2015 Selva Madera Ct RERF19-0183 Shingle REROOF SHINGLE PERMIT PERMIT NUMBER
" ' CITY OF ATLANTIC BEACH RERF19-0183
800 SEMINOLE ROAD ISSUED: 12/16/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 6/13/2020
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:
2015 SELVA MADERA CT REROOF SHINGLE shingle re roof FL10674 $14059.00
R12 & FL17420-R2
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169506 1652 SELVA NORTE UNIT 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
PRIME ROOF 13725 BEACH BOULEVARD, #13 JACKSONVILLE FL 32224
CONTRACTING LLC
OWNER: ADDRESS: CITY: STATE: ZIP:
STERE GARY S 2015 SELVA MADERA CT ATLANTIC BEACH FL 32233-4531
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 $125.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$129.00
Issued Date: 12/16/2019 1 of 2
r0.... �s REROOF SHINGLE PERMIT PERMIT NUMBER
-i , RERF19-0183
,., CITY OF ATLANTIC BEACH
�:)'-‘t,
� 800 SEMINOLE ROAD ISSUED: 12/16/2019
``.rt aT ATLANTIC BEACH, FL 32233 EXPIRES: 6/13/2020
Issued Date: 12/16/2019 2 of 2
Building Permit Application
City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
Phone: (904)247-5826 Fax: (904)247-5845 e Q 1
Job Address: 2015 Selva Madera Ct, Atlantic Beach, FL 32233 Permit Number: 1—L*—F `£ 0 tq
Legal Description 40-37 09-2S-29E SELVA NORTE UNIT TWO LOT 81 RE#
Valuation of Work(Replacement Cost)$14,059.00 Heated/Cooled SF 1786 Non-Heated/Cooled 498
• Class of Work(Circle one): New Addition t',tllteratior Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial lesidential)
• 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) FL17420-R2(synthetic) for multiple products use product approval form
Property Owner Information
Name: Gary S Stere Address: 2015 Selva Madera Ct
City ATLANTIC BEACH State FL Zip 32233 Phone 904-534-1048
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
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.
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
RECORD! YOUR N TI E OF COMMENCEMENT.
Signatur of Owner or Agent including Contractpr) (Signature o ntractor)
Si�ned and sworn to(or affirmed)before m this 5 day of Signedigand sworn (or affirme before me this day of
, UI°I ,by 6'� cm- JXL(Mhtr , tet ,by Mark Young
1.,-1/6'-' 11--"-:
(Signature of Notary) (Signature of Notary)
0114441.Andrew D. Davis
40,�1*,,Andrew D. Davis
[t.]�rsonally Known OR_ 1: * COMMISSION I 0241220 [►.]'personally Known OR � COMMISSION#0241220
[ ]Produced Identificatic f,.,��EXPIRES: Sept. 17, 2022 [ ]Produced Identification
Type of Identification: ' �` Type of Identification: :v im', EXPIRES: Sept. 17,2022
111." .'1 .U , •. r .;. 7 31 Z:-
'''igf„„`` Bonded Thu Aaron Notary
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:40-37 09-2S-29E SELVA NORTE UNIT TWO LOT 81
Address of property being improved:2015 Selva Madera Ct,Atlantic Beach,FL 32233
General description of improvements:Re-roof
Owner Gary S Stere
Address 2015 Selva Madera Ct,Atlantic Beach,FL 32233
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Prime Roof Contracting,LLC
Address 13725 Beach Blvd Suite 13,Jacksonville,FL 32224
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 R
Signed: '��/'y'M�'��� DATE ( l
Before m s l J ay of aeT POI vruj in th drew
V f R D. Davis
Coun of Duval, to of Florida,has personally appear-•� P � �/
t.f h
himself/hers If and affirms that all statements and dec.- - on ,.R,-in. 6 COMMISSION#GG241220
are true and accurate •
Doc#2019286392,OR BK 19038 Page 1484, y &7.?``c EXPIRES:Sept 17,2022
Number Pages:1 °����Qiu���`• Bonded Th�A9101)NO�I
Recorded 12/16/2019 01:03 PM,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL .
COUNTY No ry Public at Large,State2f_ _. County of 1!i Yet
My commission expires:
RECORDING $10.00 Personally Known 1� or
Produced Identification