515 Selva Lakes Cir RERF19-0161 Shingle !.41.1 REROOF SHINGLE PERMIT PERMIT NUMBER
A_ CITY OF ATLANTIC BEACH RERF19-0161
800 SEMINOLE ROAD ISSUED: 11/18/2019
44"ir ' ATLANTIC BEACH. FL 32233 EXPIRES: 5/16/2020
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:
515 SELVA LAKES CIR REROOF SHINGLE SHINGLE ROOF $10206.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172027 5046 SELVA LAKES
COMPANY: ADDRESS: CITY: STATE: ZIP:
J & M RESIDENTIAL 6020 PARKWAY DRIVE NORTH CUMMING GA 30040
SERVICES, LLC
OWNER: ADDRESS: CITY: STATE: ZIP:
HOPE REBEKAH GLEASON 515 SELVA LAKES CIR 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.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $105.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$109.00
Issued Date: 11/18/2019 1 of 2
REROOF SHINGLE PERMIT PERMIT NUMBER
RERF19-0161
CITY OF ATLANTIC BEACH ISSUED: 11/18/2019
Alp, v 800 SEMINOLE ROAD EXPIRES: 5/16/2020
ATLANTIC BEACH. FL 32233
Issued Date: 11/18/2019 2 of 2
•`'u'`�c� Building Permit Application Updated 12/8/17
+y�� City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
�
1 /+ Phone:(904)247-5826 Fax:(904)247-5845
' `G7-5845 / / 1 /
Job Address: 51S- c�t,1V4 G r Ak4lkiC (6114 1'� 22433 Permit Number: R�lci - lJ 1 W
Legal Description I/-SS 11—2S 2'iE SEW4-, LG dS LFI ZZ RE#
Valuation of Work(Replacement Cost)$ /(.)f COG Heated/Cooled SF WA- Non-Heated/Cooled Pik
• Class of Work(Circle one): New Addition Alteratio Repair ove P• o Pool Window/Door •
• Use of existing/proposed structure(s)(Circle one): Commercial Residenti.
• If an existing structure,is a fire sprinkler system Installed?(Circle one): Yes No WO
• 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:
- erooP G 'S,�n �,v.c 1k'O FUo)Z4 -R20
Florida Product Approval# -/012(1.. f�ZG for multiple products use product approval form
Property Owner Information
Name: tr¢5 Address: �C •••)(2t 04" L.AkeS (3�
City A4trnkrC r�2G.0 State PL Zip Z1.32 Phone 7 1 RCt -r114(
E-Mail Jt'"'Pe. wx \-COAV%
Owner or Agent(If gent,Poe&of Attorney or Agency Letter Required)
Contractor Information
Name of Company:rm rRjr, c i UA, So fs, CoS LLCQualifying Agent:—1-Fi Spar\ I ?
Address LTA) � }� #S X) City Ctmflrn State f 3c Zip 7604/e)
Office Phone 94 7 — US6Q' Job Site/Contact Number-) 9Olf
State Certification/Registration#(r7l2iit1 E-Mail L.er-. 5a\fri; J rvog'n^. Cow,
Architect Name&Phone# JJ
Engineer's Name&Phone#
Workers Compensation PA.)CaEr 1 SSM 5Zotc( /Avhsrkw+ 110-f err 7tstNz,�ce
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 ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
. / 0.44:
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/ ( Igna re of Owner or Agent) (Signature of Contractor)
(including contractor) /'
Signed and sworn to(or affirmed)befo • e this -7 day of Signed and sworn to(or affirmed)before me this /`7 day of
fa`i,by '--' 6'cr , 2a14\ ,by 1. a-. ..
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, My Commission GG 214865 My Commission GG 214865
4/ `�0 Expires 05/06/2022 Pe-.o4 owxOPFs 05/08/2022
( i Personally Known OR ( 1
()if Produced Identlficati r••• • .. •• •
Type of Identification: rL Type of Identification: rr1�
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Doc M 2019260957, OR BK 19000 Page 1601, Number Pages: 1,
Recorded 11/12/2019 04:08 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
NOTICE OF COMMENCEMENT
(PREPARE N GIPUCAT!I
Permit No. Tax Folio No.
State of ibrfde county of D+
- 1
To whom It may concern:
The undersigned hereby informs you that improvements will ba mads lo certain real property,and In
accordance with Section 713 of the Florida Statutes,the following information Is staled In thls NOTICE Of
COMMENCEMENT.
Legal description of property being improved:41-55 17-2S-29E SELVA LAKES LOT 22
Address a propetb being Unproved: 515 SELVA LAKES OR ATLANTIC BEACH,FL 32233
emend description of knprovementst Refoof —
•
a,,f,e,HOPE REBEKAH GLEASON;JAMES DALE
Address • 515 SELVA LAKES OR ATLANTIC BEACH,FL 32233
Owner's Interest in site of the improvement OW"(
Fee Simple TAlehader(If other than owner)N/A
Name
Address
Contractor AM RESIDENTIAL SERVICES Lit
Address e020 PARKWAY NORTH SUIT!500,CUMMNG,GA.30040
Phone No.e04.357.0:10G Fax No. •
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 cci SWeiSon of the knprovements.
Ns"N/A
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself,desynaled by owner upon whom notices or other
documents maybe served:
Name WA
Address
Phone No. Fax No.
In addition to himself,owner designates the following person to receNe a copy of the Uenofs Notice as prov4Qed 1T
Section 713.08(2)CO),Florid.Statutes.(FBI In it Owwner's option).
Name N/A
Address
Phone No. Fax No. •
Expiration data of Nota of Commencement(the expiration date Is one(1)year from the date of reenrdlo°unless a
awl.
different date Is upecifled) .
I .
THIS SPACE FoR RECORDER'S Use ONLY / • , id • •
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BONNIE MARSHALL� 4�_/• ►. i `„'Slit.of Florida•Notay Public
4110 tston a 00 228484
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