860 Bonita Rd RERF19-0118 Shingle REROOF SHINGLE PERMIT PERMIT NUMBER
RERF19-0118
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ISSUED: 8/28/2019
ATLANTIC BEACH, FL 32233 EXPIRES: 2/24/2020
MUST CALL INSPECTION PHONE91 . . BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK • • ' TO THE CURRENT 6TH EDITION1 OF • '
CODE, OF • OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, 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:
860 BONITA RD REROOF SHINGLE shingle re-roof FL18355.1, $7500.00
2569R16, 5680R19
TYPE OF
• • GROUP:
171105 0000 ROYAL PALMS UNIT 01
COMPANY: ADDRESS:
PIMENTEL ROOFING INC 402 St. Augustine Blvd. JACKSONVILLE FL 32250
BEACH
• ADDRESS:
KNIERIEMEN DANIEL JR 860 BONITA RD ATLANTIC BEACH FL 32233-4229
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 $90.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$94.00
Issued Date: 8/28/2019 1 of 2
Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department "ALL INFORMATION
V 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
9
Phone: (904) 247-58266 Email: Building-Dept@coab.us D.
p �j IS REQUIRED.
Job Address: 6&oAte/ , 944 Permit Number: F—U_F'
Legal Description RE#
Valuation of Work(Replacement Cost)$ pyo Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition [;Iteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial R111esidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes D1Go
• Will trees be removed in association with Proposed roiect? ❑Yes must submit separate Tree Removal Permit ❑No
Describe in detail the type ofworkto be performed:
5 ' (.e, `J(il t v2 ,
Florida Product Approval# for multiple products use product approval form
Property Owner Information /
Name_DAM Addressligr} ,�a�,�/rte �pQ•
City— 7'/�Ay 4,4 State L�Z7 —Zip Phone S—W—�?�a�
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
[�
Name of Company R/ 4 e,)� s ,�
e f! T/JC rA2C, Qualifying Agent
Address '4/02 6T, City City3 LLLA,, _State ;S� zip,�ZZ�
Office Phone hoV�_� �'B Job Site Contact Number'/—S�y8
State Certificatlo Registration# V5— E-Mail
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
RES IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TOCM IN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNE E
RE ORD G Y URfN TICE OF COMMENCEMENT ) 'T
V 1 (�C
(Signature of Owner or Agent) (Signature of Contra
ned and sworn to W[
fir )bef9r e this 1 of Si ed and worn to(or affirmed)before me this day
! y N � �1 11111 / /
ign ur r ) ��1 tine �') L
r,.PERGER _
* - _ My Comm.Expires
fi s FF 925951 August 17,2021
[ ]Personally Known OR 2019 [. Personally Known OR — No.GG135675
Produceci Identification de rite I �7 ]Produced Identification
Type of I en i ica ion: �� ` �" �pe f I ntification: %�' 'PUBUG �`
/,//I0F11F�1��.
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. 171105-0000
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: 30-60 17-2S-29E ROYAL PALMS UN IT 1
LOT15 BLK1
Address of property being improved: 860 BONITA RD ATLANTIC BEACH FL 32233
General description of improvements: RE-ROOF
Owner DANIEL KNIERIEMEN
Address 860 BONITA RD ATLANTIC BEACH FL 32233
Owner's interest in site of the improvement OWNER
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor PIMENTEL ROOFING,INC
Address 402 SAINT AUGUSTINE BLVD JACKSONVILLE BEACH,FL 32250
Phone No.90-591-5498 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 or herself,designated by owner upon whom
notices or other documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself or herself,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
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expirannd, is one(1)year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY �-Ow
ER
Signed: j DATE 1
Before me this day Of —
_ in e
County of Duval, tate of Florida,hasp ovally appeared h �\\ \\e M
himself/herself and affirms that all statements and declarations h n�0
Doc#2019199715,OR BK 18912 Page 21 t o +O N O T 9
�y�����, are true and accurate /�`
Number Pages: 1 v N
Recorded 08/27/2019 10:01 AM, = My C9n'm.Ex
BONNIE FUSSELL CLERK CIRCUIT COURT DUVAL August 77,20 _
COUNTY - N0 GG135675
RECORDING $10.00 Not Public at Large. taeot untyo
My commission expireI G
Personally Known or Q \�
Produced Identification �/, F LOQ'\O\\
/////111111\\\
y
�P/RODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH FLORIDA
Project Name:—k ,��ey ,�Nt-A)
.4mo Permit #
Project Address: (L ,,,�,���� f�
As required by Florida Statute 553.842 and Florida Administrative Code Rule 9B-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.floridabuildin .or .
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local 4
A.EXTERIOR DOORS -
1. Swinging
2. Sliding
3. Sectional
4.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-throuall
8.Projected
9.Mullion
10.Wind breaker
11.Dual action
12. Other
Category/Subcategory Manufacturer Product Description
imitation 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
A ROOFING PRODUCTS
1.Asphalt shingles koo
�g
2.Underlayments ALJc
35571
tz 6& 2
3.Roofing fasteners - - _
4.Nonstructural metal roof
5.Built-up roofing
6.Modified bitumen
7. Single ply roofing 6-k h'r; ye, F
8.Roofing tiles
9..Roofina 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
10
17. Other
Category/Subcategory Manuf icturcr Product e Description imitation of Use Stat #
P Local#
E. SHUTTERS
1.Accordion
2.Bahama
3. Storm panels
4.Colonial
,I
5.Roll-up
6.Equipment
7.Other
TF 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
Cateo /Subcate o
g r g �' Manufacturer Product Description imitation of Use State#
H.NEW EXTERIOR Local#
ENVELOPE PRODUCTS
1.
2
In addition to completing the above list of manufacturers, product description and State approval number for the products used on thispro'ec th
Contractor shall maintain on the job site and available to the Inspector, a legible copy of each m
instructions along with this Product Approval Sheet. anufacturer's printed specifications and installation
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 R
(Print Name) � (Signature)
Company Name: o
Mailing Address:
city:
State-_EL_Zip Code-_3��
Telephone Number: ( a /// �� Fax Number: ( )
Cell Phone Number: (9p� )_ �, /� �� E-mail Address: