registration# CCC1328917 E-Mail jennifer@stonebridgebuilt.com
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Bridgefield Casualty Ins Co 05/16/19
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 OBTAI INANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECOR G URN T OF COMMENCEMENT. _
(Signature of Owner or Agent) gnature of Contractor
(including contractor)
Signed and sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed)before me a this 31'5 day of
t( 'lotby bU(f ✓Sw- }r�. byi V� '
S, =t3re
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°v, Nota Public State of Florida
o`er Notary 4fP"� ubli=-n]Personally Known OR sJennifer Lynn Schlachterpe ovally Known OR Lyn(Produced Identification o` My Commisswn GG 1096a(i]Pr uced Identification isExpires 05/31/2021 ` 5/3
Type of Identification: C T Identification:
NOTICE OF COMMENCEMENT
State of Florida Tax Folio No. 170703-0286
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:
35-64 17-2S-29E Seaspray Lot 7 Blk 2
Address of property being improved: 562 Vikings Ln Atlantic Beach, FL 32233
General description of improvements: Roof Replacement
Owner: Robert or Lynn Henderson Address: 159 11th St Atlantic Beach, FL 32233
Owner's interest in site of the improvement: 100%
Fee Simple Titleholder(if other than owner):
Name:
Contractor: Stonebridge Construction Services LLC
Address: 6956 Philips Parkway Dr N Jacksonville, FL 32256
Telephone No.: 904-262-6636 Fax No: 904-262-2247
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 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:
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: —z I
Before is 9 '54- day of 0,20 I in the County of Duval,State
OfFlori a,has personally peared
Doc#2019065539,OR BK 18728 Page 2374, Notary Public at Large, ate f lo , Coun of Duv
Number Pages:1 My commission expires:
Recorded 03/25/2019 02:20 PM, Personally Known: or
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Produce d f
COUNTYn„, Notary Public State of Florida
RECORDING $10.00 YE, ,lennifer Lynn schlachter If
c My Commission GG 109844
VOF Expires 0513112021