237 Magnolia St RERF19-0082 Shingle REROOF SHINGLE PERMIT PERMIT NUMBER
r s, RERF19-0082
v� CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 6/10/2019
EXPIRES: 12/7/2019
ATLANTIC BEACH. FL 32233
MUST CALL • • • • • 1 BY 4 PM FOR ' •
ALL • ' K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • '
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, 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:
237 MAGNOLIA ST REROOF SHINGLE SHINGLE ROOF $6580.00
TYPE OF
• • GROUP:
170545 0050 SALTAIR SEC 03
ADDRESS:
MERRITT ROOFING &
GENERAL CONTRACTOR 1704 GIRVIN ROAD JACKSONVILLE FL 32225
INC
• ADDRESS:
SUMMERS COLLIER S 237 MAGNOLIA ST ATLANTIC BEACH FL 32233-4007
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 • •
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 $85.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 j 0 $2.00
TOTAL: $89.00
Issued Date:6/10/2019 1 of 2
Building Permit Application Updated 1019118
City of Atlantic Beach Building Department **ALL INFORMATION
V 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: IS REQUIRED.
Permit
(904) 247-5826 Email: Building-Dept@coab.us n' Permitum F71 9
1Q - O Q )vlob Address:
Legal Description / 0-/0 O� -�� 0 K S�C3RE# /705 W-
-0052)
ol`
Valuation of Work(Replacement Cost)$ 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 ['�!!Cesidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will trees be removed in association with proposed ro ect? ❑Yes must submit separate Tree Removal Permit ❑No
Describe in detail the type of work to be performed: BOO c:a
` � J
Florida Product Approval# 0 1- -! , (a for multiple products use product approval form
Property Owner Information
Name -e SLS>�11 rn � Address a 3�il�al n0//a's�-
City C C.c State P1 zip 3223 Phone o UY_ :3/35
E-Mail e'l c b ve is Ce C
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information y�,/) `(� �y
Name of Company Q12-�I ti11`-� i 6�""� Qualifying Agent PA eil
Address I ✓ City V-Wk)4Vll( -C State -" Zip
Office Phone 40 - 93 - Job Site Contact Num��er
State Certification/Registration# CC! Z E-Mail �1✓�1aW,,,)-?
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, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFOR
RECORDING YOUR NO ICE OF COMMENCEMENT. c�yy
(Signature of Owner or Agent) (Signature of Contractor)
Sig ed and sworn to or affirmedl1 before me this� day of Signe and sworn to CQr affirmed)before e this � day of
� 1� by l(t?„.enSu�n —=� 7�// ,by ✓lit ���Ssg7�
°� *nat r o
gay ignatu� �PQRAEL BOWEN ,�o��"Y y�; }�o�ary ����State of Florida
• ��_ Notary Public-State of Florida _ = Commission # GG 040126
Commission # GG 040126 ?N, `o; M Comm.Expires Oct 19,2020
[ ]Personally Known OR ��',;�oF Fro?: My Comm. Expires Oct 19,2020 Personally Known OR �'',',FOF F�°°�° Bonded through National Notary Assn.
[ ]Produced Identificati
Bonded through National Notary Assn. [ ]Produced Identification
Type of Identification: Type of Identification:
1JOC ff LU1y134L03, Vti at\ toozl YdyC ic.y, INUILLL.JCt raycM. i ,
Recorded 06/10/2019 10 :58 AM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10. 00
NOTICE OF COMMENCEMENT �]
State of Al 0vi" "" Tax Folio No. /
County of Qat tA
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713
of the Florida Statutes,the following information is stated In this NOTICE OF COMMENCEMENT.
Legal Description of property
being improved: fQ
_ -
Address of property being improved: `' 1 r Sfi ��J 3�a33
General description of improvements: Rork/n,;
Owner: C� S Address: a 3-7 A4 aA no bel 51- Ale
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner): —
Name:
Contractor: -�7 l lT► 1
Address: 100 C k/ i'1 le t`I �J'l•(yZ�Z ^7
Jc!I lV �I 7 Fax No: �LI�dUZ� !2� �O
1 P b f Telephone No..
Surety(if any) —
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any p rson making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within t e State of Florida,other than himself;designated by owner upon whom notices or other documents may
be served:Name:
Address:
Telephone 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 Stat s. (Fill in at Owner's option)
Name:
Address:
Telephone N 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 OWNER
S• � "_—,+'_ Date; lz
Be ore me this day of in.the County_of Duyal,,State
of Florida,has personally appeared
a;„ Notary Public at Large,State of Florida,Count' q>' er's '..
Notary Public=State of Florida
My commission expires: = • • =
Personally Known: '•sExpi Ocl 19,?620
Produced ntification: oFv q,
n: