240 Main St RERF19-0108 Shingle REROOF SHINGLE PERMIT PERMIT NUMBER
r CITY OF ATLANTIC BEACH RERF19-0108
J V 800 SEMINOLE ROAD ISSUED:
ATLANTIC BEACH. FL 32233 EXPIRES:
MUST CALL INSPECTION • • • 1 i + BY 4 PM FOR + INSPECTION.
ALL •RK MUST CONFORM TO THE CURRENT6TH EDITION1 OF • ' + BUILDING
CODE, • AND OF ATLANTIC + CH CODE OF ORDINANCES .
ALL • i OF PERMIT APPLY, PLEASE READCAREFULLY.
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:
240 MAIN ST REROOF SHINGLE SHINGLE ROOF $6500.00
TYPE OF !
• • GROUP: SUBDIVISION: 77 1
170867 0500 ATLANTIC BEACH SEC H
ADDRESS:
SUNBELT HOMES AND 450-106 STATE ROAD 13 NORTH, #409 ST. JOHNS FL 32259
ROOFING, LLC
• ADDRESS:
ALEY MARK A 240 MAIN ST ATLANTIC BEACH FL 32233-2528
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. 77
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 0 $2.00
TOTAL: $89.00
Issued Date: 1 of 2
Building Permit Application
Updated 10/9/18
r - City of Atlantic Beach Building Department "ALL INFORMATION
,
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
�a�
Phone: (904) 247-582 .
6 Email: Build (� REQUIRED.
Job Address: H V m '� SK
Permit Number: Re'Rpi IC�IS REQQ v io8 8
Legal Description '3 Li I I -'1.S - 1.q C- S L'_C H is-rt C 9LAQ4 RE# l )b 'V6-1 — ofbo
Valuation of Work(Replacement Cost)$ (7�0OW 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 ❑Residential
• If an existing structure, is a fire sprinkler system installed?: Dyes []No
• Will trees be removed in association with proposed pro0ect? ❑Yes must submit separate Tree Removal Permit ❑No
Describe in detail the type of work to be performed:
126fLoU
Florida Product Approval# /amAL P /'31't', 1 0 146 et/ for multiple products use product approval form
Property Owner Information
Name M AR k /A L L:1 Address _
City State Zip Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company S i,N Q Lf i40M e i i, ROM(►d ri Qualifying Agent -r0 b✓.,A S
Address 450 - IJP 511- 11 Llo i city 5'li.,,,,f ToNAJJ state P_ Zip lttS_c
Office Phone ci oL/ ,63S"- -)ai `i Job Site Contact Number
State Certification/Registration# C C L I til b k 1 E-Mail L f- LANG oo,tlCL i Q rlc u•Cv +.
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 BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT. ``j
(Signature f Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed)before me this g day of
ti 1 `1 l0 19
by /YIA n I-CA L L'"J by
iC/ #a
in
En"KV
'.. THOMAS BRADLEY SMITH DAVIDCASSMY COMMISSION Il GG 001103 o My COMMISSION*FPA6317"1[ ersonally Known O :;? EXPIRES:A4gW22,2020 [ Personally Known OR EXPIRES:MAY 25,2020
Produced Identificat „ ��edTM+NoteryPuDRcUndnwdlsn [ ]Produced Identification a Bonded throughlstStatelnsurance
Type of Identification: Type of Identification:
Doc # 2019181022, OR BK 18887 Page 1145, Number Pages: 1,
Recorded 08/05/2019 11 :00 AM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
NOTICE OF COMMENCEMENT
11RER-R—It:DL:=Lir A-E
Fem?t No. rax Folio Ne. I �?(,7 L� l? ll J(`
State of t o(L 1 County of L3 ut L
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: 13 y
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Address of property being improved:
ZOO rriALA,) CFi �L3?.23s 2�
eneraldescription of improsements: R a cc,F
Address .�i'1 V 0 n -i Al )'i (11 L �N 'f C. R .AC L -
.r:per's interest in site of the improvement 0tJVL-
Fee Simple Titleholder iif other than o,.-,peri
Name
.address
Contractor SUJi6'- ROCIELjsZ(-, LL(..
Address t..l 5 O -- I t,:C-ti S fL i.3 �j Wtit)Cj /1f 1' --,r''1w I. 22 S��
Phone No. al 0_ 1, (,13 10 t Cj Fax No.
Surely(if any)
Address
Amount of bend S
P;tone No. Fax Aro.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person:•ithin Me State of Florida.other than himseif.destgnated by owner upon whom notices or comer
documents may be served:
Name
Address
Phone No. Fax No.
t
In addition to himself.owner des:gnates the folio,ing person t0 receive a copy of the Lienor s Not,ce as provided in
Section 713106(2)(b),Florida Statutes.(Fitt in at 0,:ner•s option).
Name
Address
Phone No. Fax No.
Exciration dare of Notice of Commencement(the expiration date is one;1 I year from
dihe gate of recording unless e
erent date is specified};
THIS SPACE FOR RECORDER'S USE ONLY ,, OWNER
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