336 6th St RERF19-0130 Shingle REROOF SHINGLE PERMIT PERMIT NUMBER
RERF19-0130
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 9/17/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 3/1S/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 • ' BUILDING
CODE, OF • OF • '
ALL CONDITIONS OF . . CAREFULLY.
40TICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property
hat may be found in the public records of this county, and there may be additional permits required from other
;overnmental entities such as water management districts, state agencies, or federal agencies.
JOB ADDRESS: r • OF • '
335 6TH ST REROOF SHINGLE shingle re-roof FL10124 $14000.00
TYPE OF BUILDING
• • GROUP:
169894 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
>UMMIT CONSTRUCTION 1652 EMERSON STREET JACKSONVILLE FL 32207
GROUP, LLC
• ADDRESS: CITY: STATE: ZIP.,
FLOWER GARY P 335 6TH ST ATLANTIC BEACH FI_ 32233-5347
YARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
N YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
:OMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
NSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF . r
toll 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 $125.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $129.00
Issued Date: 9/17/2019 1 of 2
ri'y,J`Jf�` REROOF SHINGLE PERMIT PERMIT NUMBER
s, RERF19-0130
CITY OF ATLANTIC BEACH
ISSUED: 9/17/2019
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233 EXPIRES: 3/15/2020
Issued Date:9/17/2019 2 of 2
�S
'`�" Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department *"ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 3 3 5 (c,T`4 �?'� Permit NNuumb� 4er: E IU 16 - (D ��y
Legal Description 5 125 f EE D F [AT. I& Z gt�C/� PM �t� - RE#
Valuation of Work(Replacement Cost)$ ("� V o0 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 Ctesidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes Mo
• Will trees be removed in association with proposed ro ect? ❑Yes must submit separate Tree Removal Permit 1PNo
Describe in detail the type of work to be performed:
(Z C-P-c v F ` 5 f�()4 6 (, S V2- 5(P J[141ZE 5
Florida Product Approval# FL-- t O ( 2- 4 for multiple products use product approval form
Property Owner Information
Name X11 (�� Fl-o�1i✓^1't-S Address 335 &T-t+ 5-r
City kT 1_A->J"C- 30 A-c-N State - zip 3 22 3 3 Phone `l o - ( 3 - D
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company 51J►MwlIT 6VI�ST1tV6T101 GleOUf Qualifying Agent
Address 652 Sr City3ACkS09 V(t-LC-- State Zip 'Z2O?
Office Phone If o 4 -- 72.-5-'t-(D S c, Job Site Contact Number
State Certification/Registration# CcC- (32 1572 E-Mail CS(2-4Al-E OC-4 f-' L0—C-4-ST, E
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer S�UTt�G By- L`Y�S 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
RECORDJNG YOU T� OF COMMENCEMENT.
j (Signature of Owner or Agent) (Signature of Contractor)
ii
Signed and sworn to(or affirmed)before me this /3 day of Signed angl sworn to(or affirmed) before me this 13-t'day of
by G+i2Y F�-owc:2s o (q by t32/•4- EKo---#
Signature o f"A0. RENFROE gn8tcrre of tlele � —.;
iia Pia., �a�p�, TRISHA A. RENFROE
Notary Public -State of Florida _°; ;`�: Notary Public-State of Florida
Commission # FF 932297 ' Commission # FF 932297
[ ] Personally Known OR "9,F oma, My Comm.Expires Oct 29,2019 Personally Known OR ? r P;c My Comm. Expires Oct 29,2019
[%]•Produced Identification �f�"` Bonded through National Notary Assn. ]Produced Identification ••POPE°•' Bonded through National Notary Assn.
Type of Identification: DL ype of Identification:
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of FLORIDA County of VV 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: '5o V t if ( 2-S Fc--C--( c r Leg, 16,
13 1—o G K $ 1-TLA-97 I L g CA-e—4
Address of property being improved: 339 67-o- -s7-f�--cT
!4-T-LA-9 rt c_ M A-c. FL 37-7- 337
General description of improvements: P—C—'—A-V O F
Owner G A-2 Y F LZ 6-9—S
Address 3 3 5 6rW S'�'? 1, -32-2-3-3
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor SUMMIT CONSTRUCTION GROUP
Address 1652 EMERSON ST,JACKSONVILLE, FL 32207
Phone No. 904-725-4050 Fax No. 904-800-1255
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 o N
documents may be served: " o LL �w N la
Name Z „ CD
LLz
W Y LL 0 C
Address `t z* o
_ H L
Phone No. Fax No. a W
NC ._ E
JEO
In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in r¢- E E
U U o
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option). Z m
Name
Address a0
®o0:
-
Phone No. Fax No. Y. °
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
Signed: L'vv` DATE� /9
Before me this y of in th
County of Duval sta of Florida,ha rsona11 appeared
Doc#2019214619,OR BK 18934 Page 1261, Gr t !_o W herein by
Number Pages: 1 himself/herself and affirms that all statements and declarations herein
Recorded 09/17/2019 10:09 AM, are true and accurate
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING $10.00
Notary Public at Large,State of f LCountyof
My commission expires: /0 2 _ 9
Personally Known or
Produced Identification&I D L