1105 Cornell St RERF19-0186 Shingle „ ,
REROOF SHINGLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RERF19-0186
800 SEMINOLE ROAD ISSUED: 12/30/2019
�r3i�r ATLANTIC BEACH. FL 32233 EXPIRES: 6/27/2020
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:
1105 CORNELL LN REROOF SHINGLE SHINGLE ROOF $6445.00
TYPE OF REAL ESTATEZONING: i BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
177387 4015 CORNELL ONE
COMPANY: ADDRESS: CITY: STATE: ZIP:
PRIME ROOF 13725 BEACH BOULEVARD, #13 JACKSONVILLE FL 32224
CONTRACTING LLC
OWNER: ADDRESS: CITY: STATE: ZIP:
MOORE DIEDRE 1105 CORNELL LN ATLANTIC BEACH FL 32233-3484
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 $85.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $89.00
Issued Date: 12/30/2019 1 of 2
t' ''J% REROOF SHINGLE PERMIT PERMIT NUMBER
s1 RERF19-0186
CITY OF ATLANTIC BEACH
'r
t 800 SEMINOLE ROAD ISSUED: 12/30/2019
;s»r ATLANTIC BEACH. FL 32233 EXPIRES: 6/27/2020
Issued Date: 12/30/2019 2 of 2
�S
�S'=�''� Building Permit ApplicationCity of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
,,..JPf'r Phone: (904) 247-5826 Fax: (904)247-5845 A(� ER /�
Job Address: 1105 Cornell Ln., Atlantic Beach, FL 32233 Permit Number: I \ EiRF I - V( 8 (42
Legal Description 55-91 38-2S-29E .14 CORNELL 1 LOT 3 RE#
Valuation of Work(Replacement Cost)$6,445.00 Heated/Cooled SF 1125 Non-Heated/Cooled 50
• Class of Work(Circle one): New Addition • teratioj Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial d5identia1
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No 40
• 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: Diedre Moore Address: 1105 Cornell Ln.
City ATLANTIC BEACH State FL Zip 32233 Phone 904-629-9793
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: Prime Roof Contracting, LLC Ctualifying 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. 01/01/2021 870-040093/3EE6142 _
Exempt/Insurer/Lease Employees/Expiration Date R
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or installation has E
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 OBT. ' - NANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECO• II ING OUR NOTI /F 'OMMENCEMENT.
. ..... ' A Al ,
•:nature of Owner or Ag- t i ,..Ming Contracto (Si:, ature o . ractor)
Sed an sworn to(or affirmed)before me
this L34day of Signed and sworn to(• affirme. :efore me this 23/Ajay of
DnCL cr, ZvI'i ,by �I eA f1 nmre tkG+tmr , Z0►41 , by JV , •�-,
B / -
a ire .`, 'd{ D. Davis (Signature of Notary) •
`i� Si a _a1� lit Andrew D Davis
3 • '`; •=COMMISSION I GG241220 ,.. °' •
*, , £COMMISSION$GG241220
[a-Personally Known ,,, ;.;,: EXPIRES: Sept. 17,2022 [ rsonally Known OR `• ',,'';=EXPIRES:Sept 17,2022
Bonded ihru Aaron NO
[ ]Produced Identificati +nnr [ ]Produced Identification lit
Z. .
Type of Identification: Type of Identification: I�f'++•'++i 0,` Bonded 111N 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:55-91 38-2S-29E14 CORNELL 1 LOT 3
Address of property being improved:1105 Cornell Ln.,Atlantic Beach,FL 32233
General description of improvements:Re-roof
Owner Diedre Moore
Address 1105 Cornell Ln.,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
.1)t Address 13725 Beach Blvd Suite 13,Jacksonville,FL 32224
�f Q�, , Phone No.(904)625-1446 Fax No.
urety(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 • N
Signed: , 4 e•TE /
.4i
Before me this fi day- • In ii' rew
County Duv.I,Steeo Flor. h ersonally apps.... ' D. Davis
Doc#2019295205,OR BK 19051 Page 1965, himself herself and affirms that all statements and• -ati•;i` e _M1MMISSI0N#GG2I1.20
are true and accurate =1C 1�rVV11I1111R1tt��77VV VVfI1�1 WL'!1liU
Number Pages:1 �, • EXPIRES: Sept. 17,2022
Recorded 12/30/2019 01:46 PM, �y' �'•., �`
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL ',••r• so0 Bonded T ru arson Notary
COUNTY
RECORDING $10.00 Nota ublic at Large.State of . County of,__`____
My commission expires:
Personally Known or
Produced Identification