64 W. 5th St. RERF19-0052 Shingle roof �S''�`'' y► REROOF SHINGLE PERMIT PERMIT NUMBER
4 CITY OF ATLANTIC BEACH RERF19-0052
800 SEMINOLE ROAD ISSUED: 4/4/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 10/1/2019
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:
64 W 5TH ST REROOF SHINGLE SHINGLE ROOF $10750.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170822 9500 ATLANTIC BEACH SEC H
COMPANY: ADDRESS: CITY: STATE: ZIP:
Perkins Express Roofing
5440 Roanoke Blvd. Jacksonville FL 32208
Inc.
OWNER: ADDRESS: CITY: ; STATE: ZIP:
KRITSKY ERIC M ET AL 196 SEMINOLE RD ATLANTIC BEACH FL 32233-4141
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.
FEES •
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $105.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$109.00
Issued Date:4/4/2019 1 of 2
, rfL.A_ i-j„ REROOF SHINGLE PERMIT PERMIT NUMBER
\,'' CITY OF ATLANTIC BEACH RERF19-0052
800 SEMINOLE ROAD ISSUED: 4/4/2019
-r a� ATLANTIC BEACH. FL 32233 EXPIRES: 10/1/2019
Issued Date:4/4/2019 2 of 2
.ylr Building Permit Application
. `
City of Atlantic Beach
. w
800 Seminole Road,Atlantic Beach, FL 32233
`ol''`',- Phone: (904) 247-5826 Fax: (904) 247-5845 /
Job Address: 6`1• 5-11+ 3f2E61T W e-3-r- Number: IRG RE I9-OO S .
RE# t '1 0 b a
Legal Description q �
(.
Valuation of Work(Replacement Cost)$ ( J11 ) ' �
v• Heated/Cooled SF Non-Heated/Cooled
• 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:
�G gooF 6767/“, 5-4-Al ST/CEE7 WAST
-� ((lk_JC1L ---
Florida Product Approval# Ft /o19y2 / Ft /r 2-/6 for multiple products use product approval form
Property Owner Information �,,.n
xName: ,ri�G l� I7 /11" J /Address: � A/^ o /20,40
City Arli9/Ur/CE,iCW State J - Zip 32233 Phone c'/—(a/2-q#.7
E-Mail g,?uL gS C l/72,4/L.Goer?
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information v `
Name of Company: Vfc.."t LP' - f A 1 - Qualifying Agent:
Address ? Gcwf .o,/ City ' ?c, State 1I Zip 7 z`Z.oi
Office Phone b`f—A r-a?-77 Job Site/Contact Number 9$4-5)S as 7
State Certification/Registration# CC.0 (930ti 0- E-Mail pe-V.A.�1-G'1c q3'•�.-j C ' b .`r'
Architect Name&Phone#
Engineer's Name&Phone# r
Workers Compensation f"
Exempt/Insurer/Lease Employees/Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of afl"t!iefaws regulationg
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc.
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature of 0 er o nt including Contr ctof) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this-,'-`1. day of Signed and sworn to(or affirmed)befQre me this ?di day of
441 V''`I ,by eerie it., J Cr+I'.$'( frt ,200 ,by C R(;i-t
l/, ,,;:State of-Florida-Notary Public ,o,..pYPC•a�,, LINDA ALVAREZ
''r'tlj- ._ Commission # GG 71592 : „ ¢.State of.Florida-Notary Public
---,'4' ,,,P. My Commission Expires ?,f l:c Commission# GG 71592
"''��""`"� February 14, 2021 °;,a ..o'A' My Commission Expires
"� February 14, 2021
[ ]Produced Identification [ ]Produced Identification .S
Type of Identification: Type of Identification:
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No._ 11 PF
2•a`�
State of _ County of DU i1' -
To whom it may concern:
The undersigned hereby informs you that Improvements will be made to certain real property,and to
accordance with Section 713 of the Florida Statutes,the following Information is stated in this NOTICE OF
COMMENCEMENT. Q (� 33 -Q9-Legal description of property being improved: t g 3 3t If
2
a1 ft Sec 1,1
i-- I ni./ . 7 ,c
Address of property being improved: Coif'6,4, 5-4'w 57-ie eA- ' (..,&,,P7,57-
A7-2/4,V 77'C
, 57't17Z w77C 13EtiCK , Cio.eil 32233
General description of improvements:
Owner +ec rn Al2/r3"
Addresw 1er& 5E weic 2opD J77l,9NT/L gE14Ck firs 32, ✓
Owner's interest in site of the improvement
Fee Simple Titleholder(it other than owner)
Name
Address
Contractor P a" 1? p
Address yutO Ci� of/� 6( .J 1 ]' 7 I
Phone No. 4°y--Sa 5'-07?Y 1 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 date is one(1)year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY
SlgmU/! Li 20,./g 3 h
_
DATE /1J/g
Before me this day of e
County of Duval,State of Florida has personally appeared
Doc#2019074221,OR BK 18740 Page 2191, rein by
Number Pages: 1 himselt<hetdelr an({ �rrms mac ar y tnsOXIM
a
'a9.
ere true en aQet1.
Recorded 04/03/2019 01:56 PM, = State Cf.Florida-Notary Public
°i r #
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL . � .� Commission 66 71592
COUNTY ,,gn•` My Commission Expires
RECORDING $10.00 February 14, 2021
Notary Public at ,St;M'.o . Coady oT
My commission expires: _
Personally Known or
ProducedIdentification �_ �_