1918 Hickory Ln RERF19-0095 Shingle ''\j J" REROOF SHINGLE PERMIT PERMIT NUMBER I
CITY OF ATLANTIC BEACH RERF19-0095
800 SEMINOLE ROAD
ISSUED: 7/15/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 1/11/2020
MUST CALL INSPECTION PHONE LINE (904) 247-S814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • '
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:
1918 HICKORY LN REROOF SHINGLE SHINGLE ROOF $18000.00
TYPE OF
• • GROUP:
172020 1314 SELVA MARINA UNIT
12B
COMPANY: ADDRESS:
HAMMER TIME ROOFING 14286 Beach Blvd JACKSONVILLE FL 32250
OWNER: ADD ® ®
BROWN LORRAINE 1918 HICKORY LN ATLANTIC BEACH FL 32233
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.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $145.00
STATE DBPR SURCHARGE 4SS-0000-208-0700 0 $2.18
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $149.18
Issued Date: 7/15/2019 1 of 2
Updated l0/9/18
Building Permit Application
J stip,,
s City of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233
HIGHLIGHTED IN GRAY
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 0/y LZ� 3 A� 3 3 Permit Number: �C(�P(Q l — (Dog
Legal Description 3(� 7r_o r��, - S - S l ScUc, 1, - RE# / 71L A C, - /3/�
Valuation of Work(Replacement Cost)$ 1Y. >()C> 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 i�-]rMidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes FIN-o
• Will trees be removed in association with proposed ro'ect? ❑Yes must submit separate Tree Removal Permit A
Describe in detail the type of work to be performed:
��$L N
Florida Product Approval# for rpkjltlplprQducts e pr uct approval form
Property Owner Information
Name Address
City '> • State r� Zip a �1 3 3 Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company / .L 1tir,{, Qualifying Agent . •�
Address / 7`1 - 1'33 s 6. City 3o., kkx /It State Zip f
Office Phone i 7L, ` q Job Site Contact Number em ) • )
State Certification/Registration# CCr 1 =1`r 9 i E-Mail Ltc �,�,• /_7,_Z cC,
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer OR Exempt Li Expiration Date �' / L rel
Application is hereby made to obtain a permit to do the work and iiInstallations 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 OU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER AN ATT FORE
RE G YOUR TICE OF COMMENCEMENT.
� J
(Si ature of Owner or Agent) "(Signature of Contractor)
Signed and sworn to(or affirmed) before me this L day of Signed and sworn to(or affirmed) bee �this ELt Nay of_
7� 1'7,by L.v�2--se /9ez�, -�" 'i by �K-amu
-r
(Signature of Notary) (Signature of Notary
•201 pw`4PATRICK RICH e otter►u4� PATRICK RICH
Personally Known OR , " '
Expires September 15,Commission x GG 137124 2021 [, Personally Known OR = Commission#GG 137126
[ J Produced Identification ^. oy ioM [ ]Produced Identification � a Expires September 15,2021
Type of Identification: '''of f�°� WA" e Type of Identification: ''Enc noP g,,y�n,,,g dporraayS•rvbe•
Tc+�
or COMMr�
ax olio No.
Qb —f l
Ar,�it i`?o. CCUniy Oi i v
State Of ^
To Whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property.and in
accordance with Section 7'i3 o the Florida Statutes,the following information is stated in this NOTICE OF
COPJiMENCEPAEN T• _
GQGI description or properry being improved:
Address of propary beingimproved: / _ fC°�7
� n
General description of im;:rovements:
G:err /I/I .u_ 7_1?/' r 2 31
Addre
O:vra C s in Merest in sita of the Im0raI i i
=83 S'tnlpiz Tit (if other than o:�lher)
�� P1crn3
i;ddrass
contractor
5_1 /!v G Fax No.
Shona No. Lf z
Surety(if an v)
Amount at bond S
'ddre_a
Phone No. Fax No.
Pteme and address or any person,making a loan for the construction of the impro:'ernants.
Nam=
.ddr=-s
Phoria;de. =ax No.
NGme Of p:r=on`;Ji h'in ih=St to of Florida.other then him==F deSla ated by O':ll icf tic-ont':hom notices or ether
documents may be 9erlc�:
Name
ddrsss
Phone No. -2''�°'
In addition to ivmsslf,owner designates the foilo.,ing person to receive a copy of th_Lienor's Notce as provided in
Section 713.06(2)(b),Florida Statutas.(Fill in at Owner's option)_
Name
;address
Phone No. Fax No.
Expiration date of ldotice of Commencament(the expiration dale is one(1)year from the date of recording unless a
13111erant data is specif,ed):
THIS SPACEFOF.RECORDER'S USE ONLY 1
DAIT: C/
mr•of ouc_?.gist:Of- Z5 peMon_ily appeared12
�
Doc#2019164173,OR BK 18863 Page 1502, i : ;t ,;,_ ,_;,_:.,s and c=_cl_r_. PA(R1CK RICH
Number Pages:1 off.. A( 137126
I ars s:c z_curet_ :o;• •. c Commission#GG
Recorded 07/15/2019 10:34 AM, ` Expires Septemb'r 15'2021
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING $10.00
Criy cf v o .
'Kit a :.
Prod%cid icsnF�;u.='uLrl