1020 Main St RERF19-0164 Shingle REROOF SHINGLE PERMIT PERMIT NUMBER
r
ry CITY OF ATLANTIC BEACH RERF19-0164
�� g ISSUED: 11/14/2019
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233 EXPIRES: 5/12/2020
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:
1020 MAIN ST REROOF SHINGLE shingle re roof FL10124, $8995.00
18686, 6267
TYPE OF 1 REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: 1 NUMBER: GROUP:
170996 0100 ATLANTIC BEACH SEC H
COMPANY: ADDRESS: CITY: STATE: ZIP:
BENTON INTEGRITY 5570 FLORIDA MINING BOULEVARD, JACKSONVILLE FL 32257
ROOFING & WINDOWS #310
OWNER: ADDRESS: CITY: STATE: ZIP:
DALCERO RICHARD J 212 MAGNOLIA ST ATLANTIC BEACH FL 32233-4008
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 $95.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$99.00
Issued Date: 11/14/2019 1 of 2
REROOF SHINGLE PERMIT PERMIT NUMBER
r CITY OF ATLANTIC BEACH
RERF19-0164
800 SEMINOLE ROAD
ISSUED: 11/14/2019
``,'i yr ATLANTIC BEACH, FL 32233 EXPIRES: 5/12/2020
Issued Date: 11/14/2019 2 of 2
Building Permit Application Updated 12/8/17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845
Job Address:(02o Fkci,l1 Meek 1P++/an•vic ccj iL s33 Permit Number: - l L ^V (
Legal Description ()-34q SFC i/AT/A011C$ c4-1 Lzir 5 Lk- 19'4 RE# 80976, —a/C19
Valuation of Work(Replacement Cost)$e9 S•W Heated/Cooled SF a�$ Non-Heated/Cooled .1(00'-I
• Class of Work(Circle one): Ne Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial •esiden
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No ('V/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: Qe_goo F 1 ,t7S tC f3LA.;lc (' a(•33'15 l0(a.Pi*-CI•-
64F-114D5ror5(e5 Ft._ /o19'/ ke/.tE 51-e< underlay mem FL (gusto Cobra PtdlPQ.A nner FL UP-44
Florida Product Approval# /O 1'.,44 for multiple products use product approval form
Property Owner Information
Name: th56.a1 ( 1c.c° Address:p'7i� t (101iC, c treek
City A• Gn-fC- Reac State fl- Zip 3a-33 Phone coI- 72 -(-egBkI'
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: ' Qti{ors J-11.4-elrt 120. , Qualifying Agent: Joh" A
Address 55-40 FIDf•Id40. )--Vmi IG\k. d - r}C*WityA•�1�1r1{�C 1� State �L Zip 50,933
Office Phone li -.2.02-'?U(D > Job Site/Contact Number 9•DY- d74.3bm
G
State Certification/Registration# CC /3a n
Miis E-Mail -avVrY\c ' b \ 4ew5•Cor`--
Architect Name& Phone# —
Engineer's Name& Phone#
Workers Compensation Wit /tRNA Se Sn5.v<r5 ¶ AQ/ e5-11A L 5tbf4,O(e CO f Aikt 12(3(('.tom
Exempt/Insurer/Lease Employees/Expiration Date
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 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. 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 A .'•NEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
Sl(,EJ divl.•rL Da.Q Cil , _
(Signature of Owner or Agent) F' Signature of Contractor)
(including contractor)
Signed and sworn to(or affirmed)before me this 221 day of Signed a • sworn to(or affirmed)before me this_29 day of
October , at) (q , by Susanne ale.ero DCtnber , a0/q , by John Albrit-ipn
- - - - - - - A , --
KRYSTAL K SALO
Notary Pubiic-State of Florida Signature of Notary) Sienature<of_NQtaLyi--
, Cammnvcn t GG 908969 �s•+� KK STAL K SALM I
I I Notary Pubic-State o/Florida
orn,�� M Comm. res Sep 15,2
IL»w [ ersonally Known OR 1 mw Comrissicn Y GG 908969
roue i [ ]Produced Identification � .My Comm.Eaplres Sep 15,2023 I
Type of Identification: FL. DLb42b-780-59-•550-0 Type of Identification: Bonded trvo4INational Notary Assn. I
Doc # 2019262767, OR BK 19003 Page 683, Number Pages : 1,
Recorded 11/14/2019 11 :03 AM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10. 00
NOTICE OF COMMENCEMENT
State of FIoC1f�S� _ Tax Folio No. Ilogq(p-Q1cQ
County of Duval
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713 of
the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: IS-34 5 - .-5EC F{ ATLA tn1 TsL__BEACH LCT
— —
573W-64f
Address of property being improved: /02Q +z i(1 Stt'l�r aMiC$yra,('hr cL b 233
General description of improvements: 2 r r E.i S+if1� u.ld t►�
1 n �1v3
owner:StA►1a. —DgCti _ Address: i?I� ,1oI?
a ,Xreet,Pganfic arty c,3
Owner's interest in site of the improvement: Ice 51r. I-..
Fee Simple Titleholder(if other than owner):
Name: _
Contractor: Beni-nn ir tPsr►i-y Roofing and WindnwS —v
Address: 5570 FL rtdA Mi n)n4'1 'd. S„Ste 310; JaCkSDnYllle,_FL 32257
Telephone No.:(q04)262.-710,103 Fax No: (C104/2(00-1355
Surety(if any)
Address: Amount of Bond$
Telephone 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:
Telephone 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 Statues. (Fill in at Owner's option)
Name:
Address.
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(I)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER( r
Signed S tt 'DOJ(tet o Rate: 10 2.41q
nue e this s1� dal'of etober in the County of Pu al.Stale
CM-Florida,has personally appeared .SiLrsne In ICCro
Notary l'uhlic at Large,State f FI nida County of Duval.
My commission ecpires: 9l l5/202.3
Personally Known: c �7 i�� p 550 rx
Pr -' t"�tlot• 4.'D4'1 � :59" -0
0/,
K fM0u7►ubac fust ,311rrom(yrKtklkn t GG 94f n0Ca .r�btf fp 1f,2013_
-" !Dodd tnret4a Mattern Malan,Iwo.