96 W 5TH ST RERF19-0043 SHING ROOF PERM rS'r'''r1 , REROOF SHINGLE PERMIT PERMIT NUMBER
s RERF19-0043
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 3/25/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 9/21/2019
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 • ' ! + 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 ADDRESS: •N: VALUE • •
96 W 5TH ST REROOF SHINGLE SHINGLE ROOF $7700.00
TYPE OF + BUILDING
ZONING: : ! •
• iGROUP:
170823 0150 ATLANTIC BEACH SEC H
COMPANY: ADDRESS:
PEAK ROOFING & 8653 VILLA SAN JOSE DIR E JACKSONVILLE FL 32017
CONSTRUCTION
OWNER: ADDRESS: '
CARRELL DAVID W 96W STH 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 455-0000-322-1000 0 $90.00
STATE DBPR SURCHARGE 45S-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 4SS-0000-208-0600 0 $2.00
TOTAL: $94.00
Issued Date: 3/25/2019 1 of 2
Building Permit Application Updated 1019/18
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: SA W i t�`ST �ff LAW 1 `L._Rve-k Permit Number: ( J
Legal Description w INct Lom lc 1\\=-qfc A'tt U�CG�I '+�t4 F1 RE#f
Valuation of Work(Replacement Cost)$ -1-10C, 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 Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes Mo
• Will trees be removed in association with proposedproject? ❑Yes must submit separate Tree Removal Permit o
Describe in detail the type of work to be performed: Re-ttc51`,,dA_ "fir.-�k,.._. _ i a-`t 5Ve_A_1J I h(A&S 1,Z
Florida Product Approval# (O t�-4 I 0 "Z Co 'e 114 , (F/(o U, for multiple products use product approval form
Property Owner Information
Name Z>4 J%z C. CL-(Lf-CL-(Lf- Address C11c W
City 04-4X4 %C_ Se e t f State FL Zip :5 3 Phone 9eY (c;T 1 j
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company�et��i J iO4 Qt i CVICCAY\ �N�- Qualifying Agent (�l:c�•ti�
Address'I'M 31 •.wv4) A,tk- r3 City \iState _Zip
Office Phone 4`l -`15`1 -Io�1 32 Job Site Contact Number
State Certification/Registration# E-Mail (" ,V N
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer ���kt��C I��„p OR Exempt❑ Expiration Date 1 2 L
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or instal lation 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 OBT IN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECO I YOUR�� COMM NCEMENT l
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this a% day of Signed and sworn to(or affirmed)before me is �t day
C. 7 Ot pec k by t..
urQ 49 Pkv
•, NOTARY F LIC STATE OF FLORID
_STATE OF FLORIDA �! r Gamrtr�FF1888M
[ ersonally Known OR r C FF188898 Personally Known OR �`' yG Expires 5/9/2019
[ ]Produced Identification 1q Expires 519/2019 [ ]Produced Identification
Type of Identification: Type of Identification:
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of Florida County of 1W.A-ii--
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. A`
Legal description of property being improved:vJ Lkq P7 L-CjT'
��VA <-" _�
Address of property being improved: Chows `S-•
General description of improvements:
Owner ,•l-il'i!1
Address q'L%\ sy— L's� mi is -'OW F-C 3123-3-
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Peak Roofing&Construction Inc.
Address 7504 Slocumb Ave.Jacksonville,FL 32256
Phone No.904-756-6932 Fax No.
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 da t s ne(1)year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY �J4 Ilk
sign L�\ �- DATE
Before me this day of 11111, Mot In the
County uval,State of tdg iia.per5gnally appeared fj)
Awa)y�) ti 1tW� herein by
himself/herself and affirms that all statements and declaration er
are true urate tt�lss
Doc#2019065397,OR BK 18728 Page 1830, -n 0 •<
Number Pages:1 gg g -n T
Recorded 03125/2019 01:04 PM,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL c 6 M
COUNTY Notary Public Vt Large,State of County of
RECORDING $10.00 Mycommissi expires: _ CEJ
Personally K own or
Produced nti iication