429 Camelia St RERF19-0097 Shingle Reroof REROOF SHINGLE PERMIT PERMIT NUMBER
rRERF19-0097
CITY OF ATLANTIC BEACH
Vr 800 SEMINOLE ROAD ISSUED: 7/16/2019
ATLANTIC BEACH, FL 32233 EXPIRES: 1/12/2020
MUST CALL INSPECTION PHONE LINE (9041 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL ! 'K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF ! ' D+ 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: PERMITTYPE: DESCRIPTION: VALUE OF WORK:
429 CAMELIA ST REROOF SHINGLE shingle re-roof- FL10674- $6464.00
R12 & FL9777-R11
TYPE OF
ZONING: : • •
• • GROUP:
170874 2000 ATLANTIC BEACH SEC H
COMPANY: ADDRESS:
PRIME ROOF 13725 BEACH BLOULEVARD, #13 JACKSONVILLE FL 32224
CONTRACTING LLC
�•
ADDRESS: CITY: STATE: ZIP:
SNOOK VICKIE L 429 CAMELIA ST ATLANTIC BEACH FL 32233-2519
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 4S5-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$89.00
Issued Date: 7/16/2019 1 of 2
Building Permit Application
s, City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: 429 Camelia St., Atlantic Beach, FL 32233 Permit Number: FF1
Legal Description 18-34 17-2S-29E .117 ATLANTIC BEACH SEC H LOT 4 BLK 107 RE#
Valuation of Work(Replacement Cost)$6,464.00 Heated/Cooled SF 1120 Non-Heated/Cooled 82
• Class of Work(Circle one): New Addition Iteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial esidentia
• 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: Replace roof with asphalt shingles
Florida Product Approval#FL10674-R12(shingles) FL9777-R11 (peel and stick) for multiple products use product approval form
Property Owner Information
Name: Vickie Snook Address: 429 Camelia St.
City ATLANTIC BEACH State FL—Zip 32233 Phone 678-357-1959
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: Prime Roof Contracting, LLC Qualifying Agent: Mark Young
Address 13725 Beach Blvd Suite 13 City Jacksonville State FL Zip 32224
Office Phone (904) 530-1446 Job Site/Contact Number (904)860-0230
State Certification/Registration# CCC1329505 E-Mail office@primeroofingfl.com
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation FRSA Self Insurers Fund Inc. 12/31/19 870-040093/3EE6142 _
Exempt/Insurer/Lease Employees/Expiration Date F
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has E
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws 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
RE C R YO�UR�IOTICE OF COMMENCEMENT.
(Signar or Agent including Contractor) ignature of ntractor)
worn to(or affirm�e/d) before me this�day of Si ned a sworn to or affirmed efore me this 1241,day of
��, by V i�-E�e �V%ul) _ �� 2VI� by MArk to A m
BDf (Signature of Notary)
L NOTARY pUWWBLMMICC Andrew D. Davis
Columbia Count ? MINO #�Z�I�
State of Georgy �lA
[ ]Personally Known O Aires Nova28, 2021 [V]Personally Known OR RES. 1�, �l `y22
} Produced Identificat y C rn,Ex �` Produced Identification ��� if, � i
Type of Identification: Type of Identification: �i
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of Florida County of Duval
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:18-34 17-2S-29E.1 17 ATLANTIC BEACH SEC H LOT 4 BLK 107
Address of property being improved:429 Camelia St.,Atlantic Beach,FL 32233
General description of improvements.Re-roof
Owner Vickie Snook
Address 429 Camelia St.,Atlantic Beach,FL 32233
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Prime Roof Contracting,LLC
Address 13725 Beach Blvd Suite 13,Jacksonville,FL 32224
Phone No.(904)625-1446 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
J
Address
0
Phone No. Fax No.
o f—
co
N � Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a
o� v0 different date is specified): --
a ~ THIS SPACE FOR RECORDER'S USE ONLY OW R
V �
-1-11- 19
co :ofSigned: DATE
Q U Before me this y of in the
Co N ay _. _- -- County f uvai ate of Florid perso appeared
a o J LOUISA BOWMAN himself/herselfnd affirms that all statements and declarations herein ein by
O rn U g NOTARY PUBLIC are true and accurate
rn N_j o Columbia County
C) w
� CO State of Georgia
cao LQ LQ z My Comm. Expires Nov.28,2021
o a w> O Notary Public at Large.St f County of 6 �l
a-0 Z Z p My commission expires:
L) EZ Personally Knov:n or
o . v O O w Produced Identification
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