349 19th St. RERF19-0053 Shingle roof REROOF SHINGLE PERMIT PERMIT NUMBER
RERF19-0053 CITY OF ATLANTIC BEACH ISSUED: 4/8/2019
800 SEMINOLE ROAD
.!P ATLANTIC BEACH. FL 32233 EXPIRES: 10/5/2019
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
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: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
346 19TH ST REROOF SHINGLE SHINGLE ROOF $14800.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: . NUMBER: GROUP:
172020 1240 SELVA MARINA UNIT
12A
COMPANY: ADDRESS: CITY: STATE: ZIP:
ELO
OWNER: ADDRESS: CITY: STATE: ZIP:
GREENWOOD MICHAEL B 346 19TH ST ATLANTIC BEACH FL 32233-4536
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.
Mir —41
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $125.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $129.00
Issued Date:4/8/2019 1 of 2
'r REROOF SHINGLE PERMIT PERMIT NUMBER
RERF19-0053
.:; ,..� .` CITY OF ATLANTIC BEACH ISSUED: 4/8/2019
800 SEMINOLE ROAD
p-pillsr ATLANTIC BEACH. FL 32233 EXPIRES: 10/5/2019
Issued Date:4/8/2019 2 of 2
--'1----,C Building Permit Application Updated 10/9/18
s. :`' City of Atlantic Beach Building Department **ALL INFORMATION
:�__.,.!, 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
't��
UIS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 39'to 1G1+h S;—Cee.—Ir- -PrIct.ryric, �jel, Permit Number: R ERE'9 oG S)
Legal Description 31x- U,Q-f DOt -as -act E 5e)sJc Ar\R U \- RE# I -7 2[•2.Z) 1 Z
%2-A LOA- L4 T
Valuation of Work(Replacement Cost)$ 114,91)D.°0 Heated/Cooled SF l cQ 4LQO Non-Heated/Cooled 57 0
• Class of Work: ❑New ❑Addition ❑Alteration Nepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial gitesidential
• If an existing structure,is a fire sprinkler system installed?: B4es-No
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) TX\Jo
Describe in detail the type of work to be performed: 4 IZ. PI-i-ch
31 t RJR sh�� los1u .ev\ay ne-rv\-- ) t ;line deck.anj
Florida Product Approval# -, 4 QAgCILA / FL. Gal C_C, for multiple products use product approval form
Property Owner Information t
Name rt\\CY1, 0 5` Y \ blee`. 00001 Address ,A).-{U Lck`Ft' (j2*--
City a--4-k,0 } ., c.'C1,(:IrN State_Zip 372 3 Phone clOL{ 1.t 9 $9' a
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company f 0 Qsc CxAirul,� \Lt.( Qualifying Agent LY�I�� t�►ate-�-5
Address 3�tS \CDt-t City JPIC:{Cspr-16,1 State Al Zip 32.251
Office Phone '104 St._' Cil CBCs Job Site Contact Number S 0310
State Certification/Registration# rtE-Mail -}-t.Quirvx_c,C e c ve l-rjV0. -icir' (_[,oc) -
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, C ULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECDI YOUR NOTIC COMMENCEMENT. ---
— -+..
(Signature of ner or Agent) • (Signature of Con
S' ned and sworn to(or affirmed)before me this 6 day of Sign and sworn to(or affirmed)before me this cc, day of
(0IC(.,�— - Z�')�1cf1.t r%, Z.0IQ ,by Ar w lVta�
(Signature o,+tary) (Signat e of ota'-
�'g4►(is., TAMMARA RENAY YUHAS
( :'0 04:; TAMMARA RENAY YUHA:
( I Personally Known OR .� l ,`. Notary Public-State of Florida ersonally Known OR ;.t ,�
Notary Public-State of F.ori,�
roduced Identificat'on ' '�i,"-.5 Commission#GG 263509
D .-e My Comm.Expires Sep 3Q 2022 ) oduced Identification ,) Commission#GG 263509
Ty e of Identification: ig c l S',` sn IType of Identification: •eov n.: My Comm.Expires Sep 30.20:.
Bonded through National Notary Assn.
Permit Na R , 1 4 ` q �tjD 6 -Q�
Tax Parcel Number 17,20,0—/ZYO
NOTICE OF COMMENCEMENT
State of Florida County of ii0a.t,/l./
The UNDERSIGNED hereby gives notice that Improvement will be made to certain real
property,and in accordance with Chapter 713,Florida Statutes,the following information
is provided in this Notice of Commencement
1. Description of Property: ILow,ide.cnptionap.
ftneprony,andstro .iris n
. av,iiaw.)3G-S 09--2S Z9E �e.�fl«jy i,,,,-t4 1(ILc.T /2-/i
3qt; ) 5 /04'1
fit& .e. e 4-41. I-c-3223 3
2. General description of Improvement:
ReRoof FOR CLERK'S OFFICE USE ONLY
3. Owner information or Lessee information If the Lessee contracted for the improvement:
a. Name and address f r ri j Glome n WOOc1
3461 j't4 5 - G
b. Interest in property irr6,,fi _ QC (-+ ,
r z— 3 2-133
c. Name and address of fee simple titleholder (if other than owner)
4. a. Contractor: Name and address
ELO Restoration
3415 Kon Road Jacksonville FL 32257
Doc#2019076900, OR BK 18744 Page 1313,
b. Contractor's phone number 904.528,0188 Number Pages- 1
Recorded 04/05/2019 01:31 PM,
5. Surety(if applicable,a copy of the payment bond is attached): RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
a. Name and address COUNTY
b. Phone number RECORDING $10.00
c. Amount of bond S .0Q -
6, a. Lender:Name and address
b. Lender's phone number
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be
served as provided by Section 713.13(1)(a)7.,Florida Statutes:
a. Name and address
b. Phone numbers of designated persons:
B. a.In addition to himself,Owner designates of to receive a copy
of the Llenor's Notice as provided in Section 713.13(1)(b),Florida Statutes
b. Phone number_----� ;}s•No"
9. Expiration date of Notice of Commencement(the expiration date is I year from the date of recording unless a different date Re5
is specified) o ` •
WARNING TO OWNER:ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED m ; _
IMPROPER PAYMENTS UNDER CHAPTER 713,PART I,SECTION 713.13,FLORIDA STATUTES,AND CAN RESULT IN YOUR PAYING TWICE FOR F,
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST o °
INSPECT. YOU INTEND TO OBTAIN FNA a,CONSULT r YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING g 3 2!
YOUR NO • COMMENCNT �J z ..,�a ti .�.•
lap
Signature of r�:r or Lessee,or Owner's or Lessee a Authoriz dOfflcerfDlrectorlPartnerfManager, (Section 113.13111(di) ci ro
ni
Signatory's Title/Office N o^±5.
State of F t < -G(`" ,County of_ b V` �" l -/ 1 /� r / ti w
The forgoing Instrument wee acknowledged before me this_ 3a day of 14AL.L 20 'i by TL WA ff L Who .,
(Type offaauthortty-.a.g."car,trustee.attorney in fact) (�y /'//^1� ,
L.r 6 L�.�//�'1,44 --- y-�.r1te1 V r 4-4--
Signature of Notary Public•Stats of Florida Prit Type or Stamp Nam.of Notary PuhFc
Personally Known OR Produced ID Type of ID Produced - r Lf