355 19th Street RERF19-0140 Shingle �S",v- REROOF SHINGLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RERF19-0140
L: Xv .. J
ov, v~ 800 SEMINOLE ROAD ISSUED: 10/17/2019
gi31,r ATLANTIC BEACH. FL 32233
EXPIRES: 4/14/2020
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:
355 19TH ST REROOF SHINGLE SHINGLE ROOF $19000.00
TYPE OF REAL ESTATE I ZONING: 1 BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172020 1260 SELVA MARINA UNIT
12A
COMPANY: ADDRESS: CITY: STATE: ZIP:
OAK CREST CONTRACTING, 536 SE 291 HWY LEES SUMMIT MO 64063
INC
OWNER: ADDRESS: CITY: ' STATE: ZIP:
LEHMAN MICHAEL E 355 19TH ST ATLANTIC BEACH FL 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 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 $150.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.25
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $154.25
Issued Date: 10/17/2019 1 of 2
f-----'
r , REROOF SHINGLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RERF19-0140
800 SEMINOLE ROAD
ISSUED: 10/17/2019
"`v__)% ATLANTIC BEACH. FL 32233 EXPIRES:4/14/2020
Issued Date: 10/17/2019 2 of 2
.. _ .___ ______
elm.' .j, Building Permit Application Updated 10/9/18
i )City of Atlantic Beach Building Department **ALL INFORMATION
< 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
cffu_ IS REQUIRED.
Phone: (904) 247-5826` Email: Building-Dept@coab.us
Job Address: S� /9 ,r7 -1- Permit Number: R 1R A 9 - V ' `" 0
Legal Description 36-(0t( 0/-a5 454q fliol;/ta.Uru 12-4 t of 11 RE# 1102-0 - 1.246 0
Valuation of Work(Replacement Cost)$ / /k90 00
9 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ONew OAddition DAiterationRepair��DMove DDemo OPool DWindow/Door
• Use of existing/proposed structure(s): DCommercial VJResidential
• If an existing structure,is a fire sprinkler system Installed?: DYes 'QfM1lo /
awe_n,►
• Will tree(sl be removed In association with or posed project?DYe (must submit separate Tree R oval Permit) L911Qo
Describe in detail the type of work to be performed: �( O d 1\ f lam 34 5q5 of 04)kat -5k '&
U
1 KO S(tii4es -FL-7 bob (k to roo-F (LAdee(a tent" - FL 15 Zt(o -9-1{
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name /1 /C/fir/ �.,e/71f7i))i n Address 3.5.:5-- f9'f14 'Sr
City 41-an7`7C J-sie 'ft State PL Zip ?2? ? .s Phone ?OfT�eE',5721/ &'9%?....
E-Mail fill Xe t o/i,t3 ,i (6)qr'-i '/.Ca'44
Owner or Agent(if Agent,Power of A Corney or Agency Letter Required)
Contractor Information /� n
Name of Company dc//(/ Gr f h Qualifying Agent
Address ,5-7. ,.:' M ,'7ii2 Tf/7 c ;S'',:/,` S- City )rtf',KSonr//fE State Ft zip . a7 c-9-
Office Phone OW 6?'D -05's' Job Site Contact Number 4"O 1 ? .1'o? 3 Y3'5-
State Certification/Registration# E-Mail -Jc?r't tirief-A...< A:l / ,/4f.(,v 1
Architect Name&Phone#
/
Engineer's Name&Phone#
Workers Compensation Insurer W C`) 18 e-,494B61-4,xempt 0 Expiration Date 5 / F2_)/ c),
Z
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 OBTAI ANCING, CONSULT WITH YOUR LENDER OR ' i I NEY BEFORE
RECORD ZI,,JR OTICE OF COMMENCEMENT./
4
(Signature o wner or Agent) (Signature of Contractor)
' ' ' before me this 7 day f ' gned and sworn to(or affirmed)before me this 27 day of
.,01„„",,. b�AOgI I)3iyD ,Cbtael L,e(tma.n 5ef4.Zolf$,"f-rr„�rr, 20/9 ,by d on �ltcu-fies
iNotary Public-State of FI p
,,410`11W,/:::_• *`- Commission# GG 3Y1 t�d/ldlrh /TVu��"4 rye_
'A !''a� i ature of of r )
o@aau�,� My Commission Expires �' v) (S' nature-af festa
ii April 9, 2023
''' LINDI BROWNFIELD
:° s Notary Public-State of Florida
( J Personally Known OR XPersonally Known OR `• 14::: Commission# GG 321567
D LKProduced Identificati [ J Produced Identification ;,f,p,„. 0''�,oc
1 tMy Commission Expires
Type of Identification: _,,��x'rv;•,,_.__L1.N_I2 __BROWNFLELD Type of Identification: April 9, 2023
: °`z-Notary Public-State of Florida
• •c Commission #GG 321567
?'?. ,,.Ari
..p, ,;ett My Commission Expires
April 9, 2023
Doc # 2019226764 , OR BK 18952 Page 82 , Number Pages: 1,
Recorded 10/01/2019 07 :37 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10. 00
I
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. t1420 - (2 6 0
State of_Florida County of:Duval
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in accordance
with section 713 of the Florida Statutes,the following information is stated in this NO'T'ICE OF COMMENCEMENT.
Legal description of property being improved: Single Family Residential 36- (e Li O4 2 S-l
Se(.10.Kkar k r'a. (AA.Z+ t. -/4 to-f (4 / / i
3 S
Address of property being improved: - //.1-1' S-/- Avike EXWA "-Z
General description
/en' provementsRe-roof
Owner Name: rA.At' /
/ ( P. /7"z-z-7
Address: 3ç' q _ f:
mi-fa,,1s/i( YAC rh ..-L
Owner's interest in site of the improvement: OW n dr
Fee Simple Titleholder(If other than owner):
Name:
Address:
Contractor: Oak Crest Contracting •_
Address: 5763.µati+;<f.-1 -.r§.t¢iig r ,Jacksonville,FL 322.S1
Phone No.(904)680-0058 Fax No.
Surety(if any):
Address: Amount of Bond$
Phone# 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 the person within the State of Florida,other than themself,designated by owner upon whom notices or other
documents may be served:
Name:
Address:
Phone No. Fax No.
In addition to themself,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 /// / OWNER q •
Signed: DATE: d�/Oc'/9. /t7
Before me is 11 day of $,ag4 'Js_v in t}{e count of
Duval,State of Florida,has personally appeared
M.,i c- .o.&l L.t hM.a.n herein by
himself/herself and affirms that all statements and declarations herein
I ,y,;,l1.'o.,, L I N D I B R O W N F I E L D are true and accurate.
°�,�Notary Public-State of Florida
3./" +z Commission#GG 321567
;+` 1 ''0 MyCommission Expires
.%�°;0.(t,:,-
` April 9, 2023 Notary blit at Large,State of (pr;Gtw.County of Ore,,age
My commission expires: 4- -2.3
Personally known: or
Produced Ideutification t>L-
,
it
r--
,, ,,,,
0 Cash Re ister Recei t Receipt Number
�' City of Atlantic Beach R10863
, -,i��3»�
DESCRIPTION I ACCOUNT I QTY PAID
PermitTRAK $55.00
RERF19-0140 Address: 355 19TH ST APN: 172020 1260 $55.00
ROOF IN PROGRESS 10/24/2019 RBE $55.00
ROOF IN PROGRESS 10/24/2019 RBE 455-0000-322-1002 0 $55.00
TOTAL FEES PAID BY RECEIPT: R10863 $55.00
Date Paid: Monday, October 28, 2019
Paid By: OAK CREST CONTRACTING, INC
Cashier: CT
Pay Method: CREDIT CARD 6
Printed: Monday, October 28, 2019 1:36 PM 1 of 1
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