1073 BEACH AVE RERF19-0044 SHING ROOF PERM REROOF SHINGLE PERMIT PERMIT NUMBER
' RERF19-0044
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ISSUED: 3/25/2019
EXPIRES: 9/21/2019
ATLANTIC BEACH. FL 32233
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 • OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLYIPLEASE
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:
1073 BEACH AVE REROOF SHINGLE SHINGLE ROOF $4000.00
TYPE OF
• • GROUP:
170268 0000 ATLANTIC BEACH
COMPANY: ADDRESS:
Vigilante Family Roofing 4565 French St Jacksonville FL 32205
Services, LLC
• ADDRESS:
OKEN DEBORAH MARIE 1073 BEACH AVE ATLANTIC BEACH FL 32233-5753
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 • .
i
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 $75.00
STATE DBPR SURCHARGE 4SS-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 4S5-0000-208-0600 0 $2.00
TOTAL: $79.00
Issued Date: 3/25/2019 1 of 2
Building Permit Application Updoted10/9/18
City of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: W-IZ� C-Permit Number:E G K F ( f --0044
Legal Description �0_- 421AyQ1_k�G c ����-1SkL _Lf J_RE# `1 U - bCSC
Valuation of Work(Replacement Cost)$ c)c-)p Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Wt6`sidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will trees be removed in association with proposed roiect? ❑Yes must submit separate Tree Removal Permit ❑No
Describe in��d"^et�a� iel�the
`tyrppe� of work to be performed: !' C,-4 l �-_
PA I r acme Sso,,{s 1 tuxes 6�l s�,, S s-4e nc �
Florida Product Approval# lbl 'piggy bU or mutiple products use product approval form
Property Owner Information
Name �k�C"1 Address
City State�zip 3 33 Phone pq -qo 3 —14 UC,
E-Mail Mtn cL) �M >�
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company � f '(�n Qualifying Agent
Address _ City State zip 3
Office Phone - 3 —k 940 Job Site Contact Number %CV Q-,eJ - v - 5 I -FW(-
State
W(-State Certification/Registration# 3 S 3-1 E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer 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 TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR F11fGT1 OF COMMENCEMENT.
(Sign ure of Owner or Agent) (Signature of Contractor)
Signed and swor to r affirm, )before m t i �S day of Signed and sworn to or affir d)befor me is�� day of
1 WiJO InCh v
epilffft* Notary PuhNc State of F
Camlen E Peet (Signature of Notary) (Signatur4Notar�y
y, ,cam My Commission FF 997310 aryPuboc state d FWW3
�wExpires 06/10720204r Carmen E Peet
n [ Personally Known OR �3` My Commission FF 897319
Produced Identification / Produced Identification ; Expires 06/10/2020
Type of Identification: �'� !/l.� Type of Identification:
NOTICE OF COMMENCEMENT
State of �Le.-�)('tA-Q- Tax Folio No.
County of �lA►/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 sated in this NOTAE`OF COMMENCEWN-T. ^-
Legal Description of property being improved: O — —{��Gt' �C— 6e-o—c' l
Address of property being improved:
General description of improvements: (,()H<C- a-,
Owner:'�� T�'�1 (�kc� Address:
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name: _
Contractor: \Iak Oc4 - F t
Address: ; 6 s P e-n
nn
Telephone No.: `coq —�p3- U 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 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 OWNE
i
Doc#2019065348,OR BK 18728 Page 1636,
''Signed: Date: 3-aS- ,t'I
Number Pages: 1 Before me this Wi day of in the Co of Duval,State
Recorded 03/25/2019 12:34 PM, Of Florida,has personally appeared
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Notary Public at Large,State f f,F orid Count of Duval. i
COUNTY My commission expires:_& �� 10 da
RECORDING $10.00 Personally Known: or q
Produced Identification: L My Commission FF 997319