1017 Camelia St RERF19-0073 Shingle REROOF SHINGLE PERMIT PERMIT NUMBER
s RERF19-0073
CITY OF ATLANTIC BEACH ISSUED: 5/21/2019
800 SEMINOLE ROAD
EXPIRES: 11/17/2019
ATLANTIC BEACH.FL 32233
ALLWORK
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.
shingle re-roof- FL18355.1 $7500.00
1017 CAMELIA ST REROOF SHINGLE FL15216.1 FL16160.1
BUILDING : .
TYPE OF REAL ESTATE ZONING: GROUP:
CONSTRUCTION: NUMBER:
1709940500 ATLANTIC BEACH SEC H
JACKSONVILLE FL 32250
FIRST COAST HOMES LLC 1719 10TH STREET NORTH BEACH
RICE CYNTHIA A 1017 CAMELIA ST ATLANTIC BEACH FL 32233-1808
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.
Roll off container company must be on City approved list. Container cannot be placed on City right-of-way.
ACCOUNT QUANTITY PAID AMOUNT
DESCRIPTION $ya ua
E66-0000-322-1W0 0
BUILDING PERMIT $2R0
ass-oa0o-zoeazca u
STATE OBPR SORCHAflGE $2M
G55-0000-3oB0600 e
STATE OCA SURCHARGE TOTAL:$94.00
Issued Date.5/21/2019
I oft
Building Permit Application Updated 1019118
City of Atlantic Beach Building Department '*ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Deot@coab.us IS REQUIRED.p ` n
Job Address: //7[7 CG mP_ir4 S'1:/iQ{-/<�,v-tl[ &^ ,,Al Permit Number: LGI-Fi "L/1�—003
13
Legal Description/B-3+/ 38-15 -14 E.111 Ht do Brtrc'A t W [..r1 SI;A REs 1 "TTg SOO
$prec'F S U/R 13" U 1 Xv`.5-yV-/0 < r
Valuation of Work(Replacement CCost)$7, COO. Co Heated/Cooled SF Non-Heated/Cooled
• Classof Work: OWew OAddition OAlteration ❑Repair ❑Move ❑Demo OPool OWindow/Door
• Use of existing/proposed structure(s): OCommercial laResidential
• If an existing structure,is a fire sprinkler system installed?: Oyes yy.0
• Will trees be removed in association with Proposed ro'ect?Oyes fmust submit separate Tree Removal Permit o
Describe in detail the type of work to be performed: �ep10✓C / eyl1gGE 5�l+n/f SGI ,,r 5 1 L $
Florida Product Approvalk/b.3.S5�1 J /SiTl6- -Z /6/6G. for multiple products use product approval form
Property Owner Information
Namen-111;C, /f Address /0/'� Cam el•4 SN're7
City At ra_,7 J?,ra.cti State !=L zip 31233 Phone ?e4— ";Z-67/F7
E-Mail /L1/14
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company r-r/'S+- C_oa5'F No &S,/ LC Qualifying Agentlo jo S C. �JO�rh L'
Address 17/17 /0 "v <t/'ccY- Nct or t-L, city Jk J3 vatic c. 3iate _zip
Office Phone 5G9 - �= S-1 Job Site Contact Number IFO - 87'--T
Co 5/7
State Certification/Registration If�C /3315`30 E-Mail au/ re✓"I/ U'F Q • Co>M
Architect Name&Phone N tV „
Engineers Name&Phone P W//,f
Workers Compensation Insurer r 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 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 entitles 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
RE ORDINGG YOUR NOTICE F COMMENCEMENT.
Vg2,f If
(Signature of Owner or Agent) I (Signature of Contractor) 11 ,,��,,
SiSnned and sworn tto,'(or affirmed)before me this a of Si ned and sworn to(or affirmed)before me this ,y of
X �v lEd4__.ALL 1 by
re of Notary) Wt -2-0 f Notary)
ALLYSON DOERR
':Stere of Floritle•NtNery Public ALLVSON DOERR
e GG pir Lz�Personall Known OR "E State of Florida-Notary Public
a Ion Expires { Producedyldentiflcatio - ' Commission a GG 1'l83a8
.� ice e d ] My Commission Expires
Type of Identification: 22
NOTICE OF COMMENCEMENT
Permit No./Qr /9-,2(223 Parcel ID/Tax Folio No. 17OW4/- a4Cf
State of Florida,County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713, Florida Statutes,Ute following information is provided in this Notice of Commencement.
1. Description of property(legal description of property and address if available): /&-.3/! sb-,2 S -;' '7 c
fF//A f C
6e4111 '�Wr }/' L' lt',� $/1 �i'ff �" N -fA� Y Cj$�u•(g 8cR BRil #bS�Y-/G
2. Garemlppescription ofi p vements: r 8/K /S3
3. Owner Information,
__ /<e.rusv� T_,✓/J IG,ce 0. S�o�,e 3�r 5 •
Xa)Name and Address: h
b)Interest in property: it 1-1
c)Namm ddress of simple titleholder(if other than owner):
4. Contractor Information:
a)Name and Address: Dou�la5 L' �oGV`Y' l7/4 /o 57r" A) Jax BSI+ rG 3125`0
b)Phone Nmnber. 904- ���
5. Surety Information:
a)Name and Address:
b)Phone Number: '
c)Amount of Bond: $
6. Lender Information:
a)Name and Address:
b)Phonc Number:
7. Person within llle State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13 (1)(a)7,F19rida Statutes:
a)Name and Address: A-IZA
b)Phone Numbers of Designated Person:
8. In addition to himself/herselQ Owner designates A/�/+ of_ to receive a
copy of the Lienor's Notice asp vided in Section 713.13(l)(b),Florida Statutes.
a)Name and Address: A
'b)Phone Number of person m entity designated by owner:.
i
9. Expiration date ofNotice of Commencement(the expiration date may not be before the completion of construction
and final payment to the Contactor,but will be one(1)year from the date of recording unless a different date is
specified:_
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I,
SECTION 713.13. FLORIDA STATUTES, AND CAN 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 COMMENCING WORK OR RECORDING
YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury, I declare that I have read the foregoing notice of commencement and that the facts stated
therein are true to the best of my knowledge and belief.
d�
Signatuic of Ownerer or Owner's Authorized l7ffi /Direc[or/Pamra/Manager Signatory's Prin[ed Name&TiddO c
The foregoing instrument was acknowledged before me this day of PtAM 20tq ,
by rn ofPcLtQ A r �y e a as Uof e✓ for 1 iyA 1 �y��¢u
(Nam ofPerson) (Type of Au lmriTy,i./eOtT/i/icer/Atmmey) (Na eofP—arry/Insavment was Ezec ed for)
=S.
N DOERRne-Not:'YPublicNOTARY P LIC,STATE OF FLORIDA
GG 1783434, 202piresPrintName: AIL&aI !�✓Y
ion
2042
❑ Personally Known
MrIdentification'I'ype: "hvi�t-YS bce^AAa
Doc#2019117880,OR BK 18798 Page 1881,
Number Pages:1
Recorded 05/21/201910:31 AM, Revised 1/18/18
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING $10.00