1140 Seminole Rd RERF19-0175 Shingle REROOF SHINGLE PERMIT PERMIT NUMBER
rye RERF19-0175
Ai CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ISSUED: 12/4/2019
""�"3'141ATLANTIC BEACH. FL 32233 EXPIRES: 6/1/2020
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:
1140 SEMINOLE RD REROOF SHINGLE SHINGLE ROOF $17225.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171978 0000 SELVA MARINA UNIT 03
COMPANY: ADDRESS: CITY: STATE: ZIP:
FLORIDA ROOFING 4320 DEERWOOD LAKE PARKWAY JACKSONVILLE FL 32216
EXPERTS 1001-403
OWNER: ADDRESS: CITY: STATE: ZIP:
GARTLAND ALICE J LIFE JACKSONVILLE
1601 OCEAN DR S UNIT 309 FL 32250
ESTATE BEACH
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 $140.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.10
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $144.10
Issued Date: 12/4/2019 1 of 2
gPERM5'v'''', REROOF SHINGLE PERMIT
IT NUMBER
CITY OF ATLANTIC BEACH RERF19-0175
800 SEMINOLE ROAD
ISSUED: 12/4/2019
`'=; !r ATLANTIC BEACH. FL 32233 EXPIRES: 6/1/2020
Issued Date: 12/4/2019 2 of 2
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'''AJ''r-f-� Building Permit Application Updated 10/9/18
?
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233
HIGHLIGHTED IN GRAY
�- oiss9%' IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
!,L11 t_:1'EL r -7
Job Address: t (� 'ij/11r1G�' "ALAI' ��, Permit Number: 1 -� l `-)
Legal Description `> iU'tX 4'Vla/1i'l&' iii--- 0 312`57 RE#-83"fes 17t t7F5 "moo
Valuation of Work(Replacement Cost)$ i1 I a- --, 0. Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ONew ❑Addition ❑Alteration Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial residential
• If an existing structure, is a fire sprinkler system installed?: ❑Yeslo
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit)kiNo
Describe in detail the type of work to be performed: V--too c- \(53s1 1 Lt r ) t FL ' b 62-1 _12-'3
Florida Product Approval# (Ole 71-I ` (2 13 for multiple products use product approval form
Property Owner Information
Name At, (' (dFf.(t{Vj0 Address iIL-10 `J�M')1krIC,(,C:, Olt/(:-1
City *-1001`L0 j ct C. State hZip j27 3 3 Phone ( 4-0(ii/LI it-/
E-Mail )Gt'ic'iYlr cfarfiaYt(ic, --e,Come a,-)f IV --
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) !tel,'Iv 1 60i- favi(1
Contractor Information (
Name of Company )"[ti OCI Ioocncj x Qualifying Agent talks S((.0 J Ctl(1 t
Address 3<7D P?eerf&)Ixyd LAK-.e 17 `I City (IN( State -r-2.2 Zip 3631'9
Office Phone c7 tY-(-3 r}cri- (D N lQ Job Site Contact Number (- VILoS 7
State Certification/Registration#COt))hCiri 1 E-Mail c-LB( a iitC f(,[ P_,X.pe( L LI OAk-.. corr..
Architect Name& Phone# J
Engineer's Name&Phone#
Workers Compensation Insurer&1)((C(S M l.1.ua1 1 Y1SurIW)(e OR Exempt❑ Expiration Date 1 I 1 IUcO
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
RECO ING YO N TICE QF COMMENCEMENT. f/
(8--- ------
(Signature of Owner or Agent) 1 (Signature of Contractor)
Sined and sworn to(or affirme of e t i 111 dayof Signed and sworn to(or affirmed)before me this a day of
,�/ , , i9 ,by ? '� 'T Ler„ , - dal , by . . j f
ture of Notary) (.ignature A Nota ) f
49#0 otit, Notary Public State of Florida ;w�Nv ASHLEY RIDGEWAY
• Earl Vought 111 1 2.7\. Notary Public-State of Florida
• My Commission GG 275728 r�' personal) Known OR " �� Commission#GG017166
[ } g�'nal�t�(tt99v1¢Xt(A�022 f V -.o. utim
9 rt o`' My Comm Expirez Jun 20,2021
• I I Produced Identification 4; ':FoFF,,,
��, � J °".,,.�• 6ondedthroughNationalNotaryAssn.
Type of Identification: may'="4�L J Ai`/t-f' � Type of Identification: _ — — — _ ._ _
DURABLE GENERAL POWER OF ATTORNEY
I, Alice Johnson Gartland (SSN: XXX-XX-0476;DOB: 01/27/1922), of: 1601 Ocean
Drive South, Unit#309,Jacksonville Beach,FL 32250 (hereinafter referred to as
PRINCIPAL), designate my son, Kevin Henry Gartland (SSN: XXX-XX-0156; DOB:
08/30/1947) of: 5433 Tierra Verde Lane,Jacksonville, FL 32258 (hereinafter referred to as
AGENT), to be my attorney-in-fact and agent.
Authority of Agent. I hereby grant to AGENT full power and authority to act for me in
any lawful way with respect to the powers enumerated below.
Except as otherwise limited by applicable law or by this durable power of attorney,
AGENT has full power and authority to perform, without prior court approval, and may take all
necessary actions to exercise, any power herein granted as fully as I might or could do if
personally present. This power is not diminished even though AGENT may be acting
individually or on behalf of any other person or entity interested in the same matters. All acts
done under this power by AGENT shall bind me, my heirs, devisees, and personal
representatives. This power is nondelegable. I hereby ratify and confirm that AGENT shall
lawfully have, by virtue of this durable power of attorney, the powers herein granted, specifically,
the authority to
a. forgive, request, demand, sue for, recover, collect, receive, and hold all sums of
money, debts,dues, commercial paper, checks, drafts, accounts, deposits, legacies, bequests,
devises,notes, interests, stock certificates, bonds, dividends, certificates of deposit, annuities,
pensions,profit sharing, retirement, social security, insurance, and other contractual benefits and
proceeds, intangible and tangible property and property rights and any demands whatsoever,
liquidated or unliquidated,that I now or hereafter own or that are due,owing, or payable or
belonging to me or in which I may now have or hereafter acquire an interest.
b. have, use, and take all lawful means and equitable and legal remedies and
proceedings in my name for the collection and recovery of any property now or hereafter owned
by me, and adjust, sell, compromise, and agree for the same, and execute and deliver for me, on
my behalf and in my name, all endorsements, releases, receipts, or other sufficient discharges for
the same.
c. conduct investment transactions as provided in Section 709.2208(2), Florida
Statutes; and acquire, purchase, invest, reinvest. exchange,grant options to sell, and sell and
convey personal property, tangible or intangible, or interests therein, for such price and on such
terms and conditions as AGENT shall deem proper, including, without limitation, stocks, bonds,
wa . its, debentures, commodities,precious metals, futures, currencies, and investment funds,
g 1°t
al Initials
Witness Initials Witness Initials Principal
Subject: DURABLE GENERAL POWER OF ATTORNEY: Alice Johnson Gartland
SSN: XXX-XX-0476
DOB: 01/27/1922
including common trust funds, in domestic and foreign markets.
d. execute stock powers or similar documents and delegate to a transfer agent or
similar person the authority to register any stocks, bonds,or other securities either into or out of
my name or my nominee's name.
e. redeem bonds issued by the United States Government or any of its agencies or
any other bonds.
f. acquire, purchase, exchange, options elle l and cor.;e -anyall
: �.,, grantto sell, and s„l n� corn v�.�� s.., and
of my real estate, lands, tenements, leases, leaseholds or other property in the nature of real
estate, or any part or parcel thereof, which I now own or may hereafter acquire, or interests
therein, including my homestead real property, at public or private sale, for such price and on
such terms and conditions as AGENT shall deem proper, and execute any and all documents
necessary to effectuate the same, including but not limited to contracts, deeds, affidavits, bills of
sale, assignments, and closing statements; provided, however, that if I am married, AGENT may
not convey or dispose of my homestead property without joinder of my spouse or my spouse's
legal guardian. (Joinder by my spouse may be accomplished by the exercise of authority in a
durable power of attorney executed by my spouse, and either my spouse or I may appoint the
other as attorney-in-fact.)
g. maintain,repair, improve, invest, manage,partition, insure,rent, lease, encumber,
and in any manner deal with any real or personal property, tangible or intangible, or any interest
therein, that I now own or may hereafter acquire, in my name and for my benefit, upon such
terms and conditions that AGENT shall deem proper, and execute, acknowledge, and deliver all
instruments necessary to effectuate the foregoing.
h. conduct banking transactions as provided in section 709.2208(1), Florida Statutes.
i. borrow from time to time such sums of money upon such terms and conditions as
AGENT shall deem appropriate for, or in relation to, any of the purposes or objects described
herein,upon the security of any of my property, whether real or personal or otherwise, and, for
such purposes, to give, execute, deliver, and acknowledge mortgages with such power and
provisions as AGENT may think proper, and also such notes, bonds, or other instruments as may
be necessary or proper in connection therewith;provided, however, that if I am married, AGENT
66ciTh
Witness Initials Witness Initials 2 Principal Initials
Subject: DURABLE GENERAL POWER OF ATTORNEY: Alice Johnson Gartland
SSN: XXX-XX-0476
DOB: 01/27/1922
shall not mortgage my homestead property without joinder of my spouse or my spouse's legal
guardian. (Joinder by my spouse may be accomplished by the exercise of authority in a durable
power of attorney executed by my spouse, and either my spouse or I may appoint the other as
attorney-in-fact.)
j• apply for a certificate of title on, and endorse and transfer title to, any automobile,
truck, recreational vehicle, off-road vehicle, van, motorcycle, or other motor vehicle, airplane, or
vessel, and to represent in such transfer or assignment that the title to said motor vehicle,
airplane, or vessel is free and clear of all liens and encumbrances except those specifically set
forth in such transfer or assignment.
k. conduct or participate in any lawful business of whatever nature for me and in my
name; execute partnership agreements and amendments thereto; incorporate, reorganize, merge,
consolidate,recapitalize, sell, liquidate, or dissolve any business; enter into voting trusts and
other agreements or subscriptions; elect or employ officers, directors, and agents; carry out the
provisions of any agreement for the sale of any business interest or stock therein; exercise voting
rights with respect to stock. either in person or proxy; and exercise stock options.
I. transfer any or all assets of mine to any revocable trust created by me as to which
trust I am, during my life, a primary income or principal beneficiary.
m. withdraw from any trust, whether revocable or irrevocable, in which I have a
current beneficial interest, such amounts of principal or accrued or collected but undistributed
income of such trusts as I would be permitted to receive or withdraw,pursuant to any right of
receipt or withdrawal contained in such trusts.
n. make, execute, and file any and all declarations,joint or separate returns,waivers,
consents, claims. and other instruments or forms (including,without limitation, IRS Form 2848:
Power of Attorney) relating to federal, state. municipal, and other taxes or assessments, including
income, transfer, property, excise, and other taxes of whatever nature and whether imposed or
required by any domestic or foreign authority, and in connection with any such taxes or
assessments due or claimed or believed to be due from me or in respect of any property or rights
that I may own or in which I may have any interest.
o. represent me before any office of the Internal Revenue Service, state agency, or
any other governmental or municipal body or authority of whatever nature, domestic or foreign,
and conduct and transact any case, claim, or other matter whatsoever in connection therewith;
P-6
‘a-ED drA
Witness Initia s Witness Initials3 Principal Initials
Subject: DURABLE GENERAL POWER OF ATTORNEY: Alice Johnson Gartland
SSN: XXX-XX-0476
DOB: 01/27/1922
receive confidential information regarding tax matters for all periods, whether before or after the
execution of this instrument; and make tax elections.
p. have access at any time or times to any safe-deposit box rented by me,
wheresoever located, and remove all or any part of the contents thereof, and surrender or
relinquish said safe-deposit box, and any institution in which any such safe-deposit box may be
located shall not incur any liability to me or my estate as a result of permitting AGENT to
exercise this power.
q. exercise any statutory rights cr elections, including,but not limited to, any rights
or elections in any probate or similar proceeding to which I am or may become entitled.
r. employ as investment counsel, custodians, brokers, accountants, appraisers,
attorneys-at-law or other agents such persons, firms, or organizations, including AGENT or
AGENT's firm, as deemed necessary or desirable; pay such persons, firms, or organizations such
compensation as is deemed reasonable; and determine whether to act on the advice of any such
agent without liability for acting or failing to act thereon.
AGENTS is also authorized, if I have initialed the specific act below, to:
Initial:
{ ) a. make gifts to charitable organizations or to or in trust for my spouse or any
descendant of mine in connection with estate, gift, generation-skipping
transfer, income, or other tax planning for me or to qualify me for any
government assistance program; provided, however, that no gift may be
made to AGENT other than for AGENTS'health and maintenance or to
discharge AGENTS'legal obligations.
( ) b. consent to any gift, use any gift-splitting provision or tax election, and pay
gift taxes, but only if in furtherance of my estate plan or my desire to
minimize taxes.
( ) c. create one or more inter vivos trusts of which I am an income or principal
beneficiary.
Crell VILD
1jG tress Initials Witness Initials Principal Initials
4
Subject: DURABLE GENERAL POWER OF ATTORNEY: Alice Johnson Gartland
SSN: XXX-XX-0476
DOB: 01/27/1922
( ) d. with respect to a trust created by or on behalf of the PRINCIPAL, amend,
modify, revoke, or terminate a trust created by me or on my behalf, but
only if the trust instrument explicitly provides for amendment,
modification, revocation, or termination by the settlor's agent.
( ) e. create or change rights of survivorship.
( ) f. create or change a beneficiary designation.
( ) g. waive the PRINCIPAL's right to be a beneficiary of a joint and survivor
annuity, including a survivor benefit under a retirement plan.
( ) h. renounce or disclaim any powers of appointment or property passing to me
by testate or intestate succession or by inter vivos transfer.
Interpretation and Governing Law. This instrument is to be construed and interpreted as a
general durable power of attorney. This instrument is executed and delivered in the State of
Florida, and the laws of Florida shall govern all questions as to the validity of this power and the
construction of its provisions. However, it is my intention that this power of attorney shall be
exercisable in any other state or jurisdiction where I may have any property or interests in
property.
Third-Party Reliance. Third parties may rely on the representations of AGENT as to all
matters relating to any power granted to AGENT, and no person who may act in reliance on the
representations of AGENT shall incur any liability to me or to my estate, beneficiaries, or joint
owners as a result of permitting AGENT to exercise any power prior to receipt of a written notice
of revocation, suspension, petition to determine my incapacity, partial or complete termination of
this power, or my death. Any third party may rely on a duly executed counterpart of this
instrument, or a copy certified by AGENT to be a true copy of the original hereof, as fully and
completely as if such third party had received the original of this instrument.
04
Witness Initials Witness Initials5 Principal Initials
Subject: DURABLE GENERAL POWER OF ATTORNEY: Alice Johnson Gartland
SSN: XXX-XX-0476
DOB: 01/27/1922
( ) d. with respect to a trust created by or on behalf of the PRINCIPAL, amend,
modify, revoke, or terminate a trust created by me or on my behalf, but
only if the trust instrument explicitly provides for amendment,
modification, revocation,or termination by the settlor's agent.
( ) e. create or change rights of survivorship.
( ) f. create or change a beneficiary designation.
( ) g. waive the PRINCIPAL's right to be a beneficiary of a joint and survivor
annuity, including a survivor benefit under a retirement plan.
( ) h, renounce or disclaim any powers of appointment or property passing to me
by testate or intestate succession or by inter vivos transfer.
Interpretation and Governing Law. This instrument is to be construed and interpreted as a
general durable power of attorney. This instrument is executed and delivered in the State of
Florida, and the laws of Florida shall govern all questions as to the validity of this power and the
construction of its provisions. However, it is my intention that this power of attorney shall be
exercisable in any other state or jurisdiction where I may have any property or interests in
property.
Third-Party Reliance. Third parties may rely on the representations of AGENT as to all
matters relating to any power granted to AGENT, and no person who may act in reliance on the
representations of AGENT shall incur any liability to me or to my estate, beneficiaries, or joint
owners as a result of permitting AGENT to exercise any power prior to receipt of a written notice
of revocation, suspension, petition to determine my incapacity,partial or complete termination of
this power, or my death. Any third party may rely on a duly executed counterpart of this
instrument, or a copy certified by AGENT to be a true copy of the original hereof, as fully and
completely as if such third party had received the original of this instrument.
*Thei z_Itcfp 1-e4
witness Initials Witness Initials5 Principal Initials
Subject: DURABLE GENERAL POWER OF ATTORNEY: Alice Johnson Gartland
SSN: XXX-XX-0476
DOB: 01/27/1922
Disability of Principal. This durable power of attorney is not terminated by my
subsequent incapacity, except as provided in Chapter 709, Florida Statutes, or any successor
provision of law.
IN WITNESS WHEREOF, I have set my hand and seal on this day of February,
2019.
ohn,� b tri;
Prir. ipa
SIGNED, SEALED, AND DELIVERED
IN THE PRESENCE OF:
Laura Burkley Weber V
12250 Atlantic Boulevard,#2301
Jacksonville, FL 32225
Witness
•
SiA 41. n_We)-(.....R_D
s. .er1y Kay A T.tter
21 3 Mesa G T de La
Jacksonville, FL 32224
Witness
STATE OF FLORIDA
COUNTY OF DUVAL
• The foregoing instrument was acknowledged before me on this /A, day of
February, 2019, b tit!}i �Iohnson Gartland, who identified this instrument as her
Durable Gert •yygrnev and s'Qned tt�R ir, trument willingl
• f /
•� •
•ti 'rint Notary Name: I- ✓�c. -
' �0:��� NO TARY PUBLIC—STATE OF FLOR►►%A " '
[ ,T one only] i9Py•••'.biic too'e �9,
Clc
/Personally kn �4ic.suit-
/ Produced identiticAlt#il$t e of identification produced: a Driver's License
(Rev.-LEH-01/15f12)
Subject: DURABLE GENERAL POWER OF ATTORNEY: Alice Johnson Gartland
SSN: XXX-XX-0476
DOB: 01/27/1922
Disability of Principal. This durable power of attorney is not terminated by my
subsequent incapacity, except as provided in Chapter 709, Florida Statutes, or any successor
provision of law.
IN WITNESS WHEREOF, I have set my hand and seal on this day of February,
2019.
■ ,
n`` _ .oh )7a __Jr" .
Pri Ictpa
SIGNED, SEALED, AND DELIVERED
IN THE PRESENCE OF:
•
C - „-—ca._ ` . -,L -.LE____,..��-__._
Laura Burkley Weber 1/
12250 Atlantic Boulevard, #2301
Jacksonville, FL 32225
Witness
Kimberly Kaye:Watters`
2133 Mesa Grande Lane
Jacksonville, FL 32224
Witness
STATE OF FLORIDA
COUNTY OF DUVAL
• The foregoing instrument was acknowledged before me on this .3,, day of
February, 2019, reillifigiohnson Gartland, who identified this instrument as her .1
jjDurable Genelr4R � r_;ey and s�aned he instrument willingly,
N*oir
..c.ititicikgt:;:!!, S, _...._ ,;:. _
_.;•,;_ .N,..., ,,,:t 28,zo4V.13 S. - --(.:::: ira_7:7-7? /1
#rc234566 Print Notary Name: i.F..;�ir-c.,✓ .,d ;;'i":r y if ,j
••�z ao �' t0.~•$. NOTARY PUBLIC—STATE OF FLORIDA ' -'
m
[ ,�one only] ��.94y�';i106%.*•°�
cfr
rsonally kn/ ' t,up1
rProduced ident cl{ ltll # e of identification produced: a Driver's License
(Rev.-LEH-01/15/12)
W.6),6) Kt.c,. .) 444,
Witness Initials Witness Initials6 Principal Initials