375 3rd St RERF19-0138 Shingle .,:,),\.,,J, , REROOF SHINGLE PERMIT PERMIT NUMBER
t-4,,.-4-.7.-.,; CITY OF ATLANTIC BEACH RERF19-0138
1800 SEMINOLE ROAD ISSUED: 10/9/2019
• > �;���; EXPIRES: 4/6/2020
ATLANTIC BEACH. FL 32233
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA 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: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
375 3RD ST REROOF SHINGLE SHINGLE ROOF $6677.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169824 0015 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
K & D ROOFING & JACKSONVILLE
74 6th St. S #104 FL 32250
CONSTRUCTION BEACH
OWNER: ADDRESS: CITY: STATE: ZIP:
GOLOMBEK ELLEN JOAN 2001 LINCOLN ST UNIT 1524 DENVER CO 80202
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 CONDITIONS
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 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $89.00
Issued Date: 10/9/2019 1 of 2
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office (904) 247-5826 Fax(904) 247-5845
Job Address: '��5 'fid S+• • aA-tan-�� toes t FL• N-2"-3 Permit Nt�nber: 1.- - C"RP,C1-O( , E
Legal Description 5'19 I�'a5-aqe•lb Q4�Q\k1C � �q. r pt LbP`rc l -Il Ilo.9fd4 •
l'loor Area of rt- q.1-'t
Valuation of Work SI 0,(R11 ''u Proposed Work heated/cooled 1123 non-heated/cooled 1
Class of Work(circle one): New Addition Alteration Repair Mov- Demolition pool/spa window/door
•
Use of existing/proposed structure(s) (circle one): Commercial . - • ri
If an existing structure,is a fire sprinkler system installed? (Circle one): es dm N/A
Florida Product Approval# iLl 0 I`t3U1 j s- t L ISLt B • 1
For multiple products use product approval form
Describe in detail the type of work to be performed: (tee r _p Q.CQ.M.Rfl - - u sqs @ 5`/
t L p
Property Owner LFIn ormatition: �
Name: `kr &t o th cn bC�17-- Address: j 1 5CI& •
City -:if ki C Cao.Ceirk Stated I.Zip 1)223 ,Phone pt-I-LLQ- IG iv a
E-Mail or Fax#(Optional)
Contractor Information: nn`` ,p,�
Company Name: e1$,0(2-61).P1Qualifying Agent: l �Ui411 f
Address: (Q'p(15 *1 TA
City Ct. 1Y1112.PJC State Ft-- Zip 225D
Office Phone 014- j- I -I-1 OD Job Site/Contact Number a.C}-1 - - 1.32A Fax#
State Certification/Registration# CCS 125852
Architect Name&Phone# t
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
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 laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six(6)months,or if construction or work is suspended or abandoned for a period of six(6)months at any time after
work is commenced. I understand that separate permits must be secured for Electricaf Work,Plumbing,Signs, Wells,Pools, Furnaces, Boilers,Heaters,
Tanks and Air Conditioners,etc
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMIENCEMENT 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 RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby certify that I have read and exaIt ned this plication and?mow the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with wh: er s.ecid herein or not. The granting of a permit does not presume to (nye authority violate or cancel the
provisions of any other federal,state, or cal aw regul. •.g construction or the performance of construction.
E 11,
.
Signature of O• .er .4—Ll Signature of Contractor
Print Name .1\ 1‘.1/4 '7i Print Name Rbb Col le.-
Sworn to and subscribed before me Sworn to and subscribed before me
this 6 Day of 1 C1"O'C)CA2-- i 201 this _Day 6 i !• .20 lel
....."/!....---,4 All AO% Adlill... - .09, -
Notary PubStri / / ' Not. ' ric
' ••i LORI WHISNAN I Revised 01.26.10
l;+ i'. MY C• •-/MMISSION#GG087345 r '�� ' LORI WMISNANT
r.\PIRcSMarch 27,2021 I _. MY COMMISSION#00087345
1 P:r,S,,,' EXPIRES March 27.2021
i.JTICE OF COMMENCEM},.i
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. Ili 80;300' 1501S
State of FLORIDA County of Clu.q OSI
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 -lL 9 I j. aC- n'l
e .15
O an C JQ Dash C Mif T Loi- Qv ety,t
Address of property being improved: 3-1t J d 3l ' (_171,07-C te(fes{ I �
I L-•
St- set 33
General description of improvements: RE ROOF/50 YR SHINGLES
y Owner etken clot wobe 12_
f-tatl � Address 31 J �Jrd ST ' ci Wa antic_ h t f L•
Owner's interest in site of the improvement OWNER
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor K&D ROOFING&CONSTRUCTION COMPANY,INC.
Address 74 6TH STREET SOUTH,SUITE 104 JACKSONVILLE BEACH,FL 32250
Phone No. 904-541-1700/904-223-6068 Fax No. 904-369-3249 E-FAX
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 -h r OWNE-J
gne• _ ;�.�-�� DATE
Befor=. ••y of 11it"th.if mum,
.► Y"Minhe
County of Duval,S•te of F rids,has per nallY appeared
herein by
Doc#2019233341,OR BK 18962 Page 110, himself/herse�irmS at I statements and declarations herein
are true and accurate
Number Pages:1
Recorded 10/09/2019 02:03 PM,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL /
COUNTY / �/ . `
RECORDING $10.00 Nota , .Ilc- arge,State of FLORIDA county'D I-AL
My .. Ission expires: 3-7_1- 2 I
Personally Known '' or
Produced Identification
ss,4�R' ''�' LORI WHISNANT
1 MY COMMISSION#GG087345
'' EXPIRES March 27,2021