609 Camelia St RERF19-0067 Shingle P ' REROOF SHINGLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RERF19-0067
800 SEMINOLE ROAD ISSUED:
EXPIRES:
a ATLANTIC BEACH. FL 32233
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.
Fthatmay
In addition to the requirements of this permit,there may be additional restrictions applicable to this property
be found in the public records of this county,and there may be additional permits required from other
ental entities such as water management districts,state agencies,or federal agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUEOFWORK:
609 CAMELIA ST REROOF SHINGLE SHINGLE ROOF $8280.00
TYPE OF SUBDIVISION:ING USE
CONSTRUCTION: NUMBER: GROUP:
170917 0150 ATLANTIC BEACH SEC H
COMPANY: ADDRESS:
1 ROGERO CONSTRUCTION 5151 SUNBEAM RD STE 4 JACKSONVILLE FL 32257
INC
• ADDRESS:
REID HELEN B 609 CAMELIA ST ATLANTIC BEACH FL 32233-2564
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
BUILDINGPERMIT 455.0000-322-1000 1 0 $9500
STATE 08PR SURCHARGE 455-0000-2080700 0 $gym
STATE DCA SURCHARGE 455-0000-2OS-0600 0 $2.00
TOTAL:$99.00
Issued Date: 1 of 2
Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department *'ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
p Phone: (904) 247-58,126 Email: Building-Dept(@coab.us p IS REQUIRED.
Job Address: 6-u9q (✓Y),AI A S4 Q}acyl}if lad._ P Permit Numbei-REI\F (q — 09(c;7
Legal Description x-14 iA-AS'Ak #114A1T A'FGH rtL H 19 FT VJTS 7LtL 135 RE# tr1r91'! -&L50
Valuation of Work(Replacement Cost)$ 'Nl'rr9-nn Heated/Cooled SF Non-Heated/Cooled
• Classof Work: ❑New OAddition OAlteration ❑Repair OMove ODemo ❑Pool OWindow/Door
• Use of existing/proposed structure(s): OCommercial EKe—sidential
• If an existing structure,is afire sprinkler system installed?: OYes
• Will treeisl be removed in association with propos d ni OV (must submit separate Tree Removal Permit)
Describe in detail the type of work to be performed:
Florida Product Approval# G 4 - I for multiple products use product approval form
Property Owner Information
Name Hzl.er nli Qe�� Address l Cc,.e"Rp 5 /)1 ,p c t�� li��� --"+�-1�--
City /ITLprt4tc H State Zip 'J�33 Phone r1!/'t- �J
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company S s Qualifying Agent
Address I, 1 <e-�- City-x e1L&cn hX tate Zip p'
Office Phone 61 -Ar4Q-C11.'`A Job Site Contact Number
State Certification/Registration# 6CCA-M119n E-Mailkrt OnrIc, yJrt h�frSrrx^ MQ. !dam
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer V;o kbk_4zo Cry... fm OR Exempt U 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 ofthis
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
RECOVINfa YO7TIC OF MMENCEMENT.
(Signature of Owner or Agent) Signature of Contractor)
Signed� and sworn to(or affirmed)before me this (o day of Signed and sworn to(or affirmed)before m this_C,day of
A
T a')IC4. . '
( na eof Notary) fg
W ANYMMORRIS r -gytaarpkaidg
No"lFalge-gWeafFlodtla personally Known OR CaalrYdaa#
[ ]Personally Known OR ��M9879R IYrtl1.31a0
[N Produced Identification ..a �qg I ]Produced Identification C _ _
Type of Identification:l� DL. Type of Identification:
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICFTE)
Permit N . Tax Folio No. 1100 7 -CJI 5n
State of 'eL County of DAw 1
To whom R may conwm:
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. ^
gal desai b of property being improved: ( LI 3 - C, 4 T A
EA r� 5F1 d N 4G T 5 t ' 1 3
Address of Property being improved: 6A Ca,.,.¢1Ccr 6+ Alok J1�d�7
ece-j, ILL S
General description of improvements:
owner l4Rtem , fKzl d.
Address 61�111!14`g6} AVJW4 3,erkl, f - 3233
Owners interest in site of tha Improvement
Fee Simple Tdeholder(If other than owner)
Name
Address
Contractor Z b)%
Address,SlSl hm... Rr1 $N Scaf-►,c �f '�JaS
Prone No.'-1-(1"- qM6 Fax No.
Surety(i(any)
Address Amount of bond$
PMce No. Fax No.
Name and address of any Person making a loan for Me conshuntbn of the Improvements.
Name
Address
Phone No. Fax No.
Name of Person within the Stele of Florida,other than himself or herself,designated by owner upon whom
notices or other documents may be served:
Name
Address
Phone No. Fax No.
In add don to himself or herself,owner designates the following person to receive a copy of the Lienors Notice as
pravlded 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 ithe expiration data is one(1)year from the data of recording unless a
different data is speclfed):
THIS SPACE FOR R ECORDER'S USE ONLY eauay � ER
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