295 Main St RERF19-0142 Shingle REROOF SHINGLE PERMIT PERMIT NUMBER
it r
CITY OF ATLANTIC BEACH RERF19-0142
800 SEMINOLE ROAD ISSUED: 10/18/2019
j"<-74011,/19.
` N EXPIRES: 4/15/2020
�`''' 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:
295 MAIN ST REROOF SHINGLE shingle re roof fL10124 R4 $8500.00
& FL17188.1
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170867 5000 ATLANTIC BEACH SEC H
COMPANY: ADDRESS: CITY: STATE: ZIP:
Rhino Roofing of 11318 W. Distribution Ave#1 Jacksonville FL 32256
Jacksonville LLC
OWNER: ADDRESS: CITY: STATE: ZIP:
RITTER PENNY LYNN 295 MAIN ST ATLANTIC BEACH FL 32233-2527
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.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $95.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$99.00
Issued Date: 10/18/2019 1 of 2
REROOF SHINGLE PERMIT PERMIT NUMBER
��•, 4� ,; f, CITY OF ATLANTIC BEACH RERF19-0142
800 SEMINOLE ROAD ISSUED: 10/18/2019
ATLANTIC BEACH, FL 32233 EXPIRES: 4/15/2020
Issued Date: 10/18/2019 2 of 2
Building Permit Application Updated 10/9/18
-1-7'.-__ City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
,' IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us // �nJI` C
Job Address: Zq 5 Md U' Si- /44411C f ea la a 3it33 Permit Number: pp Gr r (I-0 I'-
Legal Description -39 I1 'ZS - IC • 1,11 1r1AN11 C bektH SEG N RE#
Lp'c I , i.)4) (Replacement
ICH&ftcoRy '& wbc/SS -11 4LK I0�b / ��Z�
Valuation of Work Re lacement Cost)$ 0O Heated Cooled SF II Non-Heated Cooled
• Class of Work: ❑New ❑Addition ❑Alteration l epair ❑Move ❑Demo ❑Pool DWindow/Door
• Use of existing/proposed structure(s): OCommercial li3ftesidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) e
Describe in detail the type of work to be performed: Q e , 04._ S,k ('L jj SPi�p1) 946,1i-el
I Durk - Fell- t UAo(I?rf ai�xi74� ^ FL- (\,
F- i1: • (
Florida Product Approval# 1012L4 r 4 for multiple products use product approval form
PropertyOwnerInformationgirl
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Name PENNY I ? TE12- Address ) Awl- St" 4/-1140 g ct ►`C 32Z�?
City AZ'LAiJ7'( gg-d9c -1 State Zip 32,27 3 Phone ipq S41 5o13
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Informationrri,„ it Name of Company aiiiii
6i /.„n G Qualifying Agent
Address 113( I. r,n
bii„ 4,4, r, Ch
/ 1 City (ANY 4•1 VIUF- State IL Zip 32ZS`
Office Phone 4 41/641Job Site Contact Number yb pro 6 1
State Certification/Registration# LCC 1331(11 E-Mail 1111,0 NO-0 A 1YktA(7 .air
Architect Name&Phone# V
Engineer's Name&Phone#
Workers Compensation Insurer r«rtk C rtnv'. OR Exempt 0 Expiration Date 01/01 /wt.o
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 N ATTORNEY BEFORE
REcORDING��f'QVJ NOTICE OF COMMENCEMENT.
C (Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affir -d)befo e me this 9 day of Signed and sworn to(or affirmed)befor; me this / qday of
dcf Z4919 by _ —--
O ao/
SHN TRUNG NGUYEN
,,i Y p`, ign;l a 9'�dN>33f UYEN ,:,111,f eCo°mmrss• #FF 912239da
front?-1.,•1 t'= Notary Public-State of Florida -.,;:,,,,e--0,...0,,v My Comm.Expires Oct 12,2019
Fl• •• Commission#FF 912239 F`" Bonded through National Notary Assn.
[ I Personally Know • _jam off: My Comm.Expires Oct 12,2019 (.4 Personally Known OR •
roduced Identifi.:tioh�R,`,;,; `'��
1V}'� Bonded hrough National Notary Assn.. I I Produced Identification
Type of identificatio oihigrA _ • Type of Identification:
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. I C lilt
R
Le16g I description of property being improved: l v. V`6 i1 ' (.2 I!
/'l, ` ,ti hs��-( ,� z. ' FK , - ' r osy 165 ,
Address of property being improved: 2R5 / l"k JT 0,444 /)F4(l.
pi, 3/133 ,// �/��
General description of improvements: It( 4 M4 r
Owner 4141 MIL
Address r. 111 i�l.'.:Y'.�i I LL. G(" Z
Owner's interest in site of the improvement MIA
Fee Simple Titleholder(if other than owner) ``
Name
Address
Contractor /16%6
Jus 614/11/31.14.,.+ Cdflr4
Address llO Ois III W 44.1 ditieisl
01/141(14
hal 37156
Phone No. 58 (74"
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 or herself,designated by owner upon whom
notices or other documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself or herself,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). v.•= �:,
s •
Name ..*, 'w °r:
Address 3_
-
Phone No. Fax No. qo,`.;� `
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a ` o.C c,
different date is specified): - , 3 a, o
El 3 �. v x
c H c z
THIS SPACE FOR RECORDER'S USE ONLY nip,cow m H Q -I ,
Ec `, c
Signed: �e/1�lIZ1i ..v�„/ DATE /t/} 4 z
Before methis C�?,, d yof C�Ch;I•�2 r the 6.ti C" c)
Coun of_,_Duy7l,Stit orida,has personally appeared o T Z
�/��n/1� a( herein byN rt—
Doc#2019240950,OR BK 18972 Page 2484, himself/herself and affirms that all statements and declarations herein 1 r�N T m
9 are true and accurate 4, o z
Number Pages:1 c to s
Recorded 10/18/2019 10:45 AM, CO °f
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
COUNTY '1 ;ll,�,,
RECORDING $10.00 Notary� LargKbtate of tatrf- , County of�.�r ,
My cornniipSion expires:
• a
or
Pro.uced-t:- I cation
r CITY OF ATLANTIC BEACH BUILDING DEPARTMENT
"` '! 800 SEMINOLE ROAD
97,74wATLANTIC BEACH, FL 32233
CERTIFICATE OF COMPLETION
RERF19-0142
REROOF SHINGLE
ISSUED: JOB ADDRESS: REAL ESTATE NUMBER: ZONING:
10/28/2019 295 MAIN ST 170867 5000
DESCRIPTION OF WORK:
shingle re-roof-fL10124-R4 & FL17188.1
OWNER: CONTRACTOR:
RITTER PENNY LYNN Rhino Roofing of Jacksonville LLC
295 MAIN ST 11318 W. Distribution Ave #1
ATLANTIC BEACH, FL 32233-2527 Jacksonville, FL 32256
APPROVED: �.vi 'b••k
CHIEF BUILDING OFFICIAL
VOID UNLESS SIGNED BY BUILDING OFFICIAL