233 Belvedere St RERF19-0131 Shingle REROOF SHINGLE PERMIT PERMIT NUMBER
r CITY OF ATLANTIC BEACH RERF19-0131
800 SEMINOLE ROAD ISSUED: 9/19/2019
Uj 19 ATLANTIC BEACH. FL 32233 EXPIRES: 3/17/2020
MUST CALL INSPECTION • • • + PM FORDAY • •
ALL • ' K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • ' ! + BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL • ! i 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:
233 BELVEDERE ST REROOF SHINGLE SHINGLE ROOF $7844.00
TYPE OF •
CONSTRUCTION:- GROUP:I ZONING:
170506 0000 SALTAIR SEC 01
COMPANY: ADDRESS:
PRIME ROOF 13725 BEACH BOULEVARD, #13 JACI<SONVILLE FL 32224
CONTRACTING LLC
OWNER: + D• ' '
FLORES VIOLET DAGLEY 233 BELVEDERE ST ATLANTIC BEACH FL 32233-4108
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: 9/19/2019 1 of 2
10 Building Permit Application
City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904)247-5845
Job Address: 233 Belvedere St Permit Number:
Legal Description 10-8 17-2S-29E SALTAIR SEC 1 S1/2 LOT 461,LOT 462 RE#
Valuation of Work(Replacement Cost)$7,844 Heated/Cooled SF 1507 Non-Heated/Cooled_
• Class of Work(Circle one): New Addition qqEEn Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial IEesidentia
• 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: Replace roof with asphalt shingles and modified itumen rolls
Florida Product Approval#FL10674-R12(shingles) FL17420-R2(synthetic) for multiple products use product approval form
Property Owner Infor!7gtion FL 19979-R1 (modified)
Name: Jose Flores _ Address: 233 Belvedere St
City ATLANTIC BEACH State FIL _Zip 32233 Phone (904) 614-2661
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: Prime Roof Contracting, LLC Qualifying Agent: Mark Young
Address 13725 Beach Blvd Suite 13 City Jacksonville State FL Zip 32224
Office Phone (904) 530-1446 Job Site/Contact Number (904) 860-0230
State Certification/Registration# CCC1329505 E-Mail office@primeroofingfi.com
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation FRSA Self Insurers Fund Inc. 12/31/19 870-040093/3EE6142 _
Exempt/Insurer/Lease Employees/Expiration Date R
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or installation has E
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 ATTORNEY BEFORE
RECOING YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent including Contractor) Sig a of Contractor)
Sin d and sworn to(or affirmed)before me this qday of Si n7d a d sw o(orlar ed) efore me this Amday of
Zoe by 'I - k
_ N
(S nat f No j • (Signature of Notary)
4' a ,-.And `R: Davis �' a Ani ew D. Davis
COMMISSION#GG241220 COMMISSION#GG241220
[,f'P'ersonally Known' j `: EXPIRES: Sept 17, 2021 "rsonally Known OR = .
,�„
[ I Produced Iden tificatihni %�` Bonn mN Nt'Dlit [ I Produced Identification 's., F �.� EXPIRES: Sept 17, 2021
Type of Identification: _ __ _ Type of Identification: ry�q'���"��� Bonded TIru Aillon_Notary
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
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:10-8 17-2S-29E SALTAIR SEC 1 S1/2 LOT 461,LOT 462
Address of property being improved:233 Belvedere St,Atlantic Beach,FL 32233
General description of improvements:Re-roof
Owner Jose Flores
Address 233 Belvedere St,Atlantic Beach,FL 32233
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Prime Roof Contracting,LLC
Address 13725 Beach Blvd Suite 13,Jacksonville,FL 32224
Phone No.(904)625-1446 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 SPACE FOR RECORDER'S USE ONLY NER C/
Slgn DATE_ S
Before this ay of in the
Cin of Duvph$tate Florida,has ersonally appeared ,��t
�J cn lf and �b rew D Davis
himse/ erself and affirms that all statements and decl s �� D.
Doc#2019217139,OR BK 18937 Page 2193, are true and accurate * COMMISSION#0`02412M
Number Pages: 1 EXPIRES: Sept 1T 2022
Recorded 09/19/201909:30 AM, %.,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL �n►7in��� NxxW ft As=NI
COUNTY Not ry Public at Large, to County of
RECORDING $10.00 My commission expires:
Personally Known or
Produced Identification