523 Cruiser Ln RERF19-0122 Shingle V'r�� REROOF SHINGLE PERMIT PERMIT NUMBER
r ss,
CITY OF ATLANTIC BEACH RERF19-0122
800 SEMINOLE ROAD ISSUED: 9/6/2019
�LDill!)� EXPIRES: 3/4/2020
ATLANTIC BEACH, FL 32233
MUST CALL INSPECTION PHONE LINE (904f 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL • 'K MUST CONFORM T• THE CURRENT 6TH EDITION1 OF • + 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:
523 CRUISER LN REROOF SHINGLE SHINGLE ROOF $6279.00
TYPE OF +
ZONING: : r •
• • GROUP:
170703 0342 SEASPRAY
I
COMPANY: ADDRESS:
RELIANT ROOFING INC 4230 Pablo Professional Ct#155 Jacksonville FL 32224
—OWNER:- ADDRESS: CITY: STATE: ZIP:
BEHNCKE JAMES A 523 CRISER LN ATLANTIC BEACH `! 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 • . .
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 455-0000-208-0700 0 $4.20
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.80
WORK WITHOUT PERMIT 455-0000-322-1000 0 $195.00
TOTAL:$287.00
Issued Date: 9/6/2019 1 of 2
�
Gunning 1'"efrT19L . ppll(:atlOn Updated 10/9/18
City of Atlantic Beach Building Department "ALL INFORMATION
1` 800 Seminole Road Atlantic Beach! FL 32233 HIGHLIGHTED IN GRAY
'
Phone: (904) 247-5826 Email: Buildin-- Dept a@IS REQUIRED.
coab.us (� C IR
Job Address: 523 CRUISER LN Atlantic Beach FL 32233 Permit Number:
Legal Description 35-64 17^2S-29E SEASPRAY LOT 35 BLK 2 RE# 170703-0342
Valuation of Work(Replacement Cost)$6279.00 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?: ❑Yes ❑No
• Will trees be removed in association with proposedproject? ❑Yes must submit se arate Tree Removal Permit ❑No
Ir
escribe in detail the type of work to be performed:
eroof, 16 sq,4/12 pitch,shingles FL10124-R21
Florida Product Approval# E1_1017–U1Z 9 – Rz I for multiple products use product approval form
Property Owner Information F-eif Imola 5 K Y' F LI (✓ �p F_--
Name James&Michel Behncke Address 523 CRUISER LN
City_Atlantic Beach _v State FL Zip 32233 Phone 772-361-2000 _
E-Mail hellybehncke@ mail,com
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Reliant Roofing Qualifying Agent Cameron Shouppe
Address 4230 Pablo Professional Ct#155 City Jacksonville State: F) Zip':32224
Office Phone0�57;Q880 _ _Job Site Contact Number 904-712-3111
State Certification/Registration#_CCC1330615 E-Mail amanda(ab-reliantroofing.com
Architect Name&Phone tt _
Engineer's Name& Phone#
Workers Compensation Insurer policy#:WC 90-Q0-818-08 OR Exempt o Expiration Date 12-31-19
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 maybe 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
RE f 1NGhYOUR NOTICE OF COMMENCEMENT.
s4
8090oE88EE40ignature of Owner or Agent) (Sign a Co
Si\nQed and sworn to(or affirmed)before me this 5 day of Signed and sworn to(or affirmed) before me this 5 day of
� / ��(
by�� e�1 — S
by J.. UY1 ��la tom_ Pi
(Signature of tary) (Signature o otary)
Personally Known OR AMANDA JACKSON personally Known OR AMANDA JACKSON
♦Ipv P(1'/ii FPY PV ir State of Florida Notary Public ; producedIdentification ��'Produced Identification Commission x GG 205328 �:State of Florida
Public
Type of Identification: e': mission Expires ype of Identification: Commission GG 205328
April 09,2022 Om i
y April 09,2022
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of County of
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: )
Address of property being improved:�_- s C raiser L n. A- \cky4i L
Read 'f:1 3Q2--�
General description of improvements: g1. kr� (e'(Y1e 1 -
Owner
Address r C
Owner's interest in site of the improvement—M(A DQ o f
Fee Simple Titleholder(if ctlter than owner)
Name
Address
Contractor
Address
Phone No. 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
Address
Phone 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 SPAGE FOR RECORDER'S USE ONLY �d. R
WNER
Signed:_---_- _ DAT
�Beforemetis � OtU1 _n the
�- YS�.. _
Doc#2019204688,OR BK 18920 Page 1208, 1w,
tty[�f�Duv i,Stat of F orida,h s ersonally a eare
Number Pages:1 hlms' eil'.hers�e t and rms that a s atemants and I c ,j�ereln ANDAJACKSON
are true and accurate r' ° ,State of Florida-Notary Public
Recorded 09/06/2019 09:51 AM, Commission tt GG 205328
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL r My Commission Expires
COUNTY �o..� '� ADri109,2022
RECORDING $10.00
NotI La e,St a of County of
tsy commf one fres:.
Personal /,, n--X ------or
Produce IcatloA'