480 Irex Rd RERF19-0174 Shingle -5 REROOF SHINGLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH
RERF19-0174
800 SEMINOLE ROAD
ISSUED: 12/2/2019
`Ji319r ATLANTIC BEACH. FL 32233 EXPIRES: 5/30/2020
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:
480 IREX RD REROOF SHINGLE SHINGLE ROOF $8732.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171428 0000 ROYAL PALMS UNIT
02A3.00
COMPANY: ADDRESS: CITY: STATE: ZIP:
PRIME ROOF 13725 BEACH BOULEVARD, #13 JACKSONVILLE FL 32224
CONTRACTING LLC
OWNER: ADDRESS: CITY: STATE: ZIP:
RONALD T GLUSENKAMP 480 IREX RD 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 $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: 12/2/2019 1 of 2
(vitt , REROOF SHINGLE PERMIT PERMIT NUMBER
4 io CITY OF ATLANTIC BEACH RERF19-0174
d " ISSUED: 12/2/2019
:7711I 800 SEMINOLE ROAD
ATLANTIC BEACH. FL 32233 EXPIRES: 5/30/2020
Issued Date: 12/2/2019 2 of 2
'�'%� Building Permit Application
CCity of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
`-°';D v Phone: (904) 247-5826 Fax: (904)247-5845
Job Address: 480 Irex Rd., Atlantic Beach, FL 32233 Permit Number: R f_1 F i 1 — O(7—T
Legal Description 31-16 17-2S-29E.17 R/P OF PT OF ROYAL PALMS UNIT 2A LOT 11 BLK 11 RE#
Valuation of Work(Replacement Cost)$8,732.00 Heated/Cooled SF 1424 Non-Heated/Cooled 63
• Class of Work(Circle one): New AdditioncIteratioo Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Itesidential1)
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No 0
• 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: Replace roof with asphalt shingles
Florida Product Approval#FL10674-R12(shingles) FL9777-R5(underlayment) for multiple products use product approval form
Property Owner Information '/I Z ,r.6lASertICaky
Name: Hannah Glusenkamp1 RD Milk T 6 65e-AP-In Address: 480 Irex Rd.
City ATLANTIC BEACH State FL Zip 32233 Phone 612-220-3139
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: Prime Roof Contracting, LLC Qualifying Agent: Mark Young
Address 13725 Beach Blvd Suite 13 City Jacksonville State FL Zip 32224
Office Phone (904)530-1446 Job Site/Contact Number (904) 860-0230
State Certification/Registration# CCC1329505 E-Mail office@primeroofingfl.com
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation FRSA Self Insurers Fund Inc. 12/31/19 870-040093/3EE6142 _
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 R
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg E
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.
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, • k SULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NO',1 OMMENCEMENT. /
'C _
(Sir ature of. ner or •:-• 'ncl...• g Contraqc�to�r (Si ature of Contr tor)
Sniped and • • : .r affirm d)before me this GLd�ay of Signed and sworn to( affirmed)beforereme this 1Zn�ay of
'IOV•eA ,•ZOIe\ , by (1-Aknak &LVJAAkMto Nol , ZOt°\ ,by M, k l
JC(14.., g r
, (Sig a (Signature Wary), � fi . Davisl (Signe of,, �� � Andrew D. Da�:j :..
=COMMISSION#GG241220
•
__ ;4 •`COMMISSION#GG241:`:_:,
[••]'I�rsonally Known 0 11.4. ``� EXPIRES: Sept. 17, 2022 [ rsonally Known OR
EXPIRES: Sept. 17,2022
[ ]Produced Identification"UIluu`" Bonded ThrU Aaron Notary [ ]Produced Identification I'',., # `�.° Thru Bonded Aaron Notary
Type of Identification: ���O1
____ Type of Identification: _
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
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 NOTICE OF
COMMENCEMENT.
Legal description of property being improved:31-16 17-2S-29E.17 R/P OF PT OF ROYAL PALMS UNIT 2A LOT 11 BLK 11
Address of property being improved:480 Irex Rd.,Atlantic Beach,FL 32233
General description of improvements:Re-roof
Owner Hannah Glusenkamp P..12 irtclo( T I bts>°„l St-e rt 61/use„Kt pvte
Address 480 Irex Rd.,Atlantic Beach,FL 32233 1
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Prime Roof Contracting,LLC
I() Address 13725 Beach Blvd Suite 13,Jacksonville,FL 32224
I Phone No.(904)625-1446 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,designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone 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 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 0 NE
i I
Signed: DATE
Before me this of in e
Couptir of Duvet State lorida.has personally appear VI/ drew D Davi'
naF. J and I
Doc#2019275166,OR BK 19021 Page 1871, himself/herself and a rms that�i atfemerits and d tio.A h COMMISSION
�#� 1��
Number Pages: 1 •
are true and accurate s
Recorded 12/02/2019 02:12 PM, 14,1k:41";'`' EXPIRES: 17,Sept. 2022
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL 4vei y inON Bonded Awn Notty
COUNTY
RECORDING $10.00 Not ry Public atLarge.Sta 9 . county of DV _V
My commission expires./``��
Personally Known �/ or
Produced Identification