121 Pine St RERF19-0114 Shingle r1'y'�f REROOF SHINGLE PERMIT PERMIT NUMBER
r+ , CITY OF ATLANTIC BEACH RERF19-0114
v 800 SEMINOLE ROAD ISSUED: 8/26/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 2/22/2020
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF i '
CODE, OF • 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:
121 PINE ST REROOF SHINGLE SHINGLE ROOF $5150.00
ZONING:TYPE OF REALESTATE BUILDING USE
:D •
• • GROUP:
170636 0110 SALTAIR SEC 03
COMPANY: ADDRESS:
SUNRISE ROOFING
COMPANY 762 7TH AVE S JACKSONVILLE FL 32250
• ADDRESS:
STANTIAL JAMES E 121 PINE ST 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 a
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 $80.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 45S-0000-208-0600 0 $2.00
TOTAL: $84.00
Issued Date: 8/26/2019 1 of 2
Building Permit Application Updated 10/9/18
..�._, City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
9�
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.U
Job Address: 12[ Fine, Si I'�i',���GIYI`fY �f 1L 32233 Permit Number: ��� l — C )((4-
Legal Description to—I(o 21 -2S-ZgE ,057 '5kLTAIt2 SSC, 3 )lO,T- RE# 1-70(,, 36-0 )1 l�
Valuation of Work(Replacement Cost)$ S. 1c50.0 Z) Heated/Cooled SF Non-Heated/Cooled L►
• 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?: "Ayes El No ��!!
• Will trees be removed in association with proposed ro'ect? ❑Yes must submit separate Tree Removal Permit •blNo
Describe in detail the type of work to be performed: 9a (2,C)D r- W 11HA O cJ Q Yi.S C0((I I k 'Djy oh' �,n
X'NfC,V1 k-A-t&NU VO4 S V]i V, �o S 0,(N a P—" i n 6. Yl-)-),e fit c- U V�A V, I((_q 1Y"e V1 r
Florida Product Approval# P L 1061-1,13 -4 EL 19216%n0 for multiple products use product approval form
Property Owner Information
Name S S'Ta 'h Address L9 I j?:n Q S'ffeC,+
City ayl1l State_�Zip Phone
E-Mail L Gh
Owner or A ent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company _,Son Y1 cowl P wk-1 Qualifying Agent VS rle
Address -7 1a Z J '2 PN e - -CityI tate F-L, tip 3 2 Z
Office Phone 0164 ' — I cl 2 Job Site Contact Number CJ a-J , H
State Certification/Registration# GI E-Mail A:CQ to �C20 SJ Y1 y- S2 v✓►
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
RECORDIN YOU TICE OF COMMENCEMENT. d
(si of Owner or Agent) (Signa re of Contractor)
Si ned and sworn to(or affirmed)before"�e�this day of Si ned and sworn to(or affir )before�m"e this day of
'M C4 ,b 7f ti 1 ,)vl by �r v�f k.Q
(S'tgAalure of Notary) Si n ure of Notary)
Ep�__
CINDY D.MULLINIKS .��pp�� tag,'•. C!NDY D.MULLINi .;Commission#GG323905 [: Commisslon#GG 323y�5Personal) Known O [ ]Personally Known OR : • �: Ex IreBA rllyExpires April 15,2023 P p 15,2023
[ ]Produced Identificat [ Produced Identification 'RpF«• Ba ded rhN rr FBonded Thru Troy fain Ineuranra 800.385 7019 oy aln Insura.800,9857019Type of Identification: I Type of Identification:
Doc # 2019193114, OR BK 18903 Page 2023, Number Pages: 1,
Recorded 08/19/2019 02:54 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
NOTICE OF COMMENCEMENT
State of Florida 170636-0110
Tax Folio No,
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: 10-16 21-2S-29E.057 SALTAIR SEC 3 S1/2 LOT 682
Address of property being improved: 121 PINE STREET,ATLANTIC BEACH,FL 32233
General description of improvements: RE-ROOF
Owner: JAMES STANTIAL Address: 121 PINE STREET,ATLANTIC BEACH,FL 32233 `
Owner's interest in site of the improvement: OWNER
Fee Simple Titleholder(if other than owner):
Name:
Contractor: SUNRISE ROOFING COMPANY,TRAVIS BERKEY
Address.. 762 7TH AVE.S.,JACKSONVILLE BEACH,FL 32250
Telephone No-- (904)495-1835 Fax No:
Surety(if any)
Address: Amount of Bond S _
Telephone 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:
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 Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: 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
Signed: Date:�(�I'��-
:••., Cp�pY D.k`'t L>M Before Atis day of
R' fi n rGG 323945 in the County of Duval,State
COp Of Florida,has personally appeared
Ey�App116,2023 7019 Nota Public at Lar
gaddllusTrop
•<<•`.�• F:a,;;,fv�.��804905• Notary Large, tate o F rida,County of Duval
My commission expires: )✓"`
Personally Known: 11Cor
Produced Identification: