40 Dudley St RERF19-0105 Shingle REROOF SHINGLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH
RERF19-0105
800 SEMINOLE ROAD ISSUED: 8/9/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 2/5/2020
MUST CALL INSPECTION • 904 • PM FOR NEXT DAY INSPECTION.
ALL • 'K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • ' i + BUILDING
ii AND CITY OF ATLANTIC + CH 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
DD. • • OF • .
40 DUDLEY ST REROOF SHINGLE SHINGLE ROOF $3680.00
BUILDINGTYPE OF REALESTATE
ZONING: :D •
• • GROUP:
172209 0000 DONNERS R/P
-----COMPANY:-- ADDRESS:
PATRIOT ROOFING 1695 Hereford RD MIDDLEBURG FL 32068
SERVICES, INC.
® • �� ADDRESS:
BROWN CALVIN H 515 SAILFISH DR E 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 • . •
I 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 $70.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$74.00
Issued Date: 8/9/2019 1 of 2
Building Permit Application
4 _ City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone: (904)247-5826 Fax: (904)247-5845
Job Address: 40 DUDLEY ST Atlantic Beach FL 32233 -Permit Number: RIECEloi
" w
Legal Description 19-16 17-2S-29E DONNERS RIP PT LOT 3 LOT 10 BLK 2 __ RE# 172209-0000
Valuation of Work(Replacement Cost)$3680.00 Heated/Cooled SF_624 Non-Heated/Cooled 624
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residential
• 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: Re-Roof Shingles
l� ttC�et`
Florida Product Approval#1-1-10124.1 for multiple products use product approval form
Property Owner Information
Name: BROWN CALVIN H Address: 515 SAILFISH DR E
City Atlantic Beach State FL Zip 32223 Phone 904-241-8876
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) ---
Contractor Information
Name of Company: PATRIOT ROOFING SERVICES INC Qualifying Agent: Joshua Pennington
Address 1695 HEREFORD RD. City Middleburg State FL Zip 32068
Office Phone 904-413-7725 Job Site/Contact Number 904-509-7732
State Certification/Registration# 1330098 E-Mail JOSHP@PATRIOTRSC.COM
Architect Name& Phone 4
Engineer's Name&Phone#
Workers Compensation --
Exempt/Insurer/Lease Employees/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 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 ATTO BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.—_
(Signature of Owner r gent including Contractor) ignature of Contractor)
Ign d and sworn to(or affi )bgfor e th' day of Signed and sworn to(or affirmed)before me tri day of
�� Z e o J n by l .` -IC- tt l-0 �1
/ DON
Si nature of Not MY COMMISSION(bl 944"f tart')
TORN GNDLESPERGEP ( g Y1
AlyGIkV SI'ON�FF92»951 EXPIRES November.'a 2019
`S
EXptRES Octbb9r E.24'9 aar hiss -5-3 1 bndalloba yse,vice�o
{'personally Known OR Personally Known OR
[ ]Produced Identification (� [ Produced Identification
Type of Identification: s 0 ` — 4LType of Identification:
r1;1y7.i.
a. PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH FLORIDA (*REQUIRED)
�F
*Project Address: 40 Dudley St. _ Permit#:
*Owner/Project Name: Calvin Brown/40 Dudley St
As required by Florida Statute 553.842 and Florida Administrative Code Rule 913-72, please provide the information and product approval number(s)for
the building components listed below as applicable to the building construction project for the permit number listed above. You should contact your
product supplier if you do not know the product approval number for any of the applicable listed products. Information regarding statewide product
approval may be obtained at:www.floridabuilding.org.
Category/Subcategory Manufacturer Product Description Limitation of Use State# — Local#
A.EXTERIOR DOORS -- —
1.Swinging -- ——�
2.Sliding
3.Sectional
4.Garage Roll-Up --
5.Automatic —
6.Other
B.WINDOWS
1.Single hung
2. Horizontal slider
3. Casement
4.Double hung
5. Fixed
6.Awning
7. Pass-through —
8.Projected
9.Mullion
10.Wind breaker
11.Dual action
12.Other
Page 1 of 4 Updated 10/17/18
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
C.PANEL WALL
1.Siding
2.Soffits -
3.EIFS _
4.Storefronts
5.Curtain walls —
6.Wall louvers -
7.Glass block
8.Membrane
9.Greenhouse
10.Synthetic stucco _
11.Other
D.ROOFING PRODUCTS
1.Asphalt shingles
2.Underlayments
3.Roofing fasteners Nuc
4.Nonstructural metal
roof
5.Built-up roofing
6.Modified bitumen
7.Single ply roofing
8.Roofing tiles
9.Roofing insulation
10.Waterproofing
11.Wood shingles/shakes
12.Roofing slate
13.Liquid applied roofing_
14.Cement-adhesive
coats
15.Roof tile adhesive
16.Spray applied
polyurethane roof
17.Other
Page 2 of 4 Updated 10/17/18
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
E.SHUTTERS
1.Accordion
2.Bahama
3.Storm panels
4.Colonial _
5.Roll-up
6.Equipment
7.Other - -F.STRUCTURAL
COMPONENTS
1.Wood
connector/anchor
2.Truss plates
3.Engineered lumber
4.Railing
5.Coolers-freezers
6.Concrete admixtures
7.Material
8.Insulation forms
9.Plastics
10. Deck-roof
11.Wall
12.Sheds
13. Other
G.SKYLIGHTS
1.Skylight
2-Other
H.NEW EXTERIOR
ENVELOPE PRODUCTS
1-
2.
Page 3 of 4 Updated 10/17/18
In addition to completing the above list of manufacturers, product description and State approval number for the products used on this project, the
Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and installation
instructions along with this Product Approval Sheet.
I certify that this product approval list is true and correct to the best of my knowledge. I further certify that use of different components other than the
ones listed in this document must be approved by the Building Official.
*Contractor Name (Print Name):Joshua Pennington _ Contractor Signature:
*Company Name: Patriot Roofing Services
*Mailing Address: 1695 Hereford Rd.
*City: Middleburg *State: FL *zip Code: 32068
*Telephone Number: (904) 413-7725 *E-mail Address: joshp@patriotrsc.com
Cell Phone Number: (904) 509-7732 Fax Number:
Page 4 of 4 Updated 10/17/18
Doc # 2019182698, OR BK 18889 Page 2400, Number Pages : 1 ,
Recorded 08/06/2019 04 :35 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10 . 00
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE
Tax Foho No. 172209-OON
Permit No. County of
State of °LORIDA _—--
To whom it rt*ay concern:
The undersigned
Informs you that Improvements will be Made to Certain real propa►ty,and In
accordance with Section 713 of the Florida Statutes,the foltowing information Is stated In this NOTICE OF
COMMENCEMENT.
Legal desciption of pfoperty being unproved:
19-16 17-2S-29E DONNERS R1P PT LOT 3 LOT 10 BLK 2
Address of property being improved: 40 DUDLEY ST Atlantic Beach FL 32233
General description of improvements: RE-ROOF
Owner
ok7WM CALVIN M -
Address 515 SAILFISH DRE ATLANTIC BEACH.FL 32233
owner's interest in site of the improvernent 100%
Fee Simple T tlehoider(if other man owner)
Name
Address
Contractor PATRIOT ROOFING SERVICES INC
Address 1895 HEREFORD RD.MIDDLEBURG FL 32068
Phone No. 904-413-7725 Fax No. --
Suety(if any)
Address Amount of bond$
Ph"No, Fax No.
Name and address of any Person malting 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 Lienors Notice as provided In
Section 713.06(2)(b),Florida Statirtes.(Fdl M at Owners option).
Nemo
Address
Phone No, Fax No.
Expiration date of Nonce of Commencement(the expiration date Is one(1)year from the date of recerdrng uivess a
different date is specified):
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