381 Belvedere St RERF19-0145 Shingle rS'Luirk, REROOF SHINGLE PERMIT PERMIT NUMBER
r°/'j
, RERF19-0145
�Nr. CITY OF ATLANTIC BEACH
V 800 SEMINOLE ROAD ISSUED: 10/24/2019
1`'r ATLANTIC BEACH. FL 32233 EXPIRES: 4/21/2020 I
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:
381 BELVEDERE ST REROOF SHINGLE SHINGLE ROOF $6700.00
TYPE OF REAL ESTATE ZONING: i BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170703 0262 SEASPRAY
COMPANY: ADDRESS: CITY: STATE: ZIP:
RON RUSSELL ROOFING 4419 HUDNALL RD JACKSONVILLE FL 32207
INC
OWNER: ADDRESS: CITY: STATE: ZIP:
DAVIDSON JOSEPH 0 IV 10728 PORTOBELO DR SAN DIEGO CA 92124
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. 1
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: $89.00
Issued Date: 10/24/2019 1 of 2
,,SILr,� ___...__. REROOF SHINGLE PERMIT PERMIT NUMBER
s
r RERF19-0145
CITY OF ATLANTIC BEACH
�� ISSUED: 10/24/2019
t/ 800 SEMINOLE ROAD
�`�r;s !/ EXPIRES: 4/21/2020
ATLANTIC BEACH. FL 32233
Issued Date: 10/24/2019 2 of 2
Building Permit Application Updated 10/9/18
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City of Atlantic Beach Building Department **ALL INFORMATION
- . 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 381 BELVEDERE ST Atlantic Beach, Fl 32233 Permit Number: R E RE I cA01 45
Legal Description 35-64 17-2S-29E Seapray Lot 31 BIk 1 RE# 170703-0262
Valuation of Work(Replacement Cost)$ 6,700.00 Heated/Cooled SF 1274 Non-Heated/Cooled 308
• Class of Work: ❑New DAddition DAlteration DRepair DMove DDemo DPool DWindow/Door
• Use of existing/proposed structure(s): ❑Commercial Cesidential
• If an existing structure,is a fire sprinkler system installed?: DYes C91<
• Will tree(s)be removed in association with proposed project?DYes(must submit separate Tree Removal Permit) (1JpQo
Describe in detail the type of work to be performed: Re-roofing home using GAF Architectural shingles 24sq, Pitch:3/12
Florida Product Approval# 10124.16 for multiple products use product approval form
Property Owner Information
Name Joseph Davidson _ Address 10728 Portobelo Dr.
City San Diego State CA Zip 92124 Phone 775-980-7394
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Ron Russell Roofing Inc Qualifying Agent Ronald Russell
Address 4419 Hudnall Rd City Jax State FL Zip 32207
Office Phone 904-714-1907 Job Site Contact Number 600-8883
State Certification/Registration# ccc 1327484 E-Mail ronnissellroofing@gmad.com
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer Builder Mutual Insurance Company OR Exempt[1 Expiration Date 12/31/19 _
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
RECOR NG YOUR(NjOTI OF COMMENCEMENT. / 41.011111167/1
(Signature of Owner or Agent) (Signature of Contractor)
Si ned and sworn to�(or affirmed)before me this /1 day of Signed and sworn to(or affirmed)before me this /7 day of
264y ,bYJolte} rJsor Oa— , Z0IM by Pop....l.) e,..stc tl
' ---
(Sign
(Sign of Not ry '►.igna of Notary)
`Z,py Ryan Rennick Eyrick
4 NOTARY PUBLIC `appy Ryan Rennick Eyrick
[ )Personally Known OR cv 3,, [ rsonally Known OR .t. 0
200'.'.; .�STATE OF FLORIDA NOTARY PUBLIC
[ roduced Identification o. ; [ )Produced Identification `
STATE OF FLORIDA
s , Comm#FF945229
Type of Identification: 7L Typeof Identification: 4 coffin*FF945229
xpires 1 019 i �iCE141
Expires 12/20/2019
NOTICE OF COMMENCEMENT
PREPARE IN DUPLICATE)
Permit No. R- Tax Folio No.
State of Florida 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.
Legal description of property being improved: 3S-69 t1-2S-2?d
Sects.
Lor 31 (31\4
Address of property being improved: 381 13e\ye.J e rt . S�--
a,x -L. 322?3
General description of improvements: Reroof
Owner 3o Seyoti Vo,.v;aSpn
Address (072$ r r e l.v 7)2. K T)Ce qZ l2`i
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Ron Russell Roofing,Inc.
Address 4419 Hudnall Road,Jacksonville,FL 32207
Phone No. 904-714-1907 Fax No. 904-636-9909
Surety(if any) N/A
Address Amount of bond S
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name N/A
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 Ron Russell Roofing,Inc
Address 4419 Hudnall Rd.Jacksonville,FL 32207
Phone No. 904-714-1907 Fax No.904-636-9909
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 N/A
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): x <
CiTHIS SPACE FOR RECORDER'S USE ONLY I / OW iER w:logo
Signed:A " G_ L DATE /70C( 9 v S tj- gi
i Before me this (1 day of .._Oct_..7�•!L�1 — --_-.in the c Q. Lt., IL r
County of Duval,State of Florida.has personally appeared a) > 0 rA
skae K_ �0.vi'J.SQw herein by Q LU I 2
himself.'herself and affirms that all statements and declarations herein ro f- Q E '2
Doc#2019245545,OR BK 18979 Page 147, are true and accurate a,O F- o x
Number Pages:1 CLZ co 0 1iJ•cs,
Recorded 10/24/2019 09:31 AM,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL = ;=.'
COUNTY
RECORDING $10.00 t.o at e.State of (� Count:of
L�t�'�:ssicn expires: v';-2,1-a'" fib_ y
Personally Knc::n or
Produced Identification ISL —
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4(riir ,
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PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA (*REQUIRED)
*Project Address: 381 Rc\vejtvec 51-. " 1414+;.- ReAL.t. , F-. 32-23 3 Permit#:
*Owner/Project Name: 381 3e\vt.)o e.t SI- .
As required by Florida Statute 553.842 and Florida Administrative Code Rule 9B-72, please provide the information and product approval number(s)for
the building components listed below as applicable to the building construction project for the permit number listed above. You should contact your
product supplier if you do not know the product approval number for any of the applicable listed products. Information regarding statewide product
approval may be obtained at: www.floridabuilding.org.
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
A. EXTERIOR DOORS
1.Swinging
2.Sliding
3. Sectional
4.Garage Roll-Up
5.Automatic
6. Other
B.WINDOWS
1. Single hung
2. Horizontal slider
3.Casement
4. Double hung
5. Fixed
6. Awning
7. Pass-through
8. Projected
9. Mullion
10.Wind breaker
11. Dual action
12. Other
Page 1 of 4 Updated 10/17/18
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
C. PANEL WALL
1.Siding
2.Soffits
3. EIFS
4.Storefronts
5.Curtain walls
6.Wall louvers
7. Glass block
8. Membrane
9.Greenhouse
10.Synthetic stucco
11.Other
D. ROOFING PRODUCTS
1.Asphalt shingles a/4c-- Arch S&•,NII', Ft- /ol 24 . 1(o
2. Underlayments Owv.s earifttv,451. .#r svarkeil, Fe.vv fL 152/6- e3
3. Roofing fasteners
4. Nonstructural metal
roof
5. Built-up roofing
6. Modified bitumen
7.Single ply roofing
8. Roofing tiles
9. Roofing insulation
10.Waterproofing
11.Wood shingles/shakes
12. Roofing slate
13. Liquid applied roofing
14.Cement-adhesive
coats
15. Roof tile adhesive
16.Spray applied
polyurethane roof
17.Other
Page 2 of 4 Updated 10/17/18
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
E.SHUTTERS
1.Accordion
2. Bahama
3.Storm panels
4.Colonial
5. Roll-up
6. Equipment
7.Other
F.STRUCTURAL
COMPONENTS
1.Wood
connector/anchor
2.Truss plates
3. Engineered lumber
4. Railing
5.Coolers-freezers
6.Concrete admixtures
7. Material
8. Insulation forms
9. Plastics
10. Deck-roof
11.Wall
12.Sheds
13.Other
G.SKYLIGHTS
1. Skylight
2. Other
H. NEW EXTERIOR
ENVELOPE PRODUCTS
1.
2.
Page 3 of 4 Updated 10/17/18
In addition to completing the above list of manufacturers, product description and State approval number for the products used on this project, the
Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and installation
instructions along with this Product Approval Sheet.
I certify that this product approval list is true and correct to the best of my knowledge. I further certify that use of different components other than the
ones listed in this document must be approved by the Building Official.
n
*Contractor Name (Print Name): Ronald 1��tse'1 *Contractor Signature:
*Company Name: Port Pv<sc.%1 aS1„3 C
*Mailing Address: 1Lc)hA II eJ
*City: J"t- *State: *Zip Code: 3224) 7
*Telephone Number: 907- 719-tgo/ *E-mail Address: la,Ni2vsSC4.1 C * -.•,\•ccv-
Cell Phone Number: Fax Number:
Page 4 of 4 Updated 10/17/18
CITY OF ATLANTIC BEACH BUILDING DEPARTMENT
' �"' 800 SEMINOLE ROAD
< < < ; ATLANTIC BEACH, FL 32233
0,31
CERTIFICATE OF COMPLETION
RERF19-0145
REROOF SHINGLE
ISSUED: JOB ADDRESS: REAL ESTATE NUMBER: ZONING:
11/6/2019 381 BELVEDERE ST 170703 0262
DESCRIPTION OF WORK:
SHINGLE ROOF
OWNER: CONTRACTOR:
DAVIDSON JOSEPH 0 IV RON RUSSELL ROOFING INC
10728 PORTOBELO DR 4419 HUDNALL RD
SAN DIEGO, CA 92124 JACKSONVILLE, FL 32207
APPROVED: 11 k----‘""'kCerb A
CHIEF BUILDING OFFICIAL
VOID UNLESS SIGNED BY BUILDING OFFICIAL